Abstract
Cheville AL, Yost KJ, Larson DR, Dos Santos K, O'Byrne MM, Chang MT, Therneau TM,
Diehn FE, Yang P. Performance of an item response theory-based computer adaptive test
in identifying functional decline.
Objective
To achieve a low respondent burden and increase the responsiveness of functional measurement
by using an item response theory-based computer adaptive test (CAT), the Activity
Measure for Post-Acute Care (AM-PAC) CAT.
Design
Two-year prospective cohort study.
Setting
Telephonic assessments from a quaternary medical center.
Participants
Patients (N=311) with late-stage lung cancer (LC).
Interventions
Monthly assessments for up to 2 years. Disease progression was determined via record
abstraction. Anchor-based responsiveness techniques were used to compare AM-PAC-CAT
score changes between global rating of change (GRC) question response levels, as well
as between intervals when adverse clinical events or symptom worsening did and did
not occur. Distribution-based responsiveness assessments included calculation of the
standardized effect size (SES) and standardized response mean (SRM).
Main Outcome Measures
AM-PAC-CAT, symptom numerical rating scales, and a GRC.
Results
Administration time averaged 112 seconds over 2543 interviews. AM-PAC-CAT score changes
became more positive as GRC responses reflected more improved states: a lot worse
(−11.62), a little worse (−1.92), the same (−.10), a little better (1.01), and a lot
better (2.82). Score changes were negative when associated with adverse clinical events.
The SES and SRM for score differences between 1 to 2 and 9 to 10 months prior to death
were −.87 and −1.13, respectively. The minimally important difference estimate was
defined by the mean CAT session SE at 2.0.
Conclusions
The AM-PAC-CAT imposes a low, <2-minute, respondent burden, and distribution- and
anchor-based methods suggest that is moderately responsive in patients with late-stage
LC.
Key Words
List of Abbreviations:
AM-PAC (Activity Measure for Post-Acute Care), AM-PAC-CAT (Activity measure for post acute care computer adaptive test), AUC (area under receiver operating characteristic curve), CAT (computer adaptive test), EMR (electronic medical record), GEE (generalized estimating equation), GRC (global rating of change), IRT (item response theory), LC (lung cancer), MID (minimally important difference), PRO (patient-reported outcome), PROMIS (Patient-Reported Outcomes Measurement Information System), RR (responsiveness retrospective), SES (standardized effect size), SRM (standardized response mean)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 27, 2012
Footnotes
Supported by the National Institutes of Health (grant no. KL2 RR024151-01).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
