Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function

Abstract 

Background and Objective

To test unidimensionality and local independence of a set of shoulder functional status (SFS) items, develop a computerized adaptive test (CAT) of the items using a rating scale item response theory model (RSM), and compare discriminant validity of measures generated using all items (θ_IRT) and measures generated using the simulated CAT (θ_CAT).

Study Design and Setting

We performed a secondary analysis of data collected prospectively during rehabilitation of 400 patients with shoulder impairments who completed 60 SFS items.

Results

Factor analytic techniques supported that the 42 SFS items formed a unidimensional scale and were locally independent. Except for five items, which were deleted, the RSM fit the data well. The remaining 37 SFS items were used to generate the CAT. On average, 6 items were needed to estimate precise measures of function using the SFS CAT, compared with all 37 SFS items. The θ_IRT and θ_CAT measures were highly correlated (r = .96) and resulted in similar classifications of patients.

Conclusion

The simulated SFS CAT was efficient and produced precise, clinically relevant measures of functional status with good discriminating ability.

Keywords: Computerized adaptive testing, Item response theory, Rehabilitation, Flexilevel Scale of Shoulder Function