Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Feral Scholars, Broaddus, Texas, USA.
Pain Med. 2021 Jul 25;22(7):1669-1675. doi: 10.1093/pm/pnab159.
The 22-item PROMIS®-Rx Pain Medication Misuse item bank (Bank-22) imposes a high response burden. This study aimed to characterize the performance of the Bank-22 in a computer adaptive testing (CAT) setting based on varied stopping rules.
The 22 items were administered to 288 patients. We performed a CAT simulation using default stopping rules (CATPROMIS). In 5 other simulations, a "best health" response rule was added to decrease response burden. This rule stopped CAT administration when a participant selected "never" to a specified number of initial Bank-22 items (2-6 in this study, designated CATAlt2-Alt6). The Bank-22 and 7-item short form (SF-7) scores were compared to scores based on CATPROMIS, and the 5 CAT variations.
Bank-22 scores correlated highly with the SF-7 and CATPROMIS, Alt5, Alt6 scores (r=0.87-0.95) and moderately with CATAlt2- Alt4 scores (r=0.63-0.74). In all CAT conditions, the greatest differences with Bank-22 scores were at the lower end of misuse T-scores. The smallest differences with Bank-22 and CATPROMIS scores were observed with CATAlt5 and CATAlt6. Compared to the SF-7, CATAlt5 and CATAlt6 reduced overall response burden by about 42%. Finally, the correlations between PROMIS-Rx Misuse and Anxiety T-scores remained relatively unchanged across the conditions (r=0.31-0.43, Ps < .001).
Applying a stopping rule based on number of initial "best health" responses reduced response burden for respondents with lower levels of misuse. The tradeoff was less measurement precision for those individuals, which could be an acceptable tradeoff when the chief concern is in discriminating higher levels of misuse.
22 项 PROMIS®-Rx 疼痛药物滥用项目库（Bank-22）的响应负担很重。本研究旨在根据不同的停止规则，描述 Bank-22 在计算机自适应测试（CAT）环境下的表现。
22 项被分配给 288 名患者。我们使用默认停止规则（CATPROMIS）进行 CAT 模拟。在另外 5 个模拟中，添加了“最佳健康”响应规则以减少响应负担。当参与者对特定数量的初始 Bank-22 项目（本研究中为 2-6 个项目）选择“从不”时，该规则会停止 CAT 管理，将其命名为 CATAlt2-Alt6。将 Bank-22 评分与基于 CATPROMIS 的评分、5 种 CAT 变化和 7 项短式量表（SF-7）评分进行比较。
Bank-22 评分与 SF-7 和 CATPROMIS、Alt5、Alt6 评分高度相关（r=0.87-0.95），与 CATAlt2-Alt4 评分中度相关（r=0.63-0.74）。在所有 CAT 条件下，与 Bank-22 评分差异最大的是滥用 T 评分的较低端。与 Bank-22 和 CATPROMIS 评分差异最小的是 CATAlt5 和 CATAlt6。与 SF-7 相比，CATAlt5 和 CATAlt6 减少了大约 42%的总体响应负担。最后，PROMIS-Rx 滥用和焦虑 T 评分之间的相关性在整个条件下相对不变（r=0.31-0.43，P<.001）。
应用基于初始“最佳健康”响应数量的停止规则可减少滥用程度较低者的响应负担。权衡是对这些个体的测量精度降低，当主要关注点是区分更高水平的滥用时，这可能是一个可以接受的权衡。
