title: Computerized adaptive testing--ready for ambulatory monitoring?
abstract: BACKGROUND
  Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.
  
  
  METHODS
  We reviewed the literature and evaluated existing data to discuss the potential of CATs for use in ambulatory monitoring outside clinical facilities.
  
  
  RESULTS
  Computerized adaptive tests are not being used for ambulatory monitoring, but initial results from their use in health care research allow for discussion of some issues relevant to ambulatory care. Evidence shows that CATs can capture the most relevant health outcomes as well as established static tools, with substantially decreased respondent burden. They can be more precise than static tools of similar length and can reduce floor and ceiling effects. Computerized adaptive tests can reliably measure a construct over time with different items, which yields the potential of introducing item exposure control in ambulatory monitoring. Studies have shown that CATs can be at least as valid as well-designed static tools in group comparisons, but further investigation is needed to determine whether psychometric advantages lead to increased responsiveness of CATs.
  
  
  CONCLUSIONS
  Ambulatory monitoring of PROs demands short, yet very precise measurements, which can be repeated up to many times a day. Computerized adaptive tests may address several present shortcomings in ambulatory monitoring of PROs efficiently. However, most CAT developments have primarily focused on psychometric improvements. To use the full potential of CATs for ambulatory monitoring purposes, content must also be carefully considered.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, USA. matthias.rose@umassmed.edu
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Jakob B
authors.initials: JB
authors.lastname: Bjorner
authors.forename: Felix
authors.initials: F
authors.lastname: Fischer
authors.forename: Milena
authors.initials: M
authors.lastname: Anatchkova
authors.forename: Barbara
authors.initials: B
authors.lastname: Gandek
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
authors.forename: John E
authors.initials: JE
authors.lastname: Ware
mesh_terms: D034201:Computers, Handheld; D006801:Humans; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D011594:Psychometrics; D057566:Self Report; D012984:Software; D014584:User-Computer Interface