Computerized Adaptive Testing for Follow-Up After Discharge From Inpatient Rehabilitation: I. Activity Outcomes
Abstract
Haley SM, Siebens H, Coster WJ, Tao W, Black-Schaffer RM, Gandek B, Sinclair SJ, Ni P. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes.
Objective
To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home.
Design
Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit.
Setting
Follow-up visits conducted in patients’ home setting.
Participants
Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions.
Interventions
Not applicable.
Main Outcome Measures
Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66).
Results
AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77–.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients’ own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval.
Conclusions
Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.
aHealth and Disability Research Institute, Boston University, Boston, MA
bDepartment of Rehabilitation Medicine, University of Virginia, Charlottesville, VA
cDepartment of Occupational Therapy and Rehabilitation Counseling, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
dSpaulding Rehabilitation Hospital and the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA
Reprint requests to Stephen M. Haley, PhD, PT, Health and Disability Research Institute, Boston University, 53 Bay State Rd, Boston, MA 02215
Supported by the National Institute of Child Health and Human Development (grant no. R01 HD043568) and the Agency for Healthcare Research and Quality, and an independent scientist award (grant no. K02 HD45354-01).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or 1 or more of the authors. Haley has stock interest in CRE Care LLC, which distributes the Activity Measure for Post-Acute Care products.
ABSTRACT