Zhu Tracy Y, Plummer Otho R, Hunt Audrey, Joeris Alexander
Clinical Science, AO Innovation Translation Center, AO Foundation, Davos, Switzerland.
Universal Research Solutions, LLC, Columbia, Missouri.
JB JS Open Access. 2023 Jan 24;8(1). doi: 10.2106/JBJS.OA.22.00036. eCollection 2023 Jan-Mar.
This study aimed to determine the efficiency and accuracy of computerized adaptive testing (CAT) models of the Oswestry Disability Index (ODI) and Neck Disability Index (NDI).
The study involved simulation using retrospectively collected real-world data. Previously developed CAT models of the ODI and NDI were applied to the responses from 52,551 and 18,196 patients with spinal conditions, respectively. Efficiency was evaluated by the reduction in the number of questions administered. Accuracy was evaluated by comparing means and standard deviations, calculating Pearson r and intraclass correlation coefficient (ICC) values, plotting the frequency distributions of CAT and full questionnaire scores, plotting the frequency distributions of differences between paired scores, and Bland-Altman plotting. Score changes, calculated as the postoperative ODI or NDI scores minus the preoperative scores, were compared between the CAT and full versions in patients for whom both preoperative and postoperative ODI or NDI questionnaires were available.
CAT models of the ODI and NDI required an average of 4.47 and 4.03 fewer questions per patient, respectively. The mean CAT ODI score was 0.7 point lower than the full ODI score (35.4 ± 19.0 versus 36.1 ± 19.3), and the mean CAT NDI score was 1.0 point lower than the full NDI score (34.7 ± 19.3 versus 33.8 ± 18.5). The Pearson r was 0.97 for both the ODI and NDI, and the ICC was 0.97 for both. The frequency distributions of the CAT and full scores showed marked overlap for the ODI and NDI. Differences between paired scores were less than the minimum clinically important difference in 98.9% of cases for the ODI and 98.5% for the NDI. Bland-Altman plots showed no proportional bias. The ODI and NDI score changes could be calculated in a subgroup of 6,044 and 4,775 patients, respectively; the distributions of the ODI and NDI score changes were near identical between the CAT and full versions.
CAT models were able to reduce the question burden of the ODI and NDI. Scores obtained from the CAT models were faithful to those from the full questionnaires, both on the population level and on the individual patient level.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在确定奥斯威斯利残疾指数（ODI）和颈部残疾指数（NDI）的计算机自适应测试（CAT）模型的效率和准确性。
本研究涉及使用回顾性收集的真实世界数据进行模拟。先前开发的ODI和NDI的CAT模型分别应用于52551例和18196例脊柱疾病患者的回答。通过减少所问问题的数量来评估效率。通过比较均值和标准差、计算Pearson相关系数r和组内相关系数（ICC）值、绘制CAT和完整问卷分数的频率分布、绘制配对分数之间差异的频率分布以及Bland-Altman绘图来评估准确性。对于术前和术后均有ODI或NDI问卷的患者，比较CAT版本和完整版本之间以术后ODI或NDI分数减去术前分数计算的分数变化。
ODI和NDI的CAT模型每位患者平均所需问题分别减少4.47个和4.03个。CAT的ODI平均分数比完整ODI分数低0.7分（35.4±19.0对36.1±19.3），CAT的NDI平均分数比完整NDI分数低1.0分（34.7±19.3对33.8±18.5）。ODI和NDI的Pearson相关系数r均为0.97，ICC均为0.97。CAT分数和完整分数的频率分布显示ODI和NDI有明显重叠。配对分数之间的差异在ODI的98.9%的病例和NDI的98.5%的病例中小于最小临床重要差异。Bland-Altman图显示无比例偏差。分别在6044例和4775例患者的亚组中可以计算ODI和NDI分数变化；CAT版本和完整版本之间ODI和NDI分数变化的分布几乎相同。
CAT模型能够减轻ODI和NDI的问题负担。从CAT模型获得的分数在总体水平和个体患者水平上都与完整问卷的分数一致。
预后III级。有关证据水平的完整描述，请参阅作者指南。
