Measuring activity in children with cerebral palsy with a computer adapted test

Measuring activity in children with cerebral palsy with a computer adapted test
SM HALEY PHD PT 1, MA FRAGALA-PINKHAM MS2, H DUMAS MS2, P NI MD1, G GORTON BS3,
K WATSON DPT4, K MONTPETIT MSCOT5, M MULCAHEY PHD4

1 Health and Disability Research Institute, Boston University School of Public Health, Boston, MA;
2 Franciscan Hospital for Children, Boston, MA;
3 Shriners Hospital for Children, Springfield, MA;
4Shriners Hospital for Children, Philadelphia, PA, USA;
5 Shriners Hospital for Children, Montreal, QC, Canada

Background/Objectives: Recently, clinicians and researchers have emphasized using activity-level measures to evaluate the impact of health care interventions on children’s physical functioning in home, school and community settings. The purpose of this study was to develop a comprehensive activity measure by building an item bank, using item response theory methods (IRT) and, developing a computer adapted test (CAT).
Design: Prospective, cross-sectional study (Instrument development).
Participants and Setting: We collected parent-report data on a convenience sample of 307 children with CP (ages 2-20 years; mean 10.7 years; SD 4.0 years; GMFCS levels I 24.5%^; II 29.6%; III 25.6%; IV/V 20.3%) from four rehabilitation hospitals.
Materials/Methods: The sample was administered 45 parent-reported activity items, and concurrent instruments: Pediatrics Outcome Data Collection Instrument (PODCI), and the PedsQLTM Cerebral Palsy Version. Parents completed the surveys by either using computer tablets in the hospital facility, or finished the surveys at home via the Internet (n=11). Pearson correlation coefficients were used to test the accuracy of CAT scores with the full item bank and to examine concurrent validity. A simulated CAT was built using the real data set with stop-rules of 5-, 10-, and 15-items.
Results: A fixed slope graded response model was effective in calibrating a final set of 36 activity items and generating accurate person scores. The activity full-item bank scores and scores from all the CAT versions were able to discriminate across GMFCS levels and across types of CP (quadriplegia, hemiplegia and diplegia). CAT scores were highly correlated with scores from the full set of items; 15-item CAT r=0.98; 10-item CAT r=0.97; 5-item CAT r=0.93. We found trivial ceiling (1.0%) and floor (3.6%) effects. Concurrent validity of the scores was supported by high to moderate correlations in expected corresponding domains of the legacy measures.
Conclusions/Significance: The Activity item bank covered the range of activity seen in children with CP between ages 2-20 years. We conclude that this initial item bank development work has the potential to produce a CAT that efficiently assesses activity functioning in children with CP. Acknowledgements : Support was provided by the Shriners Hospital for Children Research Grant #8957.

 
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