03148nas a2200457   4500008004100000020004100041245015500082210006900237250001500306260000800321300001200329490000700341520174100348653002502089653001902114653002502133653003002158653001502188653003602203653001002239653002102249653003302270653001102303653001102314653000902325653001802334653001702352653001902369653001602388100001502404700001002419700001502429700002502444700001802469700001702487700001602504700001602520700001402536700001602550856012402566       2009                        eng d  a0962-9343 (Print)0962-9343 (Linking)00aMeasuring global physical health in children with cerebral palsy: Illustration of a multidimensional bi-factor model and computerized adaptive testing0 aMeasuring global physical health in children with cerebral palsy  a2009/02/18  cApr  a359-3700 v183 aPURPOSE: The purposes of this study were to apply a bi-factor model for the determination of test dimensionality and a multidimensional CAT using computer simulations of real data for the assessment of a new global physical health measure for children with cerebral palsy (CP). METHODS: Parent respondents of 306 children with cerebral palsy were recruited from four pediatric rehabilitation hospitals and outpatient clinics. We compared confirmatory factor analysis results across four models: (1) one-factor unidimensional; (2) two-factor multidimensional (MIRT); (3) bi-factor MIRT with fixed slopes; and (4) bi-factor MIRT with varied slopes. We tested whether the general and content (fatigue and pain) person score estimates could discriminate across severity and types of CP, and whether score estimates from a simulated CAT were similar to estimates based on the total item bank, and whether they correlated as expected with external measures. RESULTS: Confirmatory factor analysis suggested separate pain and fatigue sub-factors; all 37 items were retained in the analyses. From the bi-factor MIRT model with fixed slopes, the full item bank scores discriminated across levels of severity and types of CP, and compared favorably to external instruments. CAT scores based on 10- and 15-item versions accurately captured the global physical health scores. CONCLUSIONS: The bi-factor MIRT CAT application, especially the 10- and 15-item versions, yielded accurate global physical health scores that discriminated across known severity groups and types of CP, and correlated as expected with concurrent measures. The CATs have potential for collecting complex data on the physical health of children with CP in an efficient manner.10a*Computer Simulation10a*Health Status10a*Models, Statistical10aAdaptation, Psychological10aAdolescent10aCerebral Palsy/*physiopathology10aChild10aChild, Preschool10aFactor Analysis, Statistical10aFemale10aHumans10aMale10aMassachusetts10aPennsylvania10aQuestionnaires10aYoung Adult1 aHaley, S M1 aNi, P1 aDumas, H M1 aFragala-Pinkham, M A1 aHambleton, RK1 aMontpetit, K1 aBilodeau, N1 aGorton, G E1 aWatson, K1 aTucker, C A  uhttp://mail.iacat.org/content/measuring-global-physical-health-children-cerebral-palsy-illustration-multidimensional-bi02866nas a2200325   4500008004100000020002700041245007400068210006900142250001500211260000800226300001100234490000700245520188300252653003202135653003202167653002502199653002302224653004802247653001102295653001102306653000902317653001602326653001902342653002702361100001502388700001502403700001002418700001202428856010002440       2008                        eng d  a1537-7385 (Electronic)00aAdaptive short forms for outpatient rehabilitation outcome assessment0 aAdaptive short forms for outpatient rehabilitation outcome asses  a2008/09/23  cOct  a842-520 v873 aOBJECTIVE: To develop outpatient Adaptive Short Forms for the Activity Measure for Post-Acute Care item bank for use in outpatient therapy settings. DESIGN: A convenience sample of 11,809 adults with spine, lower limb, upper limb, and miscellaneous orthopedic impairments who received outpatient rehabilitation in 1 of 127 outpatient rehabilitation clinics in the United States. We identified optimal items for use in developing outpatient Adaptive Short Forms based on the Basic Mobility and Daily Activities domains of the Activity Measure for Post-Acute Care item bank. Patient scores were derived from the Activity Measure for Post-Acute Care computerized adaptive testing program. Items were selected for inclusion on the Adaptive Short Forms based on functional content, range of item coverage, measurement precision, item exposure rate, and data collection burden. RESULTS: Two outpatient Adaptive Short Forms were developed: (1) an 18-item Basic Mobility Adaptive Short Form and (2) a 15-item Daily Activities Adaptive Short Form, derived from the same item bank used to develop the Activity Measure for Post-Acute Care computerized adaptive testing program. Both Adaptive Short Forms achieved acceptable psychometric properties. CONCLUSIONS: In outpatient postacute care settings where computerized adaptive testing outcome applications are currently not feasible, item response theory-derived Adaptive Short Forms provide the efficient capability to monitor patients' functional outcomes. The development of Adaptive Short Form functional outcome instruments linked by a common, calibrated item bank has the potential to create a bridge to outcome monitoring across postacute care settings and can facilitate the eventual transformation from Adaptive Short Forms to computerized adaptive testing applications easier and more acceptable to the rehabilitation community.10a*Activities of Daily Living10a*Ambulatory Care Facilities10a*Mobility Limitation10a*Treatment Outcome10aDisabled Persons/psychology/*rehabilitation10aFemale10aHumans10aMale10aMiddle Aged10aQuestionnaires10aRehabilitation Centers1 aJette, A M1 aHaley, S M1 aNi, P1 aMoed, R  uhttp://mail.iacat.org/content/adaptive-short-forms-outpatient-rehabilitation-outcome-assessment03708nas a2200481   4500008004100000245005200041210005200093300001200145490000700157520221100164653001902375653002902394653005802423653001002481653005302491653000902544653001102553653002502564653002602589653003302615653001102648653001002659653000902669653001602678653002402694653007402718653001802792653002902810653005802839653003102897653003202928653003602960653003202996100001503028700001603043700001603059700001603075700001003091700001403101700001803115700001503133856007803148       2004                        eng d00aActivity outcome measurement for postacute care0 aActivity outcome measurement for postacute care  aI49-1610 v423 aBACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual's execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Personal Care & Instrumental Activities (19%), and Physical & Movement Activities (9%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.10a*Self Efficacy10a*Sickness Impact Profile10aActivities of Daily Living/*classification/psychology10aAdult10aAftercare/*standards/statistics & numerical data10aAged10aBoston10aCognition/physiology10aDisability Evaluation10aFactor Analysis, Statistical10aFemale10aHuman10aMale10aMiddle Aged10aMovement/physiology10aOutcome Assessment (Health Care)/*methods/statistics & numerical data10aPsychometrics10aQuestionnaires/standards10aRehabilitation/*standards/statistics & numerical data10aReproducibility of Results10aSensitivity and Specificity10aSupport, U.S. Gov't, Non-P.H.S.10aSupport, U.S. Gov't, P.H.S.1 aHaley, S M1 aCoster, W J1 aAndres, P L1 aLudlow, L H1 aNi, P1 aBond, T L1 aSinclair, S J1 aJette, A M  uhttp://mail.iacat.org/content/activity-outcome-measurement-postacute-care04033nas a2200433   4500008004100000245012300041210006900164260000800233300001200241490000700253520252400260653001902784653002902803653005802832653001002890653000902900653002202909653002602931653003302957653001102990653001103001653000903012653001603021653007403037653003003111653003603141653005803177653003103235653004503266653004103311653003203352100001603384700001503400700001603415700001603431700001403447700001203461856012603473       2004                        eng d00aRefining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain0 aRefining the conceptual basis for rehabilitation outcome measure  cJan  aI62-1720 v423 aBACKGROUND: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. OBJECTIVE: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. METHODS: Participants (N = 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional setting-specific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. RESULTS: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92% of the participants fit the model. CONCLUSIONS: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches.10a*Self Efficacy10a*Sickness Impact Profile10aActivities of Daily Living/*classification/psychology10aAdult10aAged10aAged, 80 and over10aDisability Evaluation10aFactor Analysis, Statistical10aFemale10aHumans10aMale10aMiddle Aged10aOutcome Assessment (Health Care)/*methods/statistics & numerical data10aQuestionnaires/*standards10aRecovery of Function/physiology10aRehabilitation/*standards/statistics & numerical data10aReproducibility of Results10aResearch Support, U.S. Gov't, Non-P.H.S.10aResearch Support, U.S. Gov't, P.H.S.10aSensitivity and Specificity1 aCoster, W J1 aHaley, S M1 aAndres, P L1 aLudlow, L H1 aBond, T L1 aNi, P S  uhttp://mail.iacat.org/content/refining-conceptual-basis-rehabilitation-outcome-measurement-personal-care-and-instrumental02889nas a2200301   4500008004100000020002200041245013700063210006900200250001500269260000800284300001000292490000700302520186600309653001102175653003302186653001102219653004602230653002402276653002902300653003002329653002902359100001502388700001602403700001602419700001602435700001002451856012602461       2004                        eng d  a0003-9993 (Print)00aScore comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care0 aScore comparability of short forms and computerized adaptive tes  a2004/04/15  cApr  a661-60 v853 aOBJECTIVE: To compare simulated short-form and computerized adaptive testing (CAT) scores to scores obtained from complete item sets for each of the 3 domains of the Activity Measure for Post-Acute Care (AM-PAC). DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston metropolitan area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient and community-based short forms and CAT applications were developed for each of 3 activity domains (physical & mobility, personal care & instrumental, applied cognition) using item pools constructed from new items and items from existing postacute care instruments. RESULTS: Simulated CAT scores correlated highly with score estimates from the total item pool in each domain (4- and 6-item CAT r range,.90-.95; 10-item CAT r range,.96-.98). Scores on the 10-item short forms constructed for inpatient and community settings also provided good estimates of the AM-PAC item pool scores for the physical & movement and personal care & instrumental domains, but were less consistent in the applied cognition domain. Confidence intervals around individual scores were greater in the short forms than for the CATs. CONCLUSIONS: Accurate scoring estimates for AM-PAC domains can be obtained with either the setting-specific short forms or the CATs. The strong relationship between CAT and item pool scores can be attributed to the CAT's ability to select specific items to match individual responses. The CAT may have additional advantages over short forms in practicality, efficiency, and the potential for providing more precise scoring estimates for individuals.10aBoston10aFactor Analysis, Statistical10aHumans10aOutcome Assessment (Health Care)/*methods10aProspective Studies10aQuestionnaires/standards10aRehabilitation/*standards10aSubacute Care/*standards1 aHaley, S M1 aCoster, W J1 aAndres, P L1 aKosinski, M1 aNi, P  uhttp://mail.iacat.org/content/score-comparability-short-forms-and-computerized-adaptive-testing-simulation-study-activity