Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes
Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes
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DOI：
10.1016/j.apmr.2006.04.020
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发表时间：
2006-08-01
影响因子：
4.3
通讯作者：
Ni, Pengsheng
中科院分区：
文献类型：
--
作者：
Haley, Stephen M.;Siebens, Hilary;Ni, Pengsheng
目的：对近期出院的住院康复患者进行为期3个月的前瞻性随访，以检验计算机适应测试（CAT）版急性期后护理活动测量（AM-PAC-CAT）的评分一致性、准确性、有效性、效率和反应性。设计：纵向前瞻性i组队列研究，患者在出院后约2周，然后在首次家访后3个月进行随访。设置：在患者家中进行随访。参与者：94名最近从住院康复出院的成年人，诊断为神经、骨科和医学上的复杂疾病。干预措施：不适用。主要观察指标：将AM-PAC- cat总分（包括运动和身体、个人护理和工具、应用认知三个活动域）与传统固定长度版的66项AM-PAC- cat总分（AM-PAC-66）进行比较。结果：AM-PAC-CAT评分与AM-PAC-66评分具有良好的一致性（类内相关系数模型3,1范围，0.77 - 0.86）。与AM-PAC-66相比，CAT项目平均需要43%的时间和33%的项目。这两种格式在功能严重程度组中都有区别。运动和物理固定形态的标准化反应均值（SRM）大于CAT；其他2个AM-PAC结构域的效应大小和SRM在CAT和固定格式之间表现出相似的敏感性。使用患者自己的报告作为基于锚点的变化测量，CAT和固定长度格式在对患者报告的3个月间隔变化的反应性方面具有可比性。结论：可以从CAT给药中准确估计功能活动组水平的变化，大大减少了给药时间。
Objective: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home.Design: Longitudinal, prospective I-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit.Setting: Follow-up visits conducted in patients' home setting.Participants: Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions.Interventions: Not applicable.Main Outcome Measures: Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66).Results: AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval.Conclusions: Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.