Computerized Adaptive Testing Research Articles

Designing a Measure of Body Image: Cognitive Interview Findings from an Adolescent and Young Adult Cancer Sample.

Purpose: A cancer diagnosis in adolescence and young adulthood significantly impacts a person's quality of life, particularly concerning identity, self-esteem, and subsequently, body image. This study aims to develop a psychometrically-sound patient-reported outcome measure of body image for adolescent and young adult (AYA) oncology patients that was guided by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS) Scientific Standards and our past concept elicitation interviews with AYAs. Methods: We conducted a multi-step approach involving item identification, refinement, generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYA patients participated, ensuring representation across educational levels, gender, treatment status, and cancer type. Results: Translatability and reading level reviews facilitated language adjustments. Cognitive interviews revealed that 76% of AYAs found the 50 candidate items assessing body image concerns to be easy to answer. AYAs reported that the body image items captured their lived experiences. Three items were excluded due to comprehension difficulties. Conclusion: This study addresses the critical gap in validated measures for assessing body image in AYA oncology patients. Interview findings provided evidence for the content validity and comprehensibility for 47 items assessing body image. The next steps involve large-scale psychometric testing to evaluate the reliability and validity of the body image items to form an item bank allowing the design of short forms or use of computerized-adaptive testing. Ultimately, this work lays the foundation for developing interventions to mitigate the impact of cancer on AYAs' body image during diagnosis, treatment, and recovery.

Patterns of patient-reported outcomes (PROs) in a diverse group of gynecologic cancer survivors

ObjectivesRacial and ethnic disparities in patient-reported outcomes (PROs) among gynecologic cancer survivors are not well studied. We evaluated whether individual-level characteristics were associated with PROs in diverse gynecologic cancer survivors.MethodsGynecologic cancer patients in an ambulatory oncology clinic completed a psychosocial and practical needs assessment before their appointments through the electronic medical record (EMR) patient portal. Assessments were available in English and Spanish. Fatigue, pain, physical function, depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS®) computer adaptive tests, and health-related quality of life was assessed by FACT-G7. PROs were dichotomized based on severity (normal/mild vs moderate/severe). Demographic and clinical information was collected. Analyses were performed using Chi-square, t-tests, and Kruskal–Wallis tests.ResultsA total of 582 women completed the assessment; 20% (n = 116) were racial minorities, and 54.5% (n = 310) were Hispanic. A total of 192 (32.8%) completed the assessments in Spanish. Hispanic patients had lower mean fatigue scores (49.31 vs 51.74, p = 0.01), and patients whose preferred language was Spanish had lower mean depression (47.63 vs 48.97, p = 0.05) and fatigue scores (48.27 vs 51.27, p < 0.01). There were no significant differences in the severity of PROs by race, ethnicity, or preferred language. QOL scores were worse in patients with high symptom severity for anxiety (p = 0.04) and physical functioning (p < 0.01). Current smokers had worse physical functioning (13.4% vs 6.5%, p = 0.03).ConclusionsWe found no significant differences in severity of PROs by race, ethnicity, or preferred language. Quality of life scores were worse for patients with high symptom severity for physical functioning and anxiety.

사전 정보를 활용한 컴퓨터 적응 검사의 측정 정확성 및 효율성 향상 방안

Objectives This study investigates the accuracy and efficiency of Computerized Adaptive Testing (CAT) by utilizing prior information to predict students' basic academic levels. Methods To achieve this, a simulation study was conducted with varied conditions, including initial item, partic-ipant groups, and test stopping rule. Results Results indicate that selecting initial items based on predictors of basic academic levels significantly im-proved the accuracy and efficiency of CAT measurements, with the most substantial improvements observed in low-achieving groups. Conclusions The findings suggest the need for further exploration of the applicability of basic academic level pre-dictors across different educational contexts to identify strategies for improving the precision and efficiency of CAT systems.

Investigating Approaches to Controlling Item Position Effects in Computerized Adaptive Tests

AbstractItem position effect (IPE) refers to situations where an item performs differently when it is administered in different positions on a test. The majority of previous research studies have focused on investigating IPE under linear testing. There is a lack of IPE research under adaptive testing. In addition, the existence of IPE might violate Item Response Theory (IRT)’s item parameter invariance assumption, which facilitates applications of IRT in various psychometric tasks such as computerized adaptive testing (CAT). Ignoring IPE might lead to issues such as inaccurate ability estimation in CAT. This article extends research on IPE by proposing and evaluating approaches to controlling position effects under an item‐level computerized adaptive test via a simulation study. The results show that adjusting IPE via a pretesting design (approach 3) or a pool design (approach 4) results in better ability estimation accuracy compared to no adjustment (baseline approach) and item‐level adjustment (approach 2). Practical implications of each approach as well as future research directions are discussed as well.

Exploring Sources of Bias to Improve the Universal Design of Mathematical Problem-Solving Tests

ABSTRACT Advancement of testing of mathematical problem-solving skills calls for open-ended, realistic tasks particularly susceptible to bias, compromising the score validity and fairness of tests. Informed by universal design principles, this study framed 360 prototype items developed for the Problem-solving Measures Grades 6–8 Computer Adaptive Tests as a bounded case to illuminate sources of bias in middle-school mathematics assessment. Experts’ shared understandings of potential sources of bias were collected using an iterative Delphi technique. Four themes in sources emerged from a thematic analysis of 201 sources of bias identified: assumed lived experiences, language use, item presentation, and stereotypes. These sources potentially placed subgroups of students from certain sociocultural backgrounds (e.g. culture, gender, race/ethnicity, socioeconomic status) at a disadvantage by challenging them in ways unrelated to mathematical problem solving. Recommendations for minimizing potential sources of bias in test development to achieve equitable K-12 mathematics problem-solving tests are discussed.

Modeling Growth in Reading With Curriculum-Based Measurement Versus Computer-Adaptive Tests

Modeling Growth in Reading With Curriculum-Based Measurement Versus Computer-Adaptive Tests

Assessing the measurement properties of PROMIS Computer Adaptive Tests, short forms and legacy patient reported outcome measures in patients undergoing total hip arthroplasty.

The commonly used ('legacy') PROMs evaluating outcomes of total hip arthroplasty (THA), have several limitations regarding their measurement properties and interpretation of scores. One innovation in PROMs is the use of Computerized Adaptive Testing (CAT). The Patient-Reported Outcomes Measurement Information System (PROMIS®) is a validated system of CATs. The aim of this study was to assess the measurement properties of PROMIS and legacy instruments in patients undergoing THA. Patients in this multicenter study filled out a questionnaire twice, including Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) and v1.1 Pain Interference (PROMIS-PI) CATs and short forms, PROMIS v1.0 Pain Intensity, and legacy PROMs (Hip disability and Osteoarthritis Outcome Score (HOOS), HOOS-Physical function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), and two numeric rating scales measuring pain). The reliability, measurement precision (Standard Error of Measurement (SEM)), smallest detectable change (SDC), and burden of PROMIS instruments were presented head-to-head to legacy PROMs. Furthermore, construct validity was assessed. 208 patients were included. All instruments had a sufficient test-retest reliability (range ICC: 0.83-0.96). The SEM of PROMIS CATs and short forms ranged from 1.8 to 2.2 T-score points, the SEM of legacy instruments 2.6-11.1. The SDC of PROMIS instruments ranged from 2.1 to 7.3 T-score points, the SDC of legacy instruments 7.2-30.9. The construct validity of PROMIS CAT and short forms were found sufficient, except for the PROMIS-PI short form. The burden of PROMIS CATs was smaller than PROMIS short forms (range 4.8-5.2 versus 8-20 items, respectively). The burden of legacy instruments measuring physical functioning ranged from 5 to 40 items. The PROMIS-PF is less burdensome, with high measurement precision, and almost no minimal or maximal scores, and an equal reliability compared to legacy instruments measuring physical functioning in patients undergoing THA. The PROMIS Pain Intensity 1a is comparable to the legacy pain instruments in terms of burden, reliability and SDC. Measuring the construct Pain Interference may not have additional value in this population because of its high correlation with instruments measuring physical functioning. The SDC values presented in this study can be used for individual patient monitoring.

Baseline Neck Disability Index and Patient-Reported Outcomes Measurement Information System Physical Function Predict Postoperative Return to Normal in Cervical Spine Surgery.

Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative management. The objective of this study was to assess whether preoperative patient-reported outcome measures (PROMs) can be used to predict which patients achieve "normal" levels of pain and function after surgery. This was a prospective cohort study. This study included all adult patients undergoing cervical spine surgery by 1 of 7 senior spine surgeons at our institution between 2016 and 2018. Of the 164 patients who were eligible for 6-month follow-up at the time that study data were collected, 139 had available follow-up data and were included in our analysis. Patients completed the Neck Disability Index (NDI) as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference computer adaptive tests preoperatively and at 6 months postoperatively. Patients who achieved postoperative patient-acceptable symptom state (PASS) for NDI (≤17) and the normative mean (50) for PROMIS were identified. The relationship between preoperative PROMs and the probability of achieving PASS and the normative mean was assessed. One hundred thirty-nine patients met inclusion criteria with diagnoses of myelopathy (n = 36), radiculopathy (n = 48), and myeloradiculopathy (n = 49). For NDI, a 1-point worsening in the preoperative score resulted in an OR of achieving PASS of 0.96 (P < 0.001) in the overall population. This association held true for patients with radiculopathy (OR 0.96; P = 0.022) but not myelopathy (OR 0.98; P = 0.35). For PROMIS PF, a 1-point improvement in the preoperative score resulted in an OR of achieving the normative mean of 1.10 (P < 0.001). This association held true for patients with radiculopathy (OR 1.14; P = 0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; P = 0.515). Preoperative PROMs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the normative mean for PROMIS PF, especially for patients with radiculopathy. Baseline symptoms and function, including myelopathy or radiculopathy-dominant symptoms and preoperative PROMs, may predict postoperative outcomes.

Social Support Domains Associated with Social Isolation in MCI

ABSTRACT The millions of older adults who are affected by social isolation report less social support, which has been shown to benefit well-being and decrease risk for cognitive decline. Social support is measured in different ways, including emotional, informational, and instrumental support. As an exploratory study, this secondary data analysis of 30 older adults living with Mild Cognitive Impairment examined what social support subtype is associated with social isolation. Social isolation was measured using the Patient Reported Outcomes Measurement Information System (PROMIS®) Social Isolation Computer Adaptive Test (CAT). Social support subtypes were measured using the PROMIS Informational, Emotional, and Instrumental Support CATs. We found that informational support was significantly associated with decreased self-reported social isolation. This finding increases our understanding of informational support’s potential and can inform future strategies for older adults with MCI facing social isolation.

CellKine clinical trial: first report from a phase 1 trial of allogeneic bone marrow–derived mesenchymal stem cells in subjects with painful lumbar facet joint arthropathy

Abstract Background: Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow–derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA. Objectives: This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA. Methods: Following enrollment in our IRB-approved protocol, symptomatic LFJA was confirmed through double blocks on L4 and L5 medial branches. Two 1-mL syringes, each containing 10 million BM-MSCs, were prepared in the cGMP facility and administered bilaterally to the patient’s L4-L5 lumbar facet joints. The patient underwent standardized follow-ups, including clinical examinations and functional and imaging assessments for 2 years, utilizing patient-reported outcomes measurement information system—computer adaptive tests (PROMIS CATs), visual analogue scale, Oswestry disability index, work functional status and opioid pain medication use, and MR imaging Fenton–Czervionke score. Results: The patient tolerated the procedure well, with no drug-related adverse events during the study period. Pain, spine function, and work functional status improved at multiple follow-ups. This patient also reported improvements in mental and social health, along with a notable improvement in the grade of facet synovitis observed at the one-year follow-up MRI evaluation. Conclusions: This case report suggests the safety and feasibility of administering intra-articular allogeneic BM-MSCs, offering therapeutic benefits for pain management and functional activities.

Effect of Differential Item Functioning on Computer Adaptive Testing Under Different Conditions.

This study provides an overview of the effect of differential item functioning (DIF) on measurement precision, test information function (TIF), and test effectiveness in computer adaptive tests (CATs). Simulated data for the study was produced and analyzed with the Rstudio. During the data generation process, item pool size, DIF type, DIF percentage, item selection method for CAT, and the test termination rules were considered changed conditions. Sample size and ability parameter distribution, Item Response Theory (IRT) model, DIF size, ability estimation method, test starting rule, and item usage frequency method regarding CAT conditions were considered fixed conditions. To examine the effect of DIF, measurement precision, TIF and test effectiveness were calculated. Results show DIF has negative effects on measurement precision, TIF, and test effectiveness. In particular, statistically significant effects of the percentage DIF items and DIF type are observed on measurement precision.

An adaptive testing item selection strategy via a deep reinforcement learning approach.

Computerized adaptive testing (CAT) aims to present items that statistically optimize the assessment process by considering the examinee's responses and estimated trait levels. Recent developments in reinforcement learning and deep neural networks provide CAT with the potential to select items that utilize more information across all the items on the remaining tests, rather than just focusing on the next several items to be selected. In this study, we reformulate CAT under the reinforcement learning framework and propose a new item selection strategy based on the deep Q-network (DQN) method. Through simulated and empirical studies, we demonstrate how to monitor the training process to obtain the optimal Q-networks, and we compare the accuracy of the DQN-based item selection strategy with that of five traditional strategies-maximum Fisher information, Fisher information weighted by likelihood, Kullback‒Leibler information weighted by likelihood, maximum posterior weighted information, and maximum expected information-on both simulated and real item banks and responses. We further investigate how sample size and the distribution of the trait levels of the examinees used in training affect DQN performance. The results show that DQN achieves lower RMSE and MAE values than traditional strategies under simulated and real banks and responses in most conditions. Suggestions for the use of DQN-based strategies are provided, as well as their code.

The irtQ R package: a user-friendly tool for item response theorybased test data analysis and calibration.

Computerized adaptive testing (CAT) has become a widely adopted test design for high-stakes licensing and certification exams, particularly in the health professions in the United States, due to its ability to tailor test difficulty in real time, reducing testing time while providing precise ability estimates. A key component of CAT is item response theory (IRT), which facilitates the dynamic selection of items based on examinees' ability levels during a test. Accurate estimation of item and ability parameters is essential for successful CAT implementation, necessitating convenient and reliable software to ensure precise parameter estimation. This paper introduces the irtQ R package (http://CRAN.R-project.org/), which simplifies IRTbased analysis and item calibration under unidimensional IRT models. While it does not directly simulate CAT, it provides essential tools to support CAT development, including parameter estimation using marginal maximum likelihood estimation via the expectation-maximization algorithm, pretest item calibration through fixed item parameter calibration and fixed ability parameter calibration methods, and examinee ability estimation. The package also enables users to compute item and test characteristic curves and information functions necessary for evaluating the psychometric properties of a test. This paper illustrates the key features of the irtQ package through examples using simulated datasets, demonstrating its utility in IRT applications such as test data analysis and ability scoring. By providing a user-friendly environment for IRT analysis, irtQ significantly enhances the capacity for efficient adaptive testing research and operations. Finally, the paper highlights additional core functionalities of irtQ, emphasizing its broader applicability to the development and operation of IRT-based assessments.

Differences in Patient-Reported Outcome Measures in Patients With Cancer Six Months Before Death.

Patient-reported outcome measures (PROMs) provide a direct report of the patient's perspective, complementary to clinician assessment. Currently, understanding the real-time changes in PROM scores near the end of life remains limited. This study evaluated differences in mean PROM scores between patients with cancer within 6 months before death compared with surviving patients with cancer. This retrospective case-control study uses the National Institutes of Health's Patient-Reported Outcomes Measurement Information System computer adaptive testing instruments to assess pain interference, physical function, fatigue, and depression. Patients dying within 6 months of PROM completion were selected as cases and matched to controls 1:3 by age at PROM completion, sex, cancer disease site, and cancer stage at diagnosis. Generalized estimating equation models assessed the difference in mean PROM score in cases compared with controls. A total of 461 cases and 1,270 controls from September 2020 to January 2023 were included. After adjustment for ethnicity, Charlson Comorbidity Index, and census tract median household income, significant differences in mean scores were demonstrated. Physical function domain showed the largest difference, with cases averaging 6.52 points lower than controls (95% CI, -8.25 to -4.80). Fatigue and pain interference domains showed a rise in PROMs scores by 4.83 points (95% CI, 2.94 to 6.72) and 4.33 points (95% CI, 2.53 to 6.12), respectively. Compared with controls, patients dying within 6 months of PROM completion demonstrated worse PROM scores in the four domains assessed. These findings suggest the utility of routinely collected PROMs as a real-time indicator of the terminal stage of life among patients with cancer to allow for earlier intervention with supportive oncology services.

Assessment and Evaluation Methods for 21st Century Education: Measuring What Matters

In modern education, not only teaching methods, but also assessment methods play an important role. An adequate assessment system is essential to the development of skills that are necessary for successful careers of applicants. Therefore, the purpose of the research is the analysis of modern assessment methods in the educational process and their significance for the formation of 21st century skills. The PRISMA approach was used to search for relevant materials. Google Scholar was chosen as the main database for literature search. Works written in English or with English annotations were taken into analysis. 10 criteria for the inclusion of literature were developed, which related to the relevance, practical importance and scientific novelty of the research. Therefore, 40 positions were selected. The study used the coding method for the systematic analysis of textual data. Hence, the results showed that the main approaches to assessment in modern education are summative and formative assessment. Summative assessment summarizes student achievement after the learning process is complete, while formative assessment improves learning outcomes in real time through feedback. Special attention is paid to the active use of digital technologies, such as computer adaptive testing, e-portfolios and platforms for online testing. The conclusions emphasize that innovative assessment should contribute to the development of key skills of the 21st century. The development of digital literacy is especially important, as it allows all participants of the study to actively use technologies and understand them.

Patients Undergoing Hip Arthroscopy With Concomitant Periacetabular Osteotomy Demonstrate Clinically Meaningful Improvement at 2 Years Using the Patient-Reported Outcome Measurement Information System and International Hip Outcome Tool 12

PurposeTo report the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) values using the Patient-Reported Outcome Measurement Information System (PROMIS) and International Hip Outcome Tool 12 (iHOT-12) in patients undergoing hip arthroscopy (HA) with concomitant periacetabular osteotomy (PAO), HA+PAO for acetabular dysplasia and intra-articular pathology with minimum 2-year follow up. MethodsData from patients who underwent HA+PAO was prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients who had a diagnosis of hip dysplasia or hip instability and had minimum 2-year PROMs follow up. Data was collected electronically preoperatively and postoperatively at 6 months, 1year, and 2 years. Outcome measures analyzed were the iHOT -12 and PROMIS computer adaptive tests (CAT): Physical Function (PF), Pain Interference (PI), and Global Physical Health (GPH). MCID and SCB were calculated for these measures. Results106 patients were included in the study with an average age of 23.5 ± 6.6, an average body mass index (BMI) of 24.3, and the majority being female (94%). The values for MCID were calculated to be 40.9, 40.7, 60.2, and 43.5 and the percentage achieving MCID at 2 years was 82.6%, 82.9%, 79.6%, and 80.1% for the iHOT-12, PROMIS-PF, PROMIS-PI, and PROMIS-GPH respectively. The 1 year and 2-year SCB scores for ≥ 80% satisfaction and percent achieving were as follows respectively: iHOT-12 (71.8 (60.3%), 61.9 (65.1%)); PROMIS-PF (47.1 (64.2%), 47.2 (71.7%)); PROMIS-PI (50.6 (48.1%), 52.3 (49.1%)); PROMIS-GPH (49.3 (54.7%), 49.3 (55.7%)). The 1 year and 2 year SCB scores for 100% satisfaction and percent achieving were as follows respectively: iHOT-12 (80.2 (44.3%), 81.3 (47.2%)); PROMIS-PF (50.7 (46.2%), 50.3 (56.6%)); PROMIS-PI (52.4 (34.9%), 52.4 (49.1%)); PROMIS-GPH (52.5 (36.8%), 49.3 (55.7%)). ConclusionThis study reports values for MCID and SCB for PROMIS and iHOT-12 at 2-year follow up in patients undergoing HA+PAO for hip dysplasia or instability. The percentage of patients achieving MCID ranged from 79.6%-82.9% at 2-year follow-up. In addition, the percentage of patients achieving SCB at 2-year follow up for ≥ 80% satisfaction ranged from 49.1%-71.2% and the percentage for 100% satisfaction ranged from 49.1%-56.6%

52032 Validation and Feasibility of Patient-Reported Outcomes Information System Computer Adaptive Tests for Anxiety and Depression in Atopic Dermatitis: A Real-World Practice-Based Study

52032 Validation and Feasibility of Patient-Reported Outcomes Information System Computer Adaptive Tests for Anxiety and Depression in Atopic Dermatitis: A Real-World Practice-Based Study

52034 Validation and Feasibility of Patient-Reported Outcomes Information System Computer Adaptive Tests for Sleep Disturbance and Sleep-Related Impairment in Atopic Dermatitis: A Real-World Practice-Based Study

52034 Validation and Feasibility of Patient-Reported Outcomes Information System Computer Adaptive Tests for Sleep Disturbance and Sleep-Related Impairment in Atopic Dermatitis: A Real-World Practice-Based Study

Measuring Elementary Student Reading Gain in the Context of School-Implemented Multitiered Systems of Support

There is limited research with mixed results about student reading gains in Grades 1 to 5 within typical school-implemented Response to Intervention (RTI). As part of a larger study, we used school-administered screening data on a widely used computer-adaptive test (Measures of Academic Progress) to describe reading gains across one academic year. We observed relatively faster growth in the first grade than in the later grades. We found stronger growth for students not identified with a disability relative to students with low or high-incidence disabilities or a 504 plan. We explored moderation of gains for students receiving tiered interventions based on administrators’ interviews about RTI implementation. We observed that better ratings of administrators’ articulation about using the evidence-aligned RTI components of progress monitoring, data-based decision-making, and Tier 2 interventions were related to greater gains for students receiving Tier 2 or 3 intervention. We discuss implications, limitations, and directions for future research.

Designing Patient-Reported Measures of Fertility: Cognitive Interview Findings from Adolescents and Young Adults with Cancer.

Purpose: Fertility concerns (FC) are central to the well-being of many adolescent and young adult (AYA) cancer survivors. Clinical conversations about FC and fertility preservation are suboptimal, increasing patient distress. The goal of this project was to establish content validity and comprehensibility of self-report questions on FCs for AYAs with cancer. Methods: Following best practices, we conducted: (1) item identification, refinement, and generation; (2) translatability and reading level review; and (3) cognitive interviews. Items were reviewed by five AYAs in each round of cognitive interviews. Results: A systematic search yielded 63 measures and 873 items. Fifty items were subsequently modified to enhance clarity and relevance, representing subdomains of psychological and social/relational FC. Flesch-Kincaid analysis found 31 items written above the 6th grade level, which were subsequently revised. Translatability review resulted in the modification of 3 items. During cognitive interviews, 76% of AYAs found items easy to answer with 52% describing them as "very easy" and 24% as "somewhat easy." Sixty percent of participants indicated the items captured their experiences. The majority of those who reported items only somewhat reflected or did not reflect their experiences suggested items were simply not applicable for their particular case. Conclusion: This study is a critical step toward the foundation for an FC measurement system that is reliable, flexible, developmentally appropriate, comprehensible, translatable, and interpretable. Subsequent steps include psychometric testing to examine the construct validity and reliability of the FC items and calibration to enable the application of computer-adaptive testing and short form development. The evaluation will include potential item response bias by age range, gender identity, and race/ethnicity.