Computerized Adaptive Assessment of Headache Impact

描述（由申请人提供）：我们已经证明，使用项目反应理论（IRT）可以大大改善头痛的功能影响及其对健康相关生活质量（HRQOL）的影响的估计，并且使用计算机自适应测试（CAT）可以在广泛的严重程度水平上实现更实用和更精确评估的竞争目标，该测试将项目与每个患者的水平相匹配。如果更多的可用性，这些信息可能有助于加强病人与护理人员的沟通。其中的限制因素是不切实际的（受访者负担），今天的HRQOL措施。短格式（例如，SF-36（r）、MIDAS）更实用，但是，“天花板”和“地板”效应限制了它们的范围，并且它们缺乏检测个体患者评分变化的精度。为了解决这些缺陷，第一阶段的目标是使用先前开发的IRT校准，用于涵盖头痛影响的主要领域的头痛特异性问卷中的项目的组合“池”，以：（1）将头痛影响评估与一般HRQOL评估相结合，并在单个用户友好的患者报告中串联显示其结果;（2）获得项目使用情况的初步估计，（所需项目数量和给药次数），测量的水平范围（天花板和地板效应），以及与全长调查相比的评分准确性;（3）使用新的增强项目库与原始项目库1中的项目比较DYNHA（r）-HIT TM评分的测量精度;（4）评估CAT管理相对于全长问卷的接受程度;以及（5）使用原型反馈报告评估患者的体验。第一阶段的产品将是一个原型综合HEADACHE-CAT与初步证据的可行性，可接受性和经验的表现。在第二阶段，我们将把新的头痛特异性CAT与通用CAT表的项目池（基于SF-36和其他广泛使用的HRQOL指标）“结合”，以创建一个单一的综合系统。我们的方法的一个重大优势是能够利用IRT模型来交叉校准新的指标与当前广泛使用的头痛特定和通用影响工具的分数，以实现有意义的结果比较。HEADACHE-CAT软件的程序设计可在互联网上充分运行，并与个人电脑兼容，将促进临床研究，并改进临床实践中使用的评估方法。将从评分的可靠性、有效性和精确性方面对输出进行评估。通过大大降低数据收集成本，减少受访者的负担，消除“天花板”和“地板”的影响，并提高个体患者评分的精度，HRQOL的常规监测可能成为可行的头痛患者和其他慢性疾病患者的临床工具。

DESCRIPTION (provided by applicant): We have demonstrated that estimates of the functional impact of headaches and their impact on health-related quality of life (HRQOL) can be substantially improved using item response theory (IRT) and competing objectives of more practical and more precise assessments can be achieved over a wide range of severity levels using computerized adaptive testing (CAT), which matches items to each patient's level. If more available, such information could be useful in enhancing patient-caregiver communication. Among the limiting factors is the impracticality (respondent burden) of today's HRQOL measures. Short-forms (e.g., SF-36 (r), MIDAS) are more practical, however, "ceiling" and "floor" effects limit their ranges and they lack the precision to detect changes in individual patient scores. To address these deficiencies, the aims of Phase I are to use previously-developed IRT calibrations for a combined "pool" of items from headache-specific questionnaires covering major domains of headache impact to: (1) combine headache impact assessments with generic HRQOL assessments and display their results in tandem in a single user-friendly patient report; (2) obtain preliminary estimates of item usage, respondent burden (number of items required and administration times), range of levels measured (ceiling and floor effects), and score accuracy in comparison with a full-length survey; (3) comparison of the measurement precision of DYNHA(r)-HIT TM scores using the new enhanced item pool in comparison with items from the original item pools1; (4)evaluation of the acceptance of CAT administrations relative to full-length questionnaires; and (5) evaluation of the patient's experience using the prototype feedback report. The product of Phase I will be a prototype comprehensive HEADACHE-CAT with preliminary evidence regarding feasibility, acceptability and empirical performance. In Phase II, we will "marry" the new headache -specific CAT with item pools for generic CAT forms (based on SF-36 and other widely-used HRQOL measures) to create a single comprehensive system. A substantial advantage of our approach is the ability to utilize IRT models to cross-calibrate the new metrics with scores from current widely used headache-specific and generic impact tools to enable meaningful comparisons of results. HEADACHE-CAT software, programmed to be fully operational on the Internet and PC-compatible, will facilitate clinical research and improve assessment methods for use in clinical practice. Output will be evaluated in terms of reliability, validity and precision of scores. By greatly lowering data collection costs, reducing respondent burden, eliminating "ceiling" and "floor" effects and increasing the precision of individual patient scores, routine monitoring of HRQOL may become feasible as a clinical tool among headache sufferers and patients with other chronic illnesses.