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Development of a Computerized Adaptive Testing System of the Functional Assessment of Stroke

  • Gong-Hong Lin
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Yi-Jing Huang
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Shih-Chieh Lee
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Author Footnotes
    ∗ Huang and Hsieh contributed equally to this work.
    Sheau-Ling Huang
    Footnotes
    ∗ Huang and Hsieh contributed equally to this work.
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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  • Author Footnotes
    ∗ Huang and Hsieh contributed equally to this work.
    Ching-Lin Hsieh
    Correspondence
    Corresponding author Ching-Lin Hsieh, PhD, School of Occupational Therapy, College of Medicine, National Taiwan University, F4, No. 17, Xuzhou Rd, Zhongzheng District, Taipei City 100, Taiwan.
    Footnotes
    ∗ Huang and Hsieh contributed equally to this work.
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

    Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
    Search for articles by this author
  • Author Footnotes
    ∗ Huang and Hsieh contributed equally to this work.
Published:October 14, 2017DOI:https://doi.org/10.1016/j.apmr.2017.09.116

      Abstract

      Objective

      To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke.

      Design

      Simulation study.

      Setting

      One rehabilitation unit in a medical center.

      Participants

      Patients with subacute stroke (N=301; mean age, 67.3±10.9; intracranial infarction, 74.5%).

      Interventions

      Not applicable.

      Main Outcome Measures

      The UE and LE subscales of the Fugl-Meyer Assessment, Postural Assessment Scale for Stroke Patients, and Barthel Index.

      Results

      The CAT-FAS adopting the optimal stopping rule (limited reliability increase of <.010) had good Rasch reliability across the 4 domains (.88–.93) and needed few items for the whole administration (8.5 items on average). The concurrent validity (CAT-FAS vs original tests, Pearson r=.91–.95) and responsiveness (standardized response mean, .65–.76) of the CAT-FAS were good in patients with stroke.

      Conclusions

      We developed the CAT-FAS, and our results support that the CAT-FAS has sufficient efficiency, reliability, concurrent validity, and responsiveness in patients with stroke. The CAT-FAS can be used to simultaneously assess patients' functions of UE, LE, postural control, and basic activities of daily living using, on average, no more than 10 items; this efficiency is useful in reducing the assessment burdens for both clinicians and patients.

      Keywords

      List of abbreviations:

      BADL (basic activities of daily living), BI (Barthel Index), CAT (computerized adaptive testing), CI (confidence interval), FAS (Functional Assessment of Stroke), FMA (Fugl-Meyer Assessment), LE (lower extremity), LRI (limited reliability increase), PASS (Postural Assessment Scale for Stroke Patients), SRM (standardized response mean), UE (upper extremity)
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