Universal Research Solutions, LLC, Columbia, MO, USA.
Department of Shoulder and Elbow Surgery, Rothman Institute and Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2019 Jul;28(7):1273-1280. doi: 10.1016/j.jse.2018.11.068. Epub 2019 Mar 2.
Patient-reported outcome measures enable quantitative and patient-centric assessment of orthopedic interventions; however, increased use of these forms has an associated burden for patients and practices. We examined the utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the American Shoulder and Elbow Surgeons (ASES) instrument.
A previously developed ASES CAT system was applied to the responses of 2763 patients who underwent shoulder evaluation and treatment and had answered all questions on the full ASES instrument. Analyses to assess the accuracy of the CAT score in replicating the full-form score included the mean and standard deviation of both groups of scores, frequency distributions of the 2 sets of scores and score differences, Pearson and intraclass correlation coefficients, and Bland-Altman assessment of patterns in score differences.
By tailoring questions according to prior responses, CAT reduced the question burden by 40%. The mean difference between CAT and full ASES scores was -0.14, and the scores were within 5 points in 95% of cases (a 12-point difference is considered the threshold for clinical significance) and were clustered around zero. The correlation coefficients were 0.99, and the frequency distributions of the CAT and full ASES scores were nearly identical. The differences between scores were independent of the overall score, and no significant bias for CAT scores was found in either a positive or negative direction.
The ASES CAT system lessens respondent burden with a negligible effect on score integrity.
患者报告的结局测量可实现对骨科干预措施的定量和以患者为中心的评估；然而，这些表格的使用增加会给患者和医疗实践带来负担。我们研究了计算机自适应测试（CAT）方法在减少美国肩肘外科医师协会（ASES）量表问题数量方面的效用。
将先前开发的 ASES CAT 系统应用于 2763 名接受肩部评估和治疗且回答了 ASES 完整量表所有问题的患者的反应中。评估 CAT 分数复制完整形式分数的准确性的分析包括两组分数的平均值和标准差、两组分数的分布以及分数差异、Pearson 和组内相关系数，以及 Bland-Altman 评估分数差异的模式。
根据先前的反应定制问题后，CAT 将问题负担减少了 40%。CAT 和 ASES 总分的平均差异为-0.14，在 95%的情况下分数相差在 5 分以内（12 分的差异被认为是临床意义的阈值），并且分数集中在零附近。相关系数为 0.99，CAT 和 ASES 总分的分布几乎相同。分数之间的差异与总分无关，并且在正方向或负方向均未发现 CAT 分数的显著偏差。
ASES CAT 系统减轻了应答者的负担，对评分完整性的影响可以忽略不计。
