Chien Tsair-Wei, Lin Weir-Sen
Research Department, Chi-Mei Medical Center, Tainan, Taiwan.
Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
BMC Med Inform Decis Mak. 2016 Oct 10;16(1):130. doi: 10.1186/s12911-016-0370-8.
Computer adaptive testing (CAT) of the activities of daily living (ADL) functions is required (i) to reveal the advantages of using an efficient and accurate estimation method, (ii) to determine the cutpoint for classifying ADL strata in patients with stroke, and (iii) to evaluate the feasibility of online CAT used in clinical settings for smartphones.
Normally standardized distributions of ADL measurements were simulated using item parameters from published papers. We retrieved item parameters of the combined Barthel Index and Frenchay Activities Index from the literature (the 23-item comprehensive ADL [CADL] and 34-item ADL scales) and simulated three 1000-person measures from a normal standard CAT distribution: [i] CADL (CADL-CAT), [ii] ADL (ADL-CAT), and [iii] NAT (Non-Adaptive Testing). The cutpoints of ADL person strata were determined using a norm-reference method. Maximum a posteriori estimation, expected a posteriori estimation, and maximum likelihood estimation (MAP) were used to compare the Pearson correlation coefficients and different number ratios of paired measures yielded by CAT and NAT. The number of items and the cutpoints for the scale were separately determined.
We found that (i) correlation coefficients for the three CAT-estimated measures were 0.77 (CADL), 0.93 (Male ADL), and 0.93 (Female ADL) compared with their NAT counterparts. Different number ratios of person-paired measures between CAT and NAT for the three scales were all less than 5 %, indicating no difference exists between CAT and NAT. However, CAT might be 66 % more efficient than NAT. (ii) The estimated cutpoints of T scores (i.e., with a mean of 50 and a standard deviation of 10) were 45, 55, and 65 (e.g., separating person ADL function to four strata with not active, fairly active, active, and very active). (iii) An available-for-download online ADL-CAT APP for clinical practice was demonstrated.
An online ADL-CAT APP using the MAP method was created and used on smartphones to classify ADL strata in patients with stroke.
需要对日常生活活动（ADL）功能进行计算机自适应测试（CAT），（i）以揭示使用高效准确估计方法的优势，（ii）确定中风患者ADL分层的切点，以及（iii）评估在临床环境中用于智能手机的在线CAT的可行性。
使用已发表论文中的项目参数模拟ADL测量的正态标准化分布。我们从文献中检索了综合Barthel指数和Frenchay活动指数的项目参数（23项综合ADL [CADL]和34项ADL量表），并从正态标准CAT分布模拟了三个1000人的测量：[i] CADL（CADL-CAT），[ii] ADL（ADL-CAT），以及[iii] NAT（非自适应测试）。使用常模参照方法确定ADL人群分层的切点。使用最大后验估计、期望后验估计和最大似然估计（MAP）来比较CAT和NAT产生的Pearson相关系数以及配对测量的不同数量比。分别确定量表的项目数量和切点。
我们发现，（i）与NAT对应测量相比，三种CAT估计测量的相关系数分别为0.77（CADL）、0.93（男性ADL）和0.93（女性ADL）。三种量表的CAT和NAT之间的人配对测量的不同数量比均小于5%，表明CAT和NAT之间不存在差异。然而，CAT可能比NAT效率高66%。（ii）T分数（即均值为50，标准差为10）的估计切点为45、55和65（例如，将人的ADL功能分为四个层次：不活跃、相当活跃、活跃和非常活跃）。（iii）展示了一个可供下载的用于临床实践的在线ADL-CAT应用程序。
创建了一个使用MAP方法的在线ADL-CAT应用程序，并在智能手机上用于对中风患者的ADL分层进行分类。
