Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes.
OBJECTIVE
To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness.


METHODS
Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later.


METHODS
Follow-up interviews conducted in patient's home setting.


METHODS
Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions.


METHODS
Not applicable.


METHODS
Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53).


RESULTS
The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53.


CONCLUSIONS
Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden.
Haley
Stephen M
SM
Health and Disability Research Institute, School of Public Health, Boston University Medical Center, Boston, MA 02118-2639, USA. smhaley@bu.edu
Gandek
Barbara
B
Siebens
Hilary
H
Black-Schaffer
Randie M
RM
Sinclair
Samuel J
SJ
Tao
Wei
W
Coster
Wendy J
WJ
Ni
Pengsheng
P
Jette
Alan M
AM
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