计算机化自适应测试用于 Berg 平衡量表在不影响精度的情况下提高脑卒中患者的测量效率。
Computerized Adaptive Testing for the Berg Balance Scale Improves Measurement Efficiency Without Compromising Precision in People With Stroke.
机构信息
Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.
Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA.
出版信息
Phys Ther. 2024 Nov 1;104(11). doi: 10.1093/ptj/pzae112.
OBJECTIVE
The objectives of this study were to confirm the Berg Balance Scale's (BBS) measurement properties and unidimensionality with an item response theory analysis in persons with subacute and chronic stroke and to examine the precision and efficiency of computerized adaptive testing (CAT).
METHODS
Data were obtained from 519 ambulatory persons with subacute and chronic stroke in 2 retrospective databases. A principal component analysis (PCA) of residuals was used to evaluate unidimensionality. BBS fit to a rating scale model versus a partial credit model was examined, and item parameters were generated for CAT calibration. Person measures from all 14 items were defined as actual balance ability. BBS CAT simulations were used to examine changes in measurement precision with increasing number of items administered and a precision-based stopping rule (0.5 logit standard error [SE] threshold).
RESULTS
A PCA of residuals supports the BBS unidimensionality and Rasch analysis supports using the rating scale model for measurement. Maximum precision for BBS CAT was SE = 0.40 logits when administering all items. BBS CAT estimated balance ability was highly correlated with actual ability when 4 or more items were administered (r > 0.9). Precision was within 0.5 logits when 5 or more items were administered (SE < 0.48 logits). BBS CAT estimated balance ability was highly correlated with actual ability (r = 0.952) using a precision-based stopping rule. The average number of items administered with the precision-based stopping rule was 5.43.
CONCLUSION
The BBS is sufficiently unidimensional, and the rating scale model can be used for measurement. BBS CAT is efficient and replicates the full instrument's reliability when measuring balance ability in ambulatory persons with subacute and chronic stroke. Future work should aim to enhance the interpretability of measures to facilitate clinical decision-making.
IMPACT
BBS CAT provides an efficient way of measuring balance ability for individuals in stroke rehabilitation giving clinicians more time with patients.
目的
本研究旨在通过项目反应理论分析，确认 Berg 平衡量表（BBS）在亚急性和慢性脑卒中患者中的测量特性和单维性，并检验计算机自适应测试（CAT）的精度和效率。
方法
数据来自 2 个回顾性数据库中的 519 名亚急性和慢性脑卒中患者。采用残差主成分分析（PCA）评估单维性。检验 BBS 评分与等级量表模型和部分信用模型的拟合度，并为 CAT 校准生成项目参数。通过对所有 14 个项目的个体得分进行定义，来确定实际平衡能力。通过 BBS CAT 模拟，研究随着测试项目数量的增加，测量精度的变化情况，并采用基于精度的停止规则（0.5 对数单位标准误差[SE]阈值）。
结果
残差 PCA 支持 BBS 的单维性，Rasch 分析支持使用等级量表模型进行测量。当所有项目都进行测试时，BBS CAT 的最大精度为 SE=0.40 对数单位。当测试 4 个或更多项目时，BBS CAT 估计的平衡能力与实际能力高度相关（r>0.9）。当测试 5 个或更多项目时，精度在 0.5 对数单位内（SE<0.48 对数单位）。采用基于精度的停止规则时，BBS CAT 估计的平衡能力与实际能力高度相关（r=0.952）。基于精度的停止规则平均需要测试 5.43 个项目。
结论
BBS 具有足够的单维性，可以使用等级量表模型进行测量。BBS CAT 测量亚急性和慢性脑卒中患者的平衡能力时效率高，可复制完整工具的可靠性。未来的研究工作应致力于提高测量结果的可解释性，以促进临床决策。
影响
BBS CAT 为脑卒中康复患者提供了一种高效的平衡能力测量方法，使临床医生有更多时间与患者在一起。
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