title: An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception.
abstract: OBJECTIVE
  This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction.
  
  
  METHODS
  Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria.
  
  
  RESULTS
  The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations.
  
  
  CONCLUSIONS
  The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.
authors.affiliation: Clinic for Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany. rueya.kocalevent@fu-berlin.de
authors.forename: Rüya-Daniela
authors.initials: RD
authors.lastname: Kocalevent
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Janine
authors.initials: J
authors.lastname: Becker
authors.forename: Otto B
authors.initials: OB
authors.lastname: Walter
authors.forename: Herbert
authors.initials: H
authors.lastname: Fliege
authors.forename: Jakob B
authors.initials: JB
authors.lastname: Bjorner
authors.forename: Dieter
authors.initials: D
authors.lastname: Kleiber
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome