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Background and Purpose
The purpose of this study was to prospectively evaluate the practical and psychometric adequacy of the Activity Measure for Post-Acute Care (AM-PAC) "item bank" and computerized adaptive testing (CAT) assessment platform (AM-PAC-CAT) when applied within orthopedic outpatient physical therapy settings.
Method
This was a prospective study with a convenience sample of 1,815 patients with spine, lower-extremity, or upper-extremity impairments who received outpatient physical therapy in 1 of 20 outpatient clinics across 5 states. The authors conducted an evaluation of the number of items used and amount of time needed to complete the CAT assessment; evaluation of breadth of content coverage, item exposure rate, and test precision; as well as an assessment of the validity and sensitivity to change of the score estimates.
Results
Overall, the AM-PAC-CAT's Basic Mobility scale demonstrated excellent psychometric properties while the Daily Activity scale demonstrated less adequate psychometric properties when applied in this outpatient sample. The mean length of time to complete the Basic Mobility scale was 1.9 minutes, using, on average, 6.6 items per CAT session, and the mean length of time to complete the Daily Activity scale was 1.01 minutes, using on average, 6.8 items.
Background and Conclusion
Overall, the findings are encouraging, yet they do reveal several areas where the AM-PAC-CAT scales can be improved to best suit the needs of patients who are receiving outpatient orthopedic physical therapy of the type included in this study.
Computerized adaptive testing (CAT), an outcome measurement approach for comprehensive and precise assessment of patient-related outcomes, is being used with increasing frequency in the health care field.1-3 This method of patient assessment uses a computer to administer test items to patients and is adaptive in the sense that each "test" is tailored to the unique level of each patient. Each person who takes an adaptive test is taking a different version of the test because the items are administered on the basis of the patient's previous responses. By avoiding the administration of a large number of questionnaire items, by selecting only those questions from a large "item bank" that provide the maximum amount of information based on a person's responses to previous questions, CAT approaches allow for the rapid collection of accurate outcome information that can feasibly be...