title: Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score.
abstract: BACKGROUND
  The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood.
  
  
  OBJECTIVE
  To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 2.
  
  
  METHODS
  Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index.
  
  
  RESULTS
  All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good.
  
  
  CONCLUSIONS
  The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior in all psychometric aspects examined in this study. Future research should investigate the LE CAT for wider use in different populations.
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Division of Public Health, University of Utah, Salt Lake City, Utah, USA. ; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA. ; Huntsman Cancer Institute, University Medical Center, Salt Lake City, Utah, USA.
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Department of Computer & Electrical Engineering, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Shirley D
authors.initials: SD
authors.lastname: Hon
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; College of Pharmacy, Roseman University of Health Sciences, South Jordan, Utah, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Department of Education, Culture & Society, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Franklin
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Aoki
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Mike B
authors.initials: MB
authors.lastname: Anderson
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Kapron
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Pelt
keywords: HOS; LE CAT; PROMIS; Rasch modeling; mHHS; psychometrics