Development of a Computerized Adaptive Test to Assess Health-Related Quality of Life in Adults with Asthma

Abstract

Objective The purpose of this research was to calibrate an item bank for a computerized adaptive test (CAT) of asthma impact on health-related quality of life (HRQOL), test CAT versions of varying lengths, conduct preliminary validity testing, and evaluate item bank readability. Methods Asthma Impact Survey (AIS) bank items that passed focus group, cognitive testing, and clinical and psychometric reviews were administered to adults with varied levels of asthma control. Adults self-reporting asthma (N=1106) completed an Internet survey including 88 AIS items, the Asthma Control Test (ACT), and other HRQOL outcome measures. Data were analyzed using classical and modern psychometric methods, real-data CAT simulations, and known groups validity testing. Results A bi-factor model with a general factor (asthma impact) and several group factors (cognitive function, fatigue, mental health, physical function, role function, sexual function, self-consciousness/stigma, sleep, and social function) was tested. Loadings on the general factor were above 0.5 and were substantially larger than group factor loadings, and fit statistics were acceptable. Item functioning for most items and fit to the model was acceptable. CAT simulations demonstrated several options for administration and stopping rules. AIS distinguished between respondents with differing levels of asthma control. Conclusions The new 50-item AIS item bank demonstrated favorable psychometric characteristics, preliminary evidence of validity, and accessibility at moderate reading levels. Developing item banks for CAT can improve the precise, efficient, and comprehensive monitoring of asthma outcomes, and may facilitate patient-centered care.

Development of a paper-and-pencil semi-adaptive questionnaire for 5 domains of health-related quality of life (PAT-5D-QOL)

“…Usually, an IRT score for the measured attribute is estimated according to a pre-specified IRT model after each response, and the most informative question at the estimated attribute level is selected next [3][4]. A number of item banks for different health-related attributes have been developed and several CAT systems are available [5][6][7][8][9][10][11].…”

Validity of Computer Adaptive Tests of Daily Routines for Youth with Spinal Cord Injury

“…1,17,18 The advantages of CATs over traditional fixed-length measures are being demonstrated consistently with a range of clinical populations, supporting the position that CATs provide a precise, efficient, and meaningful method for evaluating patient-reported outcomes. [19][20][21][22][23][24] Computer adaptive testing is uniquely positioned to monitor outcomes of daily routines by children with SCI. With CATs, the same initial question of average difficulty (not too hard and not too easy) is presented to every person; subsequent questions are presented based on the response to previous test questions such that if the question is answered as "difficult to complete" (as an example), an easier test item appears, and if the question is answered "easy to complete" (as an example), a harder question appears.…”