School of Occupational Therapy, College of Medicine, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
Phys Ther. 2013 May;93(5):681-93. doi: 10.2522/ptj.20120173. Epub 2013 Jan 17.
An efficient, reliable, and valid measure for assessing activities of daily living (ADL) function is useful to improve the efficiency of patient management and outcome measurement.
The purpose of this study was to construct a computerized adaptive testing (CAT) system for measuring ADL function in outpatients with stroke.
Two cohort studies were conducted at 6 hospitals in Taiwan.
A candidate item bank (44 items) was developed, and 643 outpatients were interviewed. An item response theory model was fitted to the data and estimated the item parameters (eg, difficulty and discrimination) for developing the ADL CAT. Another sample of 51 outpatients was interviewed to examine the concurrent validity and efficiency of the CAT. The ADL CAT, as the outcome measure, and the Barthel index (BI) and Frenchay Activities index (FAI) were administered on the second group of participants.
Ten items did not satisfy the model's expectations and were deleted. Thirty-four items were included in the final item bank. Two stopping rules (ie, reliability coefficient >.9 and maximum test length of 7 items) were set for the CAT. The participants' ADL scores had an average reliability of .93. The CAT scores were highly associated with those of the full 34 items (Pearson r=.98). The scores of the CAT were closely correlated with those of the combined BI and FAI (r=.82). The time required to complete the CAT was about one fifth of the time used to administer both the BI and FAI.
The participants were outpatients living in the community. Further studies are needed to cross-validate the results.
The results demonstrated that the ADL CAT is quick to administer, reliable, and valid in outpatients with stroke.
评估日常生活活动（ADL）功能的高效、可靠和有效的测量方法对于提高患者管理和结果测量的效率非常有用。
本研究旨在构建一种用于测量脑卒中门诊患者 ADL 功能的计算机化自适应测试（CAT）系统。
在台湾的 6 家医院进行了两项队列研究。
开发了一个候选项目库（44 个项目），并对 643 名门诊患者进行了访谈。拟合了项目反应理论模型来对数据进行分析，并对 ADL CAT 进行了项目参数（如难度和区分度）的估计。另一组 51 名门诊患者接受了访谈，以检验 CAT 的同时效度和效率。ADL CAT 作为结果测量，以及巴氏指数（BI）和 Frenchay 活动指数（FAI）在第二组参与者中进行了测量。
有 10 个项目不符合模型的预期，被删除。最终项目库中包含 34 个项目。为 CAT 设置了两个停止规则（即，可靠性系数>.9 和最大测试长度为 7 项）。参与者的 ADL 得分平均可靠性为.93。CAT 得分与完整的 34 项得分高度相关（Pearson r=.98）。CAT 得分与 BI 和 FAI 的综合得分密切相关（r=.82）。完成 CAT 的时间大约是 BI 和 FAI 用时的五分之一。
参与者是居住在社区的门诊患者。需要进一步的研究来验证结果。
结果表明，ADL CAT 在脑卒中门诊患者中快速、可靠且有效。
