Computerized adaptive test for patients with knee impairments produced valid and responsive measures of function

Abstract 

Objective

Assess practicality of using a computerized adaptive test (CAT) in routine clinical practice, perform a psychometric evaluation of content range coverage and test precision, and assess known group construct validity, sensitivity to change and responsiveness of knee CAT functional status (FS) measures.

Study Design and Setting

Secondary analysis of retrospective intake and discharge rehabilitation FS data collected in a prospective cohort study. Data represented a convenience sample of 21,896 patients with knee impairments receiving outpatient physical therapy in 291 clinics in 30 U.S. states (2005–2007).

Results

The CAT used an average of seven items to produce precise estimates of FS that adequately covered the content range with negligible floor and ceiling effects. Test information functions and standard errors supported FS measure precision. FS measures discriminated patients by age, symptom acuity, surgical history, condition complexity, and prior exercise history in clinically logical ways. Seventy-two percent of patients obtained discharge FS measures ≥ minimal detectable change (95% confidence interval). Change of 9 FS units (0–100 scale) represented minimal clinically important improvement, which 67% of patients obtained.

Conclusion

The knee CAT was efficient and produced precise, valid, and responsive measures of FS for patients receiving therapy for knee impairments and functioned well in routine clinical application.

Keywords: Item response theory, Lower Extremity Functional Scale, Rehabilitation, Computerized adaptive testing, Functional status change, Outcomes