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)可以显著提高对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，使用将项目与每个患者的水平相匹配的计算机化自适应测试(CAT)可以在广泛的严重程度上实现更实用和更准确的评估的相互竞争的目标。如果有更多可用的信息，这些信息可能有助于加强患者与护理者的沟通。限制因素之一是今天的HRQOL测量方法的不切实际(反应负担)。短表格(如SF-36(R)、MIDAS)更实用，然而，“天花板”和“地板”效应限制了它们的范围，它们缺乏检测单个患者评分变化的精确度。为了解决这些不足，第一阶段的目标是使用先前开发的IRT校准，对涵盖头痛影响的主要领域的头痛特定问卷的项目进行组合，以：(1)将头痛影响评估与一般的HRQOL评估结合起来，并将其结果显示在一个用户友好的单一患者报告中；(2)获得项目使用、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，以及与完整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中的项目比较DYNHA(R)-HIT TM评分的测量精确度；(4)相对于完整问卷对CAT管理的接受程度的评估；以及(5)使用原型反馈报告对患者体验的评估。第一阶段的产品将是一个原型的全面头痛-CAT的可行性，可接受性和经验表现的初步证据。在第二阶段，我们将把新的专门针对头痛的CAT与通用CAT表格的项目库(基于SF-36和其他广泛使用的HRQOL测量标准)“结合”起来，以创建一个单一的综合系统。我们方法的一个显著优势是能够利用IRT模型利用当前广泛使用的头痛专用和通用影响工具的分数交叉校准新的指标，以实现结果的有意义的比较。头痛-CAT软件被编程为在互联网上完全可操作并与PC兼容，将促进临床研究并改进评估方法，以便在临床实践中使用。将根据分数的可靠性、有效性和精确度对输出进行评估。通过大幅降低数据收集成本，减轻受访者负担，消除“天花板”和“地板”效应，并提高单个患者评分的精确度，HRQOL常规监测可能成为头痛患者和其他慢性病患者的一种临床工具。

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.