title: Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning.
abstract: OBJECTIVE
  Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test.
  
  
  METHODS
  Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items.
  
  
  RESULTS
  Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r > 0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains.
  
  
  CONCLUSIONS
  Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.
authors.affiliation: Health and Disability Research Institute, School of Public Health, Boston University, 580 Harrison Ave., 4th Floor, Boston, MA 02118, USA. allendianed@gmail.com
authors.forename: Diane D
authors.initials: DD
authors.lastname: Allen
authors.forename: Pengsheng
authors.initials: P
authors.lastname: Ni
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Haley
mesh_terms: D002648:Child; D003201:Computers; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000145:classification* / Q000534:rehabilitation; D004526:Efficiency; D006801:Humans; D017063:Outcome Assessment, Health Care; D011594:Psychometrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012648:Self Care; D012680:Sensitivity and Specificity