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，并且使用计算机化自适应测试（CAT）可以在广泛的严重程度范围内实现更实用和更精确的评估目标，该测试将项目与每个患者的水平相匹配。如果能获得更多的信息，这些信息将有助于加强患者与护理者之间的沟通。限制因素之一是当今HRQOL测量的不实用性（受访者负担）。短格式（例如SF-36 (r)， MIDAS）更实用，然而，“上限”和“下限”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，对涵盖头痛影响主要领域的头痛特定问卷的组合“池”项目进行校准，以便：(1)将头痛影响评估与一般HRQOL评估结合起来，并将其结果串联显示在单个用户友好的患者报告中；(2)获得项目使用情况、受访者负担（所需项目数量和管理时间）、测量水平范围（上限和下限影响）的初步估计，以及与全面调查相比的得分准确性；(3)使用新增强题库的DYNHA(r)-HIT TM分数与原题库的测量精度比较1；(4)相对于完整问卷的CAT管理接受度评估；(5)利用原型反馈报告对患者体验进行评价。第一阶段的产品将是一个具有可行性、可接受性和经验性的初步证据的原型头痛- cat。在第二阶段，我们将把新的令人头痛的特定CAT与通用CAT表格（基于SF-36和其他广泛使用的HRQOL测量）的项目池“结合”起来，创建一个单一的综合系统。我们的方法的一个重要优势是能够利用IRT模型将新指标与当前广泛使用的头痛特异性和通用影响工具的分数进行交叉校准，从而实现有意义的结果比较。头痛- cat软件的编程可在互联网和pc上完全运行，将促进临床研究并改进临床实践中使用的评估方法。产出将根据分数的信度、效度和精度进行评估。通过大大降低数据收集成本，减轻被调查者负担，消除“天花板”和“地板”效应，提高个体患者评分的准确性，HRQOL的常规监测可能成为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.