Computerized Adaptive Testing Research Articles

Comparison of CAT and short forms for PROMIS pain and physical health domains in children with sickle cell disease

BackgroundPain and physical health domains included in Patient-Reported Outcomes Measurement Information System® (PROMIS®) can be administered as short forms (SF) or as computer adaptive tests (CAT). CAT is ideal in many settings but cannot be administered without specialized technology. We compared SF and CAT to identify items for customized SFs to improve the SF performance for children with sickle cell disease (SCD).MethodsEligible children 8–17 years old were administered CATs for 5 domains of physical health and 2 domains of pain, followed by any items on the corresponding SF that were not included in the CAT assessments. We describe the range of scores on the CAT and SFs, including the percentage of participants with floor or ceiling effects using the SF. The agreement and correlation between CAT and SF scores were assessed using Bland–Altman plots. Items frequently offered on CAT that had variable responses and were not already present on SF are recommended as additional items for customized SFs.ResultsAmong 90 children with SCD, there were strong correlations between CAT and SF scores (Concordance Correlation Coefficient > 0.8) however, the SFs for fatigue, mobility, strength impact, pain behavior, and pain interference had substantial floor/ceiling effects. Fatigue, mobility, physical stress experience, and pain behavior domains had items that were frequently offered on CAT, variable responses, and were not present on the SF.ConclusionsAdding items to the SFs for the fatigue, mobility, physical stress experience, and pain behavior domains may improve these domains’ SFs performance for children with SCD.

Item selection methods in multidimensional computerized adaptive testing for forced-choice items using Thurstonian IRT model.

Multidimensional computerized adaptive testing for forced-choice items (MFC-CAT) combines the benefits of multidimensional forced-choice (MFC) items and computerized adaptive testing (CAT) in that it eliminates response biases and reduces administration time. Previous studies that explored designs of MFC-CAT only discussed item selection methods based on the Fisher information (FI), which is known to perform unstably at early stages of CAT. This study proposes a set of new item selection methods based on the KL information for MFC-CAT (namely MFC-KI, MFC-KB, and MFC-KLP) based on the Thurstonian IRT (TIRT) model. Three simulation studies, including one based on real data, were conducted to compare the performance of the proposed KL-based item selection methods against the existing FI-based methods in three- and five-dimensional MFC-CAT scenarios with various test lengths and inter-trait correlations. Results demonstrate that the proposed KL-based item selection methods are feasible for MFC-CAT and generate acceptable trait estimation accuracy and uniformity of item pool usage. Among the three proposed methods, MFC-KB and MFC-KLP outperformed the existing FI-based item selection methods and resulted in the most accurate trait estimation and relatively even utilization of the item pool.

Neuropsychological functioning, neurobehavioral symptoms, and community reintegration in unstably housed veterans with mental health conditions

Objective: Returning Veterans often have conditions (e.g. posttraumatic stress disorder [PTSD], depression, and history of traumatic brain injury [TBI]) associated with cognitive dysfunction and problems with work, school, housing, and relationships. Rehabilitative efforts in Veterans aim to promote community reintegration, or successful adjustment in one’s home, community, and desired social roles. We examined associations between neuropsychological performance, neurobehavioral symptoms, and community reintegration in Veterans. Method: 89 Iraq/Afghanistan Veterans at risk for homelessness and receiving residential mental healthcare completed a neuropsychological assessment and the Community Reintegration for Service Members–Computer Adaptive Test (CRIS-CAT). Neuropsychological components were derived using Principal Component Analysis. Bivariate Pearson correlations between neuropsychological variables, neurobehavioral symptoms, and CRIS-CAT scales (Extent of Participation, Perceived Limitations, and Satisfaction) were used to determine significant correlates of community reintegration. Regression models were used to examine associations between bivariate-significant neuropsychological components, neurobehavioral symptoms, and CRIS-CAT scales. Results: Bivariate analyses revealed that better community reintegration was associated with better performance in attention/executive functioning and fewer neurobehavioral symptoms. Three regression models examining predictors of variance in Extent of Participation, Perceived Limitations, and Satisfaction in community reintegration were statistically significant overall, with only fewer affective symptoms emerging as significantly and uniquely associated with greater participation and greater satisfaction in community functioning. Conclusions: Veterans with fewer affective symptoms reported greater participation and satisfaction with community functioning. Future longitudinal research examining associations between neurobehavioral symptoms, cognition, and risk factors of poorer community reintegration in unstably housed Veterans is warranted.

JACEP open annual report 2022.

JACEP open annual report 2022.

Is Mobility Sufficient to Understand Community Participation of Adolescents and Young Adults With Cerebral Palsy? The Mediating and Moderating Roles of Contextual Factors

ObjectiveTo explore whether self-determination and family socioeconomic status (SES) mediate and/or moderate the relationship between mobility and community participation of adolescents and young adults with cerebral palsy (CP). DesignSurvey. SettingOnline platform. ParticipantsOf 55 eligible adolescents/young adults with CP, 50 agreed to participate and 2 were excluded. The final convenience sample included 48 individuals (N=48), aged 15-32 years, levels I-IV of the Gross Motor Function Classification System and I-II of the Communication Function Classification System. Main Outcome MeasuresThe Temple University Community Participation Measure documented the amount, breadth, and insufficiency/sufficiency ratios of participation across 26 community settings. The ARC Self-determination Scale and the Mobility Scale of the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) measured individuals’ self-determination (ie, autonomy, psychological empowerment, self-realization) and mobility skills, respectively. The Brazilian Economic Classification Criteria–2021 assessed family SES. ResultsAnalyses of mediating/moderating effects revealed that the influence of individuals’ mobility skills on their breadth of community participation was mediated by autonomy. Family SES moderated the indirect effect of mobility on community participation breadth through autonomy. When the model was adjusted for participants’ age, individuals with higher SES reported greater breadth in community participation than those from moderate and lower SES for all mobility levels. However, the magnitude of the differences among individuals of different SES levels diminished as mobility increased. ConclusionsThe mobility skills of youths with CP influence their community participation through autonomy. To foster greater engagement of these individuals in the community, rehabilitation professionals should focus not only on improvement of mobility skills but also on the promotion of self-determined behaviors, especially autonomy.

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Construction of a computerized adaptive test (CAT-CCNB) for efficient neurocognitive and clinical psychopathology assessment

BackgroundTraditional paper-and-pencil neurocognitive evaluations and semi-structured mental health interviews can take hours to administer and score. Computerized assessment has decreased that burden substantially, and contemporary psychometric tools such as item response theory and computerized adaptive testing (CAT) allow even further abbreviation. New methodThe goal of this paper was to describe the application of CAT and related methods to the Penn Computerized Neurocognitive Battery (CNB) and a well-validated clinical assessment in order to increase efficiency in assessment and relevant domain coverage. To calibrate item banks for CAT, N = 5053 participants (63% female; mean age 45 years, range 18–80) were collected from across the United States via crowdsourcing, providing item parameters that were then linked to larger item banks and used in individual test construction. Tests not amenable to CAT were abbreviated using complementary short-form methods. ResultsThe final “CAT-CCNB” battery comprised 21 cognitive tests (compared to 14 in the original) and five adaptive clinical scales (compared to 16 in the original). Comparison with existing methodsThis new battery, derived with contemporary psychometric approaches, provides further improvements over existing assessments that use collections of fixed-length tests developed for stand-alone administration. The CAT-CCNB provides an improved version of the CNB that shows promise as a maximally efficient tool for neuropsychiatric assessment. ConclusionsWe anticipate CAT-CCNB will help satisfy the clear need for broad yet efficient measurement of cognitive and clinical domains, facilitating implementation of large-scale, “big science” approaches to data collection, and potential widespread clinical implementation.

Functional impact of pediatric postthrombotic syndrome

BackgroundPostthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children. ObjectivesWe aimed to assess the impact of pediatric PTS on functioning as assessed by movement ability, mobility, functional disability, and physical activity levels in children after diagnosis of limb DVT. MethodsPatients aged 8-21 years in follow-up care after objectively documented limb DVT were prospectively recruited in this cross-sectional study. Measures of functioning (outcomes) included self-reported questionnaires that assessed: 1) movement ability, measured with the Movement Ability Measure-Computer Adaptive Test version; 2) mobility, evaluated with the Computer Adaptive Test version of the Patient-Reported Outcomes Measurement Information System Pediatric Physical Functioning, Mobility domain; 3) functional disability, evaluated with the Functional Disability Inventory; and 4) physical activity levels, evaluated with the Godin Leisure-Time Exercise Questionnaire. The main predictor was PTS severity, which was assessed using the index for the Clinical Assessment of PTS in children. The association between PTS and outcomes was analyzed using linear models. ResultsEighty-seven patients (median age, 16 years; 25th-75th percentile, 15-18 years; 56% boys) were enrolled. Adjusted for age, sex, and underlying condition, increasing PTS severity was associated with lower current movement ability, a wider gap between current vs preferred movement ability, lower mobility, and slightly higher functional disability scores. There was a nonsignificant effect of PTS severity on moderate-strenuous physical activity. ConclusionIn children, increased PTS severity is associated with lower movement ability and impaired mobility. Reducing the gap between the patients’ current vs preferred movement ability is a relevant aspect of PTS management in children.

Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs.

To calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR). The change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor-based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed. A total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P-Interference (1.8, 1.5), and P-Intensity (2.3, 2.0). Lower preoperative P-Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE. A large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P-Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful. Level III.

Responsiveness of the late life disability instrument to pulmonary rehabilitation in people with COPD

PurposeTo establish the responsiveness of the disability component of the Late Life Function and Disability Instrument (LLDI) and its Computer Adaptive Test (LLDI-CAT) in people with chronic obstructive pulmonary disease (COPD). MethodParticipants completed the LLDI, LLDI-CAT and measures of physical function, health-related quality of life (HRQOL) and symptom severity before and after pulmonary rehabilitation (PR), and global rating of change (GRC) scales at the end of PR. Responsiveness was explored by calculating correlations between LLDI and LLDI-CAT change scores and change scores on the other measures, and calculating the area under the receiver operating characteristic curve (AUC) for the ability of the LLDI and LLDI-CAT to discriminate between participants who were improved versus unchanged. We hypothesized fair correlations (−0.3 to −0.5 or 0.3 to 0.5) with other measures and considered an AUC≥0.7 acceptable. Minimal important differences (MIDs) were estimated using anchor- and distribution-based approaches. ResultsFifty participants (mean (SD) age 69.8 (7.9) years) completed the study. Only the limitation dimension of the LLDI showed improvement at follow-up (z = 2.4, p = 0.018) and was able to discriminate between participants who were improved versus unchanged (AUC 0.7 (95% CI 0.6–0.9)). Correlations between change scores were as hypothesized between the participation measures and measures of at least two other constructs. ConclusionThis study provides MID values for the LLDI and LLDI-CAT to support their clinical application. The limitation dimension of the LLDI appears to be particularly responsive to PR in people with COPD.

Efficiency and Accuracy of Computerized Adaptive Testing for the Oswestry Disability Index and Neck Disability Index.

The study involved simulation using retrospectively collected real-world data. Previously developed CAT models of the ODI and NDI were applied to the responses from 52,551 and 18,196 patients with spinal conditions, respectively. Efficiency was evaluated by the reduction in the number of questions administered. Accuracy was evaluated by comparing means and standard deviations, calculating Pearson r and intraclass correlation coefficient (ICC) values, plotting the frequency distributions of CAT and full questionnaire scores, plotting the frequency distributions of differences between paired scores, and Bland-Altman plotting. Score changes, calculated as the postoperative ODI or NDI scores minus the preoperative scores, were compared between the CAT and full versions in patients for whom both preoperative and postoperative ODI or NDI questionnaires were available. CAT models of the ODI and NDI required an average of 4.47 and 4.03 fewer questions per patient, respectively. The mean CAT ODI score was 0.7 point lower than the full ODI score (35.4 ± 19.0 versus 36.1 ± 19.3), and the mean CAT NDI score was 1.0 point lower than the full NDI score (34.7 ± 19.3 versus 33.8 ± 18.5). The Pearson r was 0.97 for both the ODI and NDI, and the ICC was 0.97 for both. The frequency distributions of the CAT and full scores showed marked overlap for the ODI and NDI. Differences between paired scores were less than the minimum clinically important difference in 98.9% of cases for the ODI and 98.5% for the NDI. Bland-Altman plots showed no proportional bias. The ODI and NDI score changes could be calculated in a subgroup of 6,044 and 4,775 patients, respectively; the distributions of the ODI and NDI score changes were near identical between the CAT and full versions. CAT models were able to reduce the question burden of the ODI and NDI. Scores obtained from the CAT models were faithful to those from the full questionnaires, both on the population level and on the individual patient level. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Computerized-adaptive testing versus short forms for pediatric inflammatory bowel disease patient-reported outcome assessment.

Computerized-adaptive testing (CAT) may increase reliability or reduce respondent burden for assessing patient-reported outcomes compared with static short forms (SFs). We compared CAT versus SF administration of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Pediatric measures in pediatric inflammatory bowel disease (IBD). Participants completed 4-item CAT, 5- or 6-item CAT, and 4-item SF versions of the PROMIS Pediatric measures. We compared average T-scores, intra-class correlations (ICCs), floor and ceiling effects, and standard error of measurement (SEM) across forms, along with mean effect sizes between active versus quiescent IBD disease activity groups. Average PROMIS T-scores across forms were <3 points (minimally important difference) of each other. All forms correlated highly with each other (ICCs ≥0.90) and had similar ceiling effects, but the CAT-5/6 had lower floor effects. The CAT-5/6 had lower SEM than the CAT-4 and SF-4, and the CAT-4 had a lower SEM than the SF-4. Mean effect sizes were similar across forms when contrasting disease activity groups. The CAT and SF forms produced similar score results, but the CAT had better precision and lower floor effects. Researchers should consider PROMIS pediatric CAT if they anticipate that their sample will skew toward symptom extremes.

The Importance of Patient Resilience on Outcomes Following Foot and Ankle Orthopaedic Surgery

Category: Other; Ankle Introduction/ Purpose: Recovery from orthopedic surgery requires a degree of both physical and mental resilience during recovery and rehabilitation. The brief resilience scale (BRS) is a validated and reliable 6-item screening tool that measures resilience as the ability to bounce back or recover from stress. BRS can provide unique and important information about patients coping with health-related stressors. To date, there is little evidence describing the use of BRS as a pre-operative benchmark to evaluate outcomes following foot and ankle orthopedic injuries and procedures. We aim to determine how patient resilience, as measured with BRS, may predict the impact of orthopedic conditions and recovery from foot and ankle surgery. Methods: All patients undergoing foot and ankle orthopedic surgery at a single institution were enrolled in U-COSMOS, a HIPAA-compliant, automated outcomes data repository. All patients undergoing surgery completed BRS pre-operatively. We used a BRS cutoff of &lt; 3 (lower resilience, LR), 3-3.9 (intermediate resilience, IR), and &gt;=4 (high resilience, HR) to create three cohorts. Patients also completed a PROMIS Physical Function (PF) Computer Adaptive Test (CAT), PROMISE Pain Interference (PI) CAT, PROMISE Depression (D) CAT, and Global Health (GH) Short Form pre-operatively as well as 3-, 6-, 12-, and 24- months post-operatively, as applicable. Patients with a minimum follow-up of 180 days were included for analysis, and the longest available follow-up was used. Differences in outcomes between the three BRS groups were determined non-parametrically using a Kruskal–Wallis one-way analysis of variance. Results: A total of 586 patients were included for analysis, with an average follow-up of 389 days. The patients were categorized as low resilience (n=44), intermediate resilience (n=229), and high resilience (n=323). Patients in the high resilience cohort had significantly higher PF and lower PI and Depression scores both pre-operatively (p &lt; 0.05 for all) and post-operatively (p &lt; 0.001 for all). The greatest disparity was found in depression where low resilience patients were greater than 1 SD worse than high resilience patients (Figure 1). Similar trends are observed for physical and mental global health. In addition to having higher absolute baseline and follow-up scores, the change of PF and PI is also significantly higher for high resilience patients (p = 0.02). Conclusion: Patients with high pre-operative resilience demonstrate better pre-operative physical function and pain interference scores compared to lower resilience patients and show greater improvement at 12 months post-op. We also found that lower BRS scores are associated with decreased pre- and post-operative mental health outcomes, including PROMIS Depression. Further analysis of the role of BRS in pre-operative assessment will help guide shared treatment decision-making. Identifying interventions for patients with low resilience will likely lead to improve surgical outcomes.

Associating Social Determinants of Health With PROMIS CAT Scores and Health Care Utilization After ACL Reconstruction.

The term "social determinants of health" (SDOH) refers to social and economic factors that influence a patient's health status. The effect of SDOH on the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores and postoperative resource utilization in patients with anterior cruciate ligament reconstruction (ACLR) have yet to be thoroughly studied. To investigate the impact SDOH have on PROMIS CAT outcomes and postoperative resource utilization in patients with ACLR. Cohort study; Level of evidence, 3. The electronic medical record was used to identify the SDOH for patients who underwent ACLR by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons between July 2017 and April 2020. PROMIS CAT measures of Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed at the preoperative, 6-month postoperative, and 12-month postoperative time points. Postoperative health care utilization was recorded as well. Independent 2-group t tests and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. Two-hundred and thirty patients who underwent ACLR were included (mean age, 27 years; 59% male). Compared with White patients, Black patients were represented more frequently in the lowest median household income (MHI) quartile (63% vs 23%, respectively; P < .001). White patients were represented more frequently in the highest area deprivation index (ADI) quartile when compared with Black patients (67% vs 12%, respectively; P = .006). Significantly worse PROMIS-PF, PROMIS-PI, and PROMIS-D scores at all 3 time points were found among patients who were Black, female, smokers, and in the lower MHI quartiles, with higher ADI and public health care coverage. In terms of resource utilization, Black patients attended significantly fewer postoperative physical therapy visits when compared with their respective counterparts. Those in the lower MHI quartiles attended significantly fewer postoperative imaging encounters, and female patients attended significantly more postoperative virtual encounters than male patients. Specific SDOH variables, particularly those that reflect racial and socioeconomic disparities, were associated with differences in postoperative health care utilization and ACLR outcomes as measured by PROMIS CAT domains.

DIGITALIZATION AT THE SERVICE OF PSYCHODIAGNOSTICS: MODERN OPPORTUNITIES IN INTELLIGENCE TESTING

The assessment of intellectual development in children and adolescents is an essential component of psychodiagnostics, facilitating an understanding of the nature of learning diffi culties. Intelligence tests have a history that spans more than a century, and even contemporary versions of widely used intelligence tests (such as the Wechsler or Stanford-Binet tests) are limited by the infl uence of their traditional paper-based formats. Nevertheless, the advent of computational capabilities and the digitalization of tests have led psychometrics to experience substantial development, opening new possibilities for assessment. The complete application of modern psychometrics holds the promise of revolutionizing the measurement of intelligence. Present-day psychometrics is deeply entwined with computational behavioral sciences, going beyond outdated principles in the development of psychological tests. Methodological approaches that notably enhance the accuracy, reliability, and equity of measurement instruments currently exist. Furthermore, the accumulation of supplementary validity evidence, simplifi - cation of result interpretation, and practical implementation far exceed conventional psychodiagnostic approaches. This presentation will show the potentialities presented by modern psychometrics, including the utilization of innovative task formats such as technology-enhanced items, the integration of universal design principles in test development, the adoption of computerized adaptive testing (CAT) and multistage testing (MST) methodologies, the application of multidimensional IRT models to establish both construct and criterion validity, the shift from discrete norms to continuous scaling, and the incorporation of longitudinal measurements. The combination of these features within a computerized intelligence testing framework will enhance respondents’ motivation and simplify the test administration process. It will facilitate frequent assessments of a child’s progress by presenting varying test versions on each occasion, thereby signifi cantly reducing errors in administration and scoring, while also safeguarding against misuse by non-professionals.

Moderators and Mediators of the Relationship of Shared Decision-Making and Satisfaction.

Background:Evidence suggests that health literacy, perceived availability of information and guidance to adapt to challenges (informational support), and symptoms of depression all have the potential to mediate or moderate the relationship between patient-rated involvement in decisions and satisfaction with care. If so these could be useful targets for improving patient experience. Methods: We prospectively enrolled 130 new adult patients visiting an orthopedic surgeon over a 4-month period. All patients were asked to complete measures of satisfaction with care (21-item Medical Interview Satisfaction Scale), perceived involvement in decisions (9-item Shared Decision-Making Questionnaire), symptoms of depression (the Patient-Reported Outcomes Measurement Information Scale [PROMIS] Depression Computerized Adaptive Test [CAT]), perceived availability of information and guidance to adapt to challenges (PROMIS Informational Support CAT), and the Newest Vital Sign test of health literacy. Results: The strong correlation between satisfaction with care (ρ = 0.60, P < .001) and perceived involvement in decisions was neither mediated nor moderated by health literacy, perceived availability of information and guidance, and symptoms of depression. Conclusions: The observation that patient-rated shared decision-making is strongly related to satisfaction with an office visit, independent of health literacy, perceived support, and symptoms of depression, is consistent with evidence that various measures of patient experience tend to correlate and emphasizes the importance of the patient-clinician relationship. Level of Evidence: Level II, prospective study.

Evaluation of Preoperative Factors Affecting Midterm Patient-Reported Outcomes Following Ligament Reconstruction Tendon Interposition: A Prognostic Study

The aim of this study was to evaluate the prognostic value of preoperative patient-reported outcomes as predictors of functional improvement following ligament reconstruction tendon interposition. We hypothesized that high levels of preoperative pain interference (PI) and upper-extremity disability are associated with lower magnitudes of functional improvement ≥1 year after surgery on the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) (primary outcome) and Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) Computer Adaptive Test (CAT) (UE CAT) v1.2 (secondary outcome). Adult patients who underwent ligament reconstruction tendon interposition between February 2014 and April 2018 at an academic tertiary institution were considered for inclusion in this longitudinal cohort study. Patient-reported outcomes were collected at baseline and ≥1 year after surgery. Univariate and multivariable linear regression analyses were performed to identify factors associated with the magnitude of functional improvement on the QuickDASH and UE CAT. Among 93 included participants, the mean age was 61 ± 7 years, and 75 (81%) were women. At 2.5 ± 1.0 years after surgery, the QuickDASH and UE CAT improved by a mean of 24.5 ± 20.9 and 9.9 ± 10.7 points, respectively. In the primary multivariable model, a greater preoperative QuickDASH (indicative of lower function; coefficient, 0.8; 95% confidence interval [CI], 0.6 to 0.9) and lower preoperative Performance of Patient-Reported Outcomes Measurement Information System PI CAT (eg, less pain interference; coefficient,-0.7; 95% CI,-1.2 to-0.2) were associated with greater QuickDASH improvement independent of potential confounders. In the secondary multivariable model, lower preoperative UE CAT (indicative of worse function; coefficient,-0.9; 95% CI,-1.1 to-0.7) and lower preoperative Patient-Reported Outcomes Measurement Information System PI CAT (coefficient,-0.3; 95% CI,-0.6 to-0.1) were associated with greater UE CAT improvement. Preoperative patient-reported outcomes may be useful in understanding the degree of improvement that certain patient populations can expect from ligament reconstruction tendon interposition. Those with lower baseline (preoperative) upper-extremity function and PI are expected to derive the greatest functional improvement in the midterm. Prognostic IV.

컴퓨터 적응검사에서 하위영역 간 상관과 문항선택기준에 따른 능력모수 추정의 정확성 및 문제은행 활용률 비교

The purpose of this study was to investigate the effects of degrees of correlations among subsections and item selection criteria on the precision of ability estimates and item pool utilization in computerized adaptive testing (CAT). Based on the results of this simulation study, the following conclusions can be made. First, the precision of ability estimates would be decreased when the correlations among subsections was relatively low. Second, when implementing an a-stratified item selection method (AST), the effects of degrees of correlations among subsections on the precision of ability estimates increased, compared to the maximum fisher information item selection method (MFI). Third, when the test length was relatively long, the effects of degrees of correlations among subsections on the precision of ability estimates decreased. Forth, MFI with content-balancing increased the precision of ability estimates, especially in the case of low correlations among subsections. The item pool utilization seemed not to be considerably affected by the correlations among subsections, implementing a-stratification item selection method and/or item exposure strategy, the item pool utilization increased.

Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home.

Infants who survive prematurity and critical illnesses but require ongoing invasive mechanical ventilation (IMV) are at high risk for developmental disabilities. However, their detailed developmental profiles are largely unknown. To understand the developmental profiles of a cohort of young children with IMV after hospital-to-home transition. Developmental testing was completed 1 month after hospital discharge to determine functioning within motor, cognitive, and communicative domains using (1) the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS);(2) the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT); and (3) The Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS). To complement validated testing, semi-structured interviews were conducted with parents to understand perceived influences on neurodevelopment. Twenty children were evaluated at median (range) age 11 (5-27) months. Nearly half (45%) were male, 40% non-Hispanic Black, and 25% Hispanic. Sixteen(80%) children were survivors of prematurity. After gestational age correction, median (range) full-scale developmental quotients (DQ) were 69.5 (8-119): CAT DQ 62.5 (3-113) and CLAMS DQ 71.5 (12-125). Parents described that prolonged restrictionwithin the hospital crib away from caregivers, despite hospital therapists, impedes development. Home environments improve development primarily through increased time with parents, but also play outside of the crib. Onemonth after hospital discharge only 10% were receiving early intervention therapies. Children with IMV display wide ranges of neurodevelopmental skills with a majority experiencing substantial delays in motor, communicative, and adaptive functioning. The degree and cross-domain challenges highlight the need for targeted and timely therapeutic strategies.

Prior Distribution and Entropy in Computer Adaptive Testing Ability Estimation through MAP or EAP

To derive a latent trait (for instance ability) in a computer adaptive testing (CAT) framework, the obtained results from a model must have a direct relationship to the examinees' response to a set of items presented. The set of items is previously calibrated to decide which item to present to the examinee in the next evaluation question. Some useful models are more naturally based on conditional probability in order to involve previously obtained hits/misses. In this paper, we integrate an experimental part, obtaining the information related to the examinee's academic performance, with a theoretical contribution of maximum entropy. Some academic performance index functions are built to support the experimental part and then explain under what conditions one can use constrained prior distributions. Additionally, we highlight that heuristic prior distributions might not properly work in all likely cases, and when to use personalized prior distributions instead. Finally, the inclusion of the performance index functions, arising from current experimental studies and historical records, are integrated into a theoretical part based on entropy maximization and its relationship with a CAT process.