Peute Linda, Scheeve Thom, Jaspers Monique
Center of Human Factors Engineering of Health Information Technology, Department of Medical Informatics, Amsterdam Institute of Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands.
Signal Processing Systems, Video Coding and Architectures, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
J Med Internet Res. 2020 Jan 30;22(1):e12509. doi: 10.2196/12509.
There is a need for shorter-length assessments that capture patient questionnaire data while attaining high data quality without an undue response burden on patients. Computerized adaptive testing (CAT) and classification and regression tree (CART) methods have the potential to meet these needs and can offer attractive options to shorten questionnaire lengths.
The objective of this study was to test whether CAT or CART was best suited to reduce the number of questionnaire items in multiple domains (eg, anxiety, depression, quality of life, and social support) used for a needs assessment procedure (NAP) within the field of cardiac rehabilitation (CR) without the loss of data quality.
NAP data of 2837 CR patients from a multicenter Cardiac Rehabilitation Decision Support System (CARDSS) Web-based program was used. Patients used a Web-based portal, MyCARDSS, to provide their data. CAT and CART were assessed based on their performances in shortening the NAP procedure and in terms of sensitivity and specificity.
With CAT and CART, an overall reduction of 36% and 72% of NAP questionnaire length, respectively, was achieved, with a mean sensitivity and specificity of 0.765 and 0.817 for CAT, 0.777 and 0.877 for classification trees, and 0.743 and 0.40 for regression trees, respectively.
Both CAT and CART can be used to shorten the questionnaires of the NAP used within the field of CR. CART, however, showed the best performance, with a twice as large overall decrease in the number of questionnaire items of the NAP compared to CAT and the highest sensitivity and specificity. To our knowledge, our study is the first to assess the differences in performance between CAT and CART for shortening questionnaire lengths. Future research should consider administering varied assessments of patients over time to monitor their progress in multiple domains. For CR professionals, CART integrated with MyCARDSS would provide a feedback loop that informs the rehabilitation progress of their patients by providing real-time patient measurements.
需要更简短的评估方法，既能获取患者问卷数据，又能保证高数据质量，同时不给患者带来过重的应答负担。计算机自适应测试（CAT）和分类回归树（CART）方法有潜力满足这些需求，并能提供缩短问卷长度的诱人选择。
本研究的目的是测试CAT或CART是否最适合减少用于心脏康复（CR）领域需求评估程序（NAP）的多个领域（如焦虑、抑郁、生活质量和社会支持）问卷项目数量，同时不损失数据质量。
使用来自多中心心脏康复决策支持系统（CARDSS）基于网络程序的2837名CR患者的NAP数据。患者通过基于网络的门户MyCARDSS提供数据。根据CAT和CART在缩短NAP程序方面的表现以及敏感性和特异性对其进行评估。
使用CAT和CART时，NAP问卷长度分别总体减少了36%和72%，CAT的平均敏感性和特异性分别为0.765和0.817，分类树为0.777和0.877，回归树为0.743和0.40。
CAT和CART均可用于缩短CR领域使用的NAP问卷。然而，CART表现最佳，与CAT相比，NAP问卷项目数量总体减少幅度是其两倍，且敏感性和特异性最高。据我们所知，我们的研究是首次评估CAT和CART在缩短问卷长度方面的性能差异。未来研究应考虑对患者进行不同时间的多样化评估，以监测他们在多个领域的进展。对于CR专业人员来说，与MyCARDSS集成的CART将提供一个反馈回路，通过提供实时患者测量数据来告知其患者的康复进展。
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