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Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Behavior

Computerized Adaptive Testing System of Functional Assessment of Stroke

Published: January 7th, 2019

DOI:

10.3791/58137

1School of Occupational Therapy, College of Medicine, National Taiwan University, 2Research Center for Psychological and Educational Testing, National Taiwan Normal University, 3Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 5Department of Occupational Therapy, College of Medical and Health Science, Asia University

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 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: ≥70% of patients had Rasch reliability score ≥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.

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 (B....

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This study protocol was approved by a local institutional review board, and all patients gave informed consent.

1. Development of the CAT-FAS

  1. 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 .......

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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 < 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

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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,.......

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

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Name Company Catalog Number Comments
Computer Any Compatible with software listed below
MATLAB software The MathWorks Inc. http://www.mathworks.com/products/matlab/ Numerical computing software, which is used in the Protocol Section 1 (Step 1.3)
Java Development Kit Oracle https://www.oracle.com/java/ Programming language, which is used in the Protocol Section 1 (Step 1.5)

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

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