title: Computerized adaptive testing of psychological factors: relation to upper-extremity disability.
abstract: BACKGROUND
  Psychological factors are important mediators of the differences between impairment and disability. The most commonly used measures of disability and psychological factors are lengthy and are usually administered as paper questionnaires. The aim of this study was to assess the correlation between perceived disability and psychological factors with use of the user-friendly, web-based Patient Reported Outcomes Measurement Information System initiative, and to compare its correlation with a frequently used, paper-based, pain self-efficacy questionnaire.
  
  
  METHODS
  A cohort of 213 patients completed a web-based version of the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), the pain self-efficacy questionnaire, the Patient Reported Outcomes Measurement Information System-based computerized adaptive testing Pain Interference questionnaire, and the Patient Reported Outcomes Measurement Information System-based computerized adaptive testing Depression questionnaire. Bivariate and multivariable analyses measured the correlation of these psychological measures with QuickDASH.
  
  
  RESULTS
  There was large correlation between QuickDASH and the Pain Interference computerized adaptive testing (r = 0.74; p < 0.001), between the Pain Interference computerized adaptive testing and the pain self-efficacy questionnaire (r = -0.72; p < 0.001), and between QuickDASH and the pain self-efficacy questionnaire (r = -0.76; p < 0.001). The Depression computerized adaptive testing showed a medium correlation both with QuickDASH (r = 0.37; p < 0.001) and with the Pain Interference computerized adaptive testing (r = 0.40; p < 0.001). The best multivariable model for QuickDASH included the Pain Interference computerized adaptive testing, prior treatment received, and smoking, and accounted for 57% of the variability. Fifty-one percent of the variability in the QuickDASH was explained by pain interference alone.
  
  
  CONCLUSIONS
  Maladaptive responses to upper-extremity pain are accurately measured by the relatively user-friendly Patient Reported Outcomes Measurement Information System-based computerized adaptive testing questionnaire.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Suite 2100, Boston, MA 02114. E-mail address for M.E. Menendez: memenendez@partners.org. E-mail address for A.G.J. Bot: abot@partners.org. E-mail address for M.G.J.S. Hageman: mhageman@partners.org. E-mail address for V. Neuhaus: vneuhaus@partners.org. E-mail address for C.S. Mudgal: cmudgal@partners.org. E-mail address for D. Ring: dring@partners.org.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.forename: Michiel G J S
authors.initials: MG
authors.lastname: Hageman
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D020407:Internet; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D020377:Self Efficacy; D011795:Surveys and Questionnaires