Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes.
OBJECTIVE
To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home.


METHODS
Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit.


METHODS
Follow-up visits conducted in patients' home setting.


METHODS
Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions.


METHODS
Not applicable.


METHODS
Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66).


RESULTS
AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval.


CONCLUSIONS
Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.
Haley
Stephen M
SM
Health and Disability Research Institute, Boston University, MA 02215, USA. smhaley@bu.edu
Siebens
Hilary
H
Coster
Wendy J
WJ
Tao
Wei
W
Black-Schaffer
Randie M
RM
Gandek
Barbara
B
Sinclair
Samuel J
SJ
Ni
Pengsheng
P
D000203:Activities of Daily Living; D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003199:Computer Systems; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge; D011446:Prospective Studies; D012046:Rehabilitation / Q000592:standards*; D019467:Subacute Care / Q000592:standards*; D011795:Surveys and Questionnaires