Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments

Abstract

Background and Objective To develop computerized adaptive tests (CATs) designed to assess lower extremity functional status (FS) in people with lower extremity impairments using items from the Lower Extremity Functional Scale and compare discriminant validity of FS measures generated using all items analyzed with a rating scale Item Response Theory model (θ IRT) and measures generated using the simulated CATs (θ CAT). Methods Secondary analysis of retrospective intake rehabilitation data. Results Unidimensionality of items was strong, and local independence of items was adequate. Differential item functioning (DIF) affected item calibration related to body part, that is, hip, knee, or foot/ankle, but DIF did not affect item calibration for symptom acuity, gender, age, or surgical history. Therefore, patients were separated into three body part specific groups. The rating scale model fit all three data sets well. Three body part specific CATs were developed: each was 70% more efficient than using all LEFS items to estimate FS measures. θ IRT and θ CAT measures discriminated patients by symptom acuity, age, and surgical history in similar ways. θ CAT measures were as precise as θ IRT measures. Conclusion Body part-specific simulated CATs were efficient and produced precise measures of FS with good discriminant validity.