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ORIGINAL RESEARCH| Volume 103, ISSUE 5, SUPPLEMENT , S3-S14, May 01, 2022
Multidimensional Computerized Adaptive Testing: A Potential Path Toward the
Efficient and Precise Assessment of Applied Cognition, Daily Activity, and
Mobility for Hospitalized Patients
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MULTIDIMENSIONAL COMPUTERIZED ADAPTIVE TESTING: A POTENTIAL PATH TOWARD THE
EFFICIENT AND PRECISE ASSESSMENT OF APPLIED COGNITION, DAILY ACTIVITY, AND
MOBILITY FOR HOSPITALIZED PATIENTS

 * Chun Wang, PhD
   Chun Wang
   Correspondence
   Corresponding author Chun Wang, Measurement and Statistics, College of
   Education, University of Washington, 2012 Skagit Ln, 312E Miller Hall,
   Seattle, WA 98105.
   Contact
   Affiliations
   College of Education, University of Washington, Seattle, WA
   Search for articles by this author
   
 * David J. Weiss, PhD
   David J. Weiss
   Affiliations
   Department of Psychology, University of Minnesota, Minneapolis, MN
   Search for articles by this author
 * Shiyang Su, PhD
   Shiyang Su
   Affiliations
   Department of Psychology, University of Central Florida, Orlando, FL
   Search for articles by this author
 * King Yiu Suen
   King Yiu Suen
   Affiliations
   Department of Psychology, University of Minnesota, Minneapolis, MN
   Search for articles by this author
 * Jeffrey Basford, MD, PhD
   Jeffrey Basford
   Affiliations
   Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester,
   MN
   Search for articles by this author
 * Andrea, L. Cheville, MD, MSCE
   Andrea, L. Cheville
   Affiliations
   Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester,
   MN
   Search for articles by this author

Published:January 24, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.002
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ABSTRACT


OBJECTIVE

To develop and evaluate an efficient and precise variable-length functional
assessment of applied cognition, daily activity, and mobility to inform mobility
preservation and rehabilitation service delivery among hospitalized patients.


DESIGN

A multidimensional item bank tapping into these dimensions was developed, with
all items calibrated using a multidimensional graded response model. The items
were adaptively selected from the item banks to maximize the test information,
and the test ended when a joint stopping rule was satisfied. A simulation study
was conducted based on the completed instrument, the Functional Assessment in
Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), to compare its
measurement precision and efficiency capabilities relative to conventional
unidimensional computerized adaptive testing. Precision was measured by the bias
and root mean squared error between the estimated and true (ie, simulated) θ
estimates, whereas efficiency was measured by average test length. Data were
collected by an interviewer reading questions from a tablet computer and
entering patients’ responses.


SETTING

A large Midwestern hospital.


PARTICIPANTS

A total of 4143 patients hospitalized with medical diagnosis and/or surgical
complications, with 2060 in the calibration sample and 2083 in the validation
cohort.


INTERVENTION

Not applicable.


RESULTS

Among the 2083 patients in the validation sample, FAMCAT administration required
an average of 6 (SD=3.11) minutes. Ninety-six percent had their tests terminated
by the standard error rule after responding to an average of 22.05 (SD=7.98)
items, whereas 15 were terminated by the change in θ rule, with an average test
length of 45.27 (SD=11.49). The remaining 76 responded until reaching the
maximum test length of 60 items.


CONCLUSIONS

The FAMCAT has the potential to satisfy the need for structured, frequent, and
precise assessment of functional domains among hospitalized patients with
medical diagnosis and/or surgical complications. The results are promising and
may be informative for others who wish to develop similar instruments when
concurrent assessment of correlated domains is required.

LIST OF ABBREVIATIONS:

CAT (computerized adaptive testing), CT-rule (change of θ rule), FAMCAT
(Functional Assessment in Acute Care Multidimensional Computerized Adaptive
Test), IRT (item response theory), LD (local dependence), MAP (maximum a
posteriori), MCAT (multidimensional computerized adaptive testing), MGRM
(multidimensional graded response model), MIRT (multidimensional item response
theory), PRO (patient-reported outcome), PROM (patient-reported outcome
measure), PROMIS (Patient-Reported Outcome Measurement Information System), RMSE
(root mean squared error), RMSEA (root mean square error of approximation), RT
(response time), SE-rule (standard error rule), UCAT (unidimensional
computerized adaptive testing)

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ARTICLE INFO


PUBLICATION HISTORY

Published online: January 24, 2022
Accepted: January 12, 2022
Received in revised form: December 20, 2021
Received: August 8, 2021


FOOTNOTES

Supported by the Eunice Kennedy Shriver National Institutes of Child Health and
Human Development of the National Institutes of Health under Award Number
R01HD079439 to the Mayo Clinic in Rochester Minnesota through a subcontract to
the University of Minnesota and the University of Washington.

Disclosures: none.

This paper is part of a supplement from the American Congress of Rehabilitation
Medicine.


IDENTIFICATION

DOI: https://doi.org/10.1016/j.apmr.2022.01.002


COPYRIGHT

© 2022 by the American Congress of Rehabilitation Medicine.


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