Nikolaus Stephanie, Bode Christina, Taal Erik, Vonkeman Harald E, Glas Cees A W, van de Laar Mart A F J
Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Expert Center for Chronic Fatigue, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Health Qual Life Outcomes. 2015 Feb 21;13:23. doi: 10.1186/s12955-015-0215-7.
This paper demonstrates the mechanism of a multidimensional computerized adaptive test (CAT) to measure fatigue in patients with rheumatoid arthritis (RA). A CAT can be used to precisely measure patient-reported outcomes at an individual level as items are consequentially selected based on the patient's previous answers. The item bank of the CAT Fatigue RA has been developed from the patients' perspective and consists of 196 items pertaining to three fatigue dimensions: severity, impact and variability of fatigue.
The CAT Fatigue RA was completed by fifteen patients. To test the CAT's working mechanism, we applied the flowchart-check-method. The adaptive item selection procedure for each patient was checked by the researchers. The estimated fatigue levels and the measurement precision per dimension were illustrated with the selected items, answers and flowcharts.
The CAT Fatigue RA selected all items in a logical sequence and those items were selected which provided the most information about the patient's individual fatigue. Flowcharts further illustrated that the CAT reached a satisfactory measurement precision, with less than 20 items, on the dimensions severity and impact and to somewhat lesser extent also for the dimension variability. Patients' fatigue scores varied across the three dimensions; sometimes severity scored highest, other times impact or variability. The CAT's ability to display different fatigue experiences can improve communication in daily clinical practice, guide interventions, and facilitate research into possible predictors of fatigue.
The results indicate that the CAT Fatigue RA measures precise and comprehensive. Once it is examined in more detail in a consecutive, elaborate validation study, the CAT will be available for implementation in daily clinical practice and for research purposes.
本文阐述了一种多维计算机自适应测试（CAT）用于测量类风湿关节炎（RA）患者疲劳程度的机制。由于项目是根据患者先前的回答依次选择的，CAT可用于在个体层面精确测量患者报告的结果。CAT疲劳RA项目库是从患者角度开发的，由196个与疲劳的三个维度相关的项目组成：疲劳的严重程度、影响和变异性。
15名患者完成了CAT疲劳RA测试。为测试CAT的工作机制，我们应用了流程图检查法。研究人员检查了每位患者的自适应项目选择程序。通过所选项目、答案和流程图说明了每个维度的估计疲劳水平和测量精度。
CAT疲劳RA按逻辑顺序选择了所有项目，所选项目提供了关于患者个体疲劳的最多信息。流程图进一步表明，CAT在严重程度和影响维度上用少于20个项目就达到了令人满意的测量精度，在变异性维度上精度稍低。患者的疲劳得分在三个维度上各不相同；有时严重程度得分最高，有时影响或变异性得分最高。CAT展示不同疲劳体验的能力可改善日常临床实践中的沟通、指导干预措施并促进对疲劳可能预测因素的研究。
结果表明，CAT疲劳RA测量精确且全面。一旦在连续、详尽的验证研究中对其进行更详细的检验，CAT将可用于日常临床实践和研究目的。
