Name: computerized adaptive testing system of functional assessment of stroke
Uploaded: 2019-01-07T14:00:00
Description: Watch this Scientific Journal Video about Computerized Adaptive Testing System of Functional Assessment of Stroke at JoVE.com

This study was supported by research grants from the Ministry of Science and Technology (105-2314-B-002 -015 -MY3).

This study protocol was approved by a local institutional review board, and all patients gave informed consent.
1. Development of the CAT-FAS
<ol>
	<li>Retrieve the secondary and encrypted data from the FAS study14 to conduct simulations (Supplementary File 1: Appendix 2). 
	NOTE: In the study, a total of 301 patients were recruited froma rehabilitation ward of a medical center and assessed at 14 d after stroke onset. Among the 301 patients, 262 ...

<ol>
	<li>Kim, S. S., Lee, H. J., You, Y. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+ankle+strengthening+exercises+combined+with+motor+imagery+training+on+the+timed+up+and+go+test+score+and+weight+bearing+ratio+in+stroke+patients.">Effects of ankle strengthening exercises combined with motor imagery training on the timed up and go test score and weight bearing ratio in stroke patients.</a> Journal of Physical Therapy Science. 27 (7), 2303-2305 (2015).</li><li>Langhorne, P., Coupar, F., Pollock, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+recovery+after+stroke:+A+systematic+review.">Motor recovery after stroke: A systematic review.</a> Lancet Neurology. 8 (8), 741-754 (2009).</li><li>Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., Van der Loos, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+movement+training+compared+with+conventional+therapy+techniques+for+the+rehabilitation+of+upper-limb+motor+function+after+stroke.">Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.</a> Archives of Physical Medicine and Rehabilitation. 83 (7), 952-959 (2002).</li><li>Fugl-Meyer, A. R., Jaasko, L., Leyman, I., Olsson, S., Steglind, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+post-stroke+hemiplegic+patient+1:+A+method+for+evaluation+of+physical+performance.">The post-stroke hemiplegic patient 1: A method for evaluation of physical performance.</a> Scandinavian Journal of Rehabilitation Medicine. 7 (1), 13-31 (1975).</li><li>Benaim, C., Perennou, D. A., Villy, J., Rousseaux, M., Pelissier, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+standardized+assessment+of+postural+control+in+stroke+patients:+The+Postural+Assessment+Scale+for+Stroke+Patients+(PASS).">Validation of a standardized assessment of postural control in stroke patients: The Postural Assessment Scale for Stroke Patients (PASS).</a> Stroke. 30 (9), 1862-1868 (1999).</li><li>Mahoney, F. I., Barthel, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+Evaluation:+The+Barthel+Index.">Functional Evaluation: The Barthel Index.</a> Maryland State Medical Journal. 14, 61-65 (1965).</li><li>Duffy, L., Gajree, S., Langhorne, P., Stott, D. J., Quinn, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+(inter-rater+agreement)+of+the+Barthel+Index+for+assessment+of+stroke+survivors:+Systematic+review+and+meta-analysis.">Reliability (inter-rater agreement) of the Barthel Index for assessment of stroke survivors: Systematic review and meta-analysis.</a> Stroke. 44 (2), 462-468 (2013).</li><li>Lin, J. H., Hsueh, I. P., Sheu, C. F., Hsieh, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychometric+properties+of+the+sensory+scale+of+the+Fugl-Meyer+Assessment+in+stroke+patients.">Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients.</a> Clinical Rehabilitation. 18 (4), 391-397 (2004).</li><li>Mao, H. F., Hsueh, I. P., Tang, P. F., Sheu, C. F., Hsieh, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+and+comparison+of+the+psychometric+properties+of+three+balance+measures+for+stroke+patients.">Analysis and comparison of the psychometric properties of three balance measures for stroke patients.</a> Stroke. 33 (4), 1022-1027 (2002).</li><li>Hsueh, I. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+computerized+adaptive+test+for+assessing+balance+function+in+patients+with+stroke.">Development of a computerized adaptive test for assessing balance function in patients with stroke.</a> Physical Therapy. 90 (9), 1336-1344 (2010).</li><li>Hsueh, I. P., Chen, J. H., Wang, C. H., Hou, W. H., Hsieh, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+computerized+adaptive+test+for+assessing+activities+of+daily+living+in+outpatients+with+stroke.">Development of a computerized adaptive test for assessing activities of daily living in outpatients with stroke.</a> Physical Therapy. 93 (5), 681-693 (2013).</li><li>Wong, A. W., Heinemann, A. W., Miskovic, A., Semik, P., Snyder, T. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+computerized+adaptive+testing+for+collection+of+patient-reported+outcomes+after+inpatient+rehabilitation.">Feasibility of computerized adaptive testing for collection of patient-reported outcomes after inpatient rehabilitation.</a> Archives of Physical Medicine and Rehabilitation. 95 (5), 882-891 (2014).</li><li>Lin, G. H., Huang, Y. J., Lee, S. C., Huang, S. L., Hsieh, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+computerized+adaptive+testing+system+of+the+Functional+Assessment+of+Stroke.">Development of a computerized adaptive testing system of the Functional Assessment of Stroke.</a> Archives of Physical Medicine and Rehabilitation. 99 (4), 676-683 (2017).</li><li>Wang, Y. L., Lin, G. H., Yi-Jing, H., Chen, M. H., Hsieh, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Refining+three+measures+to+construct+an+efficient+Functional+Assessment+of+Stroke.">Refining three measures to construct an efficient Functional Assessment of Stroke.</a> Stroke. 48 (6), 1630-1635 (2017).</li><li>Adams, R. J., Wilson, M., Wang, W. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+multidimensional+random+coefficients+multinomial+logit+model.">The multidimensional random coefficients multinomial logit model.</a> Applied Psychological Measurement. 21 (1), 1-23 (1997).</li><li>Masters, G. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Rasch+model+for+partial+credit+scoring.">A Rasch model for partial credit scoring.</a> Psychometrika. 47 (2), 149-174 (1982).</li><li>Wang, W. C., Chen, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implementation+and+measurement+efficiency+of+multidimensional+computerized+adaptive+testing.">Implementation and measurement efficiency of multidimensional computerized adaptive testing.</a> Applied Psychological Measurement. 28 (5), 295-316 (2004).</li><li>Mulder, J., Van der Linden, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multidimensional+adaptive+testing+with+optimal+design+criteria+for+item+selection.">Multidimensional adaptive testing with optimal design criteria for item selection.</a> Psychometrika. 74 (2), 273-296 (2009).</li><li>Segall, D. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=General+ability+measurement:+An+application+of+multidimensional+item+response+theory.">General ability measurement: An application of multidimensional item response theory.</a> Psychometrika. 66 (1), 79-97 (2001).</li><li>Lee, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+social+functioning+assessment+using+computerized+adaptive+testing+for+patients+with+stroke.">Development of a social functioning assessment using computerized adaptive testing for patients with stroke.</a> Archives of Physical Medicine and Rehabilitation. 99 (2), 306-313 (2018).</li><li>Paap, M. C. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+patient-reported+outcomes+adaptively:+Multidimensionality+matters!.">Measuring patient-reported outcomes adaptively: Multidimensionality matters!.</a> Applied Psychological Measurement. 42 (5), 327-342 (2018).</li><li>Paap, M. C. S., Kroeze, K. A., Terwee, C. B., van der Palen, J., Veldkamp, B. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Item+usage+in+a+multidimensional+computerized+adaptive+test+(MCAT)+measuring+health-related+quality+of+life.">Item usage in a multidimensional computerized adaptive test (MCAT) measuring health-related quality of life.</a> Quality of Life Research. 26 (11), 2909-2918 (2017).</li></ol>

The results presented here showed that the CAT-FAS administered about 10% of the items in the original tests (the average number of items used in the CAT-FAS: 8.5 items vs. the original tests: 72 items). These findings indicate that the CAT-FAS has good administrative efficiency. The results were in line with previous studies, which reported that a CAT administered only about 10 items or less to assess social function, balance, or activities of daily living in patients with stroke10,...

Dysfunctions of the upper and lower extremities (UE and LE), postural control, and basic activities of daily living (BADL) are major sequelae of stroke1,2,3. The assessment of these four functions in patients with stroke is fundamental for clinicians to evaluate patients' levels of dysfunctions, set treatment goals and plans, and monitor the longitudinal trajectories of these functions.
The Fugl-Meyer Assessment (FM),4 the Postural Assessment Scale for Stroke patients (PASS),5 and the Barthel Index (BI)6 have good psychometric properties to assess the UE/LE motor functions, postural control, and BADL, respectively, in patients with stroke7,8,9. However, the total of 72 items from these three measures impedes the feasibility of assessing all three measures within a time-limited therapeutic session. A more efficient testing method is warranted. Computerized adaptive testing (CAT) is a modern measurement method. Compared with conventional measurement methods, CAT provides a more reliable estimate of the examinee's level of function in much less time10,11,12. In conventional measurement methods, each examinee receives the same test form (or item sets), in which many items are too difficult or too easy for the examinee. These items provide limited information for estimating the examinee's level of function and are time-intensive for examinees. In contrast, in CAT, each examinee gets a tailored item set, in which the difficulty level of the selected items meets the function level of the examinee. Because these items are tailored for that particular examinee, CAT can provide a more reliable estimate of the examinee's level of function with fewer items and, thus, in much less time. The steps of CAT development are shown in Supplementary File 1: Appendix 1.
Because CAT promises reliable and efficient assessments, the CAT-FAS was developed to improve the administrative efficiency of the three measures previously used (FM, PASS, and BI)13. This paper describes the development and administration of the CAT-FAS. This protocol provides information for researchers to develop their CATs and for prospective users of the CAT-FAS to administer it. We also address the strengths and weaknesses of the CAT-FAS.

<table border="0" cellpadding="0" cellspacing="0" style="width:873px;" width="873">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:223px;">Computer</td>
			<td style="width:125px;">Any</td>
			<td style="width:353px;"></td>
			<td style="width:172px;">Compatible with software listed below</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">MATLAB software</td>
			<td>The MathWorks Inc.</td>
			<td>http://www.mathworks.com/products/matlab/</td>
			<td>Numerical computing software, which is used in the Protocol Section 1 (Step 1.3)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Java Development Kit</td>
			<td>Oracle</td>
			<td>https://www.oracle.com/java/</td>
			<td>Programming language, which is used in the Protocol Section 1 (Step 1.5)</td>
		</tr>
	</tbody>
</table>

computerized adaptive testing system of functional assessment of stroke

The computerized adaptive testing system of the functional assessment of stroke (CAT-FAS) can simultaneously assess four functions (motor functions of the upper and lower extremities, postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency. CAT, a modern measurement method, aims to provide a reliable estimate of the examinee's level of function rapidly. CAT administers only a few items whose item difficulties match an examinee's level of function and, thus, the administered items of CAT can provide sufficient information to reliably estimate the examinee's level of function in a short time. The CAT-FAS was developed through four steps: (1) determining the item bank, (2) determining the stopping rules, (3) validating the CAT-FAS, and (4) establishing a platform of online administration. The results of this study indicate that the CAT-FAS has sufficient administrative efficiency (average number of items = 8.5) and reliability (group-level Rasch reliability: 0.88 - 0.93; individual-level Rasch reliability: &#8805;70% of patients had Rasch reliability score &#8805;0.90) to simultaneously assess four functions in patients with stroke. In addition, because the CAT-FAS is a computer-based test, the CAT-FAS has three additional advantages: the automatic calculation of scores, the immediate storage of data, and the easy exporting of data. These advantages of the CAT-FAS will be beneficial to data management for clinicians and researchers.

The results of the simulation showed that the 10 candidate sets of stopping rules had sufficient average Rasch reliability (0.86 - 0.95) and varied administrative efficiency (the average number of items = 6.4 - 17.5). Considering the trade-off between reliability and administrative efficiency, the set of LRI &#60; 0.010 was selected as the optimal set of stopping rules for the CAT-FAS because of its sufficient average Rasch reliability (0.88 - 0.93, see Table 1</s...

Watch this Scientific Journal Video about Computerized Adaptive Testing System of Functional Assessment of Stroke at JoVE.com

Computerized Adaptive Testing System of Functional Assessment of Stroke

Here, we present a protocol to develop the computerized adaptive testing system of the functional assessment of stroke (CAT-FAS). The CAT-FAS can simultaneously assess four functions (two motor functions [upper and lower extremities], postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency.

The computerized adaptive testing system of the functional assessment of stroke (CAT-FAS) can simultaneously assess four functions (motor functions of the ...

The overall goal of this test development study is to develop a computerized adaptive testing system to assess the functions of the upper extremity, lower extremity, balance, and activities of daily living in stroke patients. No other tractive efficiency is found in assessing the functions of upper extremity, lower extremity, balance, and activities of daily living with patients of stroke. The computerized adaptive testing of the functional assessment of stroke was developed to improve the tractive efficiency of the full functions in patients with stroke.Begin by retrieving the secondary and encrypted data from the functional assessment of stroke study to conduct a simulation. In this study, 301 patients were recruited from a medical center rehabilitation ward, and assessed at 14 days post-stroke onset. In each assessment session, patients were assessed by a well-trained occupational therapist using the Fugl Meyer Assessment, the Postural Assessment Scale for Stroke Patients, and the Barthel Index.Establish an item bank for the testing system by adopting the bank from the study. Retrieve the item difficulties of all items in the bank, as well as each patient's responses. Also retrieve the ability distribution of the patient's for four functions.Upper extremity motor function, lower extremity motor function, postural control, and basic activities of daily living. Then, determine the operational algorithms for the testing system. Next, adopt the maximum of Posteriori Method for estimating each patient's scores of the four functions with Newton Wraps and iteration, then use the criterion of D optimality for the items selection, select an item with the maximum determinant of the Fischer information matrix from the item bank for administration.Now adopt 10 candidate sets of stopping rules to explore the properties of the testing system via simulation. Then, explore the measurement reliability and efficiency of the system. Finally, develop an online administration platform for the computerized adaptive testing system by writing a computer program to establish a website.Prior to administration, connect the examiner's personal computer, tablet, or smartphone to the online administration platform of the testing system using an internet browser, then login to the administration system. Select data management to access data from previous examinees, or select new examinee to create an account and enter the examinee's name and identification number. After selecting an examinee for the assessment, click start.The select new assessment, or results, to review the results of the examinee's previous assessments. Now, administer the items shown on the screen to the examinee. Rate the examinee's performance or responses by clicking the rating scale shown at the bottom of the screen.Once completed, explain the results from the testing system to the examinee, including the T scores with a 95%interval, the percentile ranks of the T scores, and the reliabilities of the four functions. The results will be calculated and shown automatically by the testing system. This figure shows the process of exploring the measurement reliability and efficiency via the number of items needed for administration of the assessment with ten candidates sets of stopping rules.As seen here, the average rash reliability of the four functions range from 0.88 to 0.93, and the individual level rash reliability shows more than 70%of participants with a rash reliability of 0.90 or greater. Here we see the average number of items needed for administration is 8.5 and that most participants, 66.4%were assessed using 5 to 10 items. Once mass heard of the demonstration of the computerized adaptive testing of the functional assessments of stroke can be done using 10 items or less for most patients.After watching this video, you should have a good understanding of development and of the mentration methods of the system to improve the tractive efficiency for assisting the four functions in patients with stroke.

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