An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception

作者：Kocalevent Rueya Daniela^*; Matthias Rose; Becker Janine; Walter Otto B; Fliege Herbert; Bjorner Jakob B; Kleiber Dieter; Klapp Burghard F

来源：Journal of Clinical Epidemiology, 2009, 62(3): 278-287.

DOI：10.1016/j.jclinepi.2008.03.003

• Patient reported outcomes (PRO)
• Item response theory (IRT)
• Computerized adaptive testing (CAT)
• Stress perception
• Simulation
• Clinical application

Objectives: This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction.
Study Design and Setting: Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n = 116 inpatients, (M) together with established stress questionnaires as validity criteria.
Results: The final banks included n = 38 stress exposure items and n = 31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE < 0.32; rho > 0.90) using 7.0 /- 2.3 (M /- SD) stress reaction items and 11.6 /- 1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6 /- 2.1 for the dimension stress reaction and 10.0 /- 4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations.
Conclusions: The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.

• 出版日期2009-3