Progress in Assessing Physical Function in Arthritis: PROMIS Short Forms and Computerized Adaptive Testing
Progress in Assessing Physical Function in Arthritis: PROMIS Short Forms and Computerized Adaptive Testing
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DOI：
10.3899/jrheum.090358
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发表时间：
2009-09-01
影响因子：
3.9
通讯作者：
Bruce, Bonnie
中科院分区：
文献类型：
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作者：
Fries, James F.;Cella, David;Bruce, Bonnie
Objective.使用健康评估问卷残疾指数（HAQ）和其他工具评估自我报告的身体功能/残疾已成为关节炎研究的核心。项目反应理论（IRT）和计算机化自适应测试（CAT）技术可以提高信度和统计功效。基于IRT的仪器可以在更广泛的疾病严重程度范围内大大提高测量精度。应用这些现代方法，并估计改善的幅度。通过对超过21，000名受试者（其中包括约1500名类风湿性关节炎和骨关节炎患者）进行定性和定量评估，将1865项提炼为124项，包括传统健康评估问卷（HAQ）和身体功能-10项，并提高精确度，开发了199项身体功能/残疾项目库。四种新工具，（A）患者报告的结局测量信息（PROMIS）HAQ，它是在原始（Legacy）HAQ的基础上发展而来的;（B）“最佳”PROMIS 10;（C）20项静态（短）表格;和（D）模拟PROMIS CAT，它依次选择信息量最大的项目，与HAQ进行比较。在线和邮寄管理模式产生了类似的项目和域得分。HAQ和PROMIS HAQ 20项量表在更严重疾病患者中产生的信息量大于其他量表。“最佳”PROMIS 20项量表在4个标准差的广泛范围内优于其他20项静态量表。10项模拟PROMIS CAT的表现优于所有其他形式。结论。改进的项目和工具产生了更好的信息。PROMIS HAQ目前可用，并被视为已确认，新的PROMIS简表在确认后可能代表进一步的改进。基于CAT的身体功能/残疾评估提供了优于相同长度的静态形式的上级性能。（J Rheumol 2009;36：2061-6; doi：10.3899/jrheum.090358）
Objective. Assessing self-reported physical function/disability with the Health Assessment Questionnaire Disability Index (HAQ) and other instruments has become central in arthritis research. Item response theory (IRT) and computerized adaptive testing (CAT) techniques can increase reliability and statistical power. IRT-based instruments can improve measurement precision substantially over a wider range of disease severity. These modern methods were applied and the magnitude of improvement was estimated.Methods. A 199-item physical function/disability item bank was developed by distilling 1865 items to 124, including Legacy Health Assessment Questionnaire (HAQ) and Physical Function-10 items, and improving precision through qualitative and quantitative evaluation in over 21,000 subjects, which included about 1500 patients with rheumatoid arthritis and osteoarthritis. Four new instruments, (A) Patient-Reported Outcomes Measurement Information (PROMIS) HAQ, which evolved front the original (Legacy) HAQ; (B) "best" PROMIS 10; (C) 20-item static (short) forms; and (D) simulated PROMIS CAT, which sequentially selected the most informative item, were compared with the HAQ.Results. Online and mailed administration modes yielded similar item and domain scores. The HAQ and PROMIS HAQ 20-item scales yielded greater information content Versus other scales in patients with more severe disease. The "best" PROMIS 20-item scale outperformed the other 20-item static forms over a broad ranee of 4 standard deviations. The 10-item simulated PROMIS CAT outperformed all other forms.Conclusion. Improved items and instruments yielded better information. The PROMIS HAQ is currently available and considered validated, The new PROMIS short forms, after validation, are likely to represent further improvement. CAT-based physical function/disability assessment offers superior performance over static forms of equal length. (J Rheumatol 2009;36:2061-6; doi:10.3899/jrheum.090358)