Using Computer Adaptive Testing to Improve Measurement of Clinical Outcomes

描述(由申请人提供)：国家残疾和康复研究所估计，目前美国有253,000人患有脊髓损伤(SCI)，发病率约为每百万人中有40人，或每年新增11,000例。脊髓损伤影响预期寿命、职业状况、婚姻状况和可能性，以及与健康相关的生活质量。终生成本从50岁不完全损伤的约50万美元到25岁的高度损伤的300万美元不等，不考虑工资、生产力或非正式护理的损失。脊髓损伤患者预期寿命的增加使与健康相关的生活质量的特征得到改善，这对于充分了解脊髓损伤对伤者、他们的社交圈、卫生保健系统和社会的影响至关重要。判断康复对改善脊髓损伤患者的独立性和生活质量的有效性取决于衡量治疗所针对的所有健康方面的全面功能水平。目前的工具在概念清晰度方面受到限制，传统方法限制了它们平衡测量精度和可接受性的能力。因此，具有必要测量性能的仪器要么过于广泛，不适合临床使用，要么服务于有限的患者群体。对患者和资源造成合理负担的仪器缺乏检测治疗效果、监测健康、判断护理质量、提供预后或帮助做出各种患者特征决策所需的精确度。该项目的长期目标是开发一种比目前使用当代项目反应理论(IRT)和计算机自适应测试(CAT)方法更好的SCI结果测量工具。其具体目的是：1)现场测试“项目库”，或现有的、修订的和新设计的问题集合，以获取SCI状态；2)建立“SCI-CAT”量表的原型；3)在不同程度的损伤严重程度的SCI-CAT患者中进行SCI-CAT的初步研究。完成后，SCI-CAT和相关方法将可用于未来的临床和研究用途。SCI-CAT将通过提供受SCI影响的各种限制的全面信息，同时将响应负担和资源使用降至最低，从而加强临床、研究和政策决策。

DESCRIPTION (provided by applicant): The National Institute on Disability and Rehabilitation Research estimates 253,000 persons presently live with spinal cord injury (SCI) in the U. S. Incidence is approximately 40 per million, or 11,000 new cases per year. SCI affects life expectancy, occupational status, marital status and likelihood, and health-related quality of life. Lifetime costs range from approximately $500,000 for incomplete injury at age 50 to $3 million for high-level injury at age 25, without taking into account lost wages, productivity or informal care giving. Increasing life expectancy for persons with SCI makes improved characterization of health-related quality of life crucial to a full understanding of SCI impact on injured persons, their social circle, the health care system, and society. Judging the effectiveness of rehabilitation to improve independence and quality of life for those with SCI depends on measuring the full range of functional levels across all health aspects targeted by treatment. Current instruments are limited in conceptual clarity, and traditional methods limit their ability to balance measurement precision and acceptability. Therefore, instruments with necessary measurement properties are either too extensive for clinical use or serve a limited patient population. Instruments with a reasonable burden on patients and resources lack the precision required to detect treatment effects, monitor health, judge care quality, provide prognoses, or aid decision-making across the range of patient characteristics. The long-term objective of this project is to develop a superior outcome measurement instrument for SCI than is presently available using contemporary item response theory (IRT) and computer adaptive testing (CAT) methods. The specific aims of are to: 1) field test the "item pool", or collection of existing, revised, and newly designed questions to capture SCI status, 2) build the prototype "SCI-CAT" instrument, and 3) conduct a pilot study of the SCI-CAT in SCI patients with various levels of injury severity. Upon completion, the SCI-CAT and related methods will be available for future clinical and research use. The SCI-CAT will enhance clinical, research, and policy decision-making by providing comprehensive information across the range of limitations affected by SCI while minimizing response burden and resource use.