Development and Preliminary Testing of a Computerized Adaptive Assessment of Chronic Pain

Abstract

The aim of this article is to report the development and preliminary testing of a prototype computerized adaptive test of chronic pain (CHRONIC PAIN-CAT) conducted in two stages: 1) evaluation of various item selection and stopping rules through real data simulated administrations of CHRONIC PAIN-CAT; 2) a feasibility study of the actual prototype CHRONIC PAIN-CAT assessment system conducted in a pilot sample. Item calibrations developed from a US general population sample (N=782) were used to program a pain severity and impact item bank (k=45) and real data simulations were conducted to determine a CAT stopping rule. The CHRONIC-PAIN CAT was programmed on a tablet PC using QualityMetric's Dynamic Health Assessment (DYHNA®) software and administered to a clinical sample of pain sufferers (n=100). The CAT was completed in significantly less time than the static (full item bank) assessment (p<.001). On average, 5.6 items were dynamically administered by CAT to achieve a precise score. Scores estimated from the two assessments were highly correlated (r=.89) and both assessments discriminated across pain severity levels (p<.001, RV=.95). Patients' evaluations of the CHRONIC PAIN-CAT were favourable.Perspective-This report demonstrates that the CHRONIC PAIN-CAT is feasible for administration in a clinic. The application has the potential to improve pain assessment and help clinicians manage chronic pain. KeywordsChronic Pain; Item Response Theory; Computer Adaptive Testing; Pain Assessment Chronic pain, defined as persistent or intermittent pain lasting at least three months, is common, produces substantial burden, and its treatment outcomes vary. Prevalence rates for the condition range from 2 to 40% worldwide 9,10,17,18,25,49,69 An estimated 50 million people in the US are affected by chronic pain 53 causing substantial impact on the individuals' health-related quality of life (HRQOL); 5,15,16,23,34,35,50 and a tremendous socioeconomic burden with annual US cost estimates ranging from $40 to $220 billion 1,52,59,62,66 .Pain is a uniquely subjective experience and there are no laboratory tests or external measures to assess its frequency, location, intensity, and impact. Clinicians must turn to patient reports when evaluating a pain treatment. There are a number of tools for measuring the severity and Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. may not yield scores that are precise enough to distinguish between patients at particular levels of the pain severity continuum. While practical, short forms are often limited in range due to "ceiling" and "floor" effects ...

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“…This advantage was previously demonstrated in a simulation study of the Activities of Daily Living CAT, which found that the CAT provided similar results to a static version while reducing the number of items administered by 50%. 31 Results from other studies indicate that scores similar to those obtained with full-length item banks (ranging in length from 18 -585 items) can be achieved through much shorter CATs when measuring functional status, [32][33][34] mental health status, 21,27,35,36 or the impact of conditions, such as headache, 23,37 diabetes, 30 chronic pain, 28 and asthma. 29 Most actual CAT applications used between 5 and 7 items to measure 1 construct.…”

“…Most patients in a feasibility test of a pain CAT found the CAT application to be useful, relevant, of appropriate length, and easy to complete. 28 Similarly, most respondents in a feasibility study of an asthma impact CAT found it easy to complete and of appropriate length. 29 The results of a feasibility test of a diabetes CAT gave somewhat mixed results.…”

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“…This was demonstrated in a simulation study of the activities of daily living (ADL) CAT, which found that the CAT provided similar results to a static version while reducing the number of items administered in half (59). Results from other simulation studies indicate that scores similar to those obtained with full-length item banks (ranging in length from 18 to 585 items) can be achieved through much shorter CATs when measuring functional status (38,40,46,47,52,53,60Y66), mental health status (33Y37, 42,44), or the impact of conditions like headache (17,32), diabetes (39), chronic pain (48), and asthma (51). Similar results can be found for many PROMIS domains (see www.nihpromis.org for more information), some of which have been published (67).…”

“…A series of feasibility assessments with newly developed CATs, including evaluations of participants' acceptance, were positive overall. For example, most participants in a feasibility test of a pain CAT found the CAT application to be useful, relevant, of appropriate length, and easy to complete (48). Similarly, most respondents in a feasibility study of an asthma impact CAT found it easy to complete and of appropriate length (51).…”

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