Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach.
OBJECTIVE
To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions.


METHODS
Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions.


RESULTS
The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool.


CONCLUSIONS
The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.
Siebens
Hilary
H
Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA.
Andres
Patricia L
PL
Pengsheng
Ni
N
Coster
Wendy J
WJ
Haley
Stephen M
SM
D000203:Activities of Daily Living / Q000145:classification*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004185:Disability Evaluation; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000534:rehabilitation*; D011379:Prognosis; D020127:Recovery of Function; D012046:Rehabilitation / Q000592:standards*; D012047:Rehabilitation Centers; D012680:Sensitivity and Specificity; D018434:Sickness Impact Profile; D016896:Treatment Outcome