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The primary purpose was to develop, field test, and validate a computerized-adaptive test (CAT) for posttraumatic stress disorder (PTSD) to enhance PTSD assessment and decrease the burden of symptom monitoring.Data sources included self-report and interviewer-administered diagnostic interviews. The sample included 1,288 veterans. In phase 1, 89 items from a previously developed PTSD item pool were administered to a national sample of 1,085 veterans. A multidimensional graded-response item response theory model was used to calibrate items for incorporation into a CAT for PTSD (P-CAT). In phase 2, in a separate sample of 203 veterans, the P-CAT was validated against three other self-report measures (PTSD Checklist, Civilian Version; Mississippi Scale for Combat-Related PTSD; and Primary Care PTSD Screen) and the PTSD module of the Structured Clinical Interview for DSM-IV.A bifactor model with one general PTSD factor and four subfactors consistent with DSM-5 (reexperiencing, avoidance, negative mood-cognitions, and arousal), yielded good fit. The P-CAT discriminated veterans with PTSD from those with other mental health conditions and those with no mental health conditions (Cohen's d effect sizes.90). The P-CAT also discriminated those with and without a PTSD diagnosis and those who screened positive versus negative for PTSD. Concurrent validity was supported by high correlations (r=.85-.89) with the validation measures.The P-CAT appears to be a promising tool for efficient and accurate assessment of PTSD symptomatology. Further testing is needed to evaluate its responsiveness to change. With increasing availability of computers and other technologies, CAT may be a viable and efficient assessment method.

Study Design Cross-sectional Objectives The Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM), which includes calibrated item banks (child and parent versions) for General Mobility, Daily Routines, Wheeled Mobility and Ambulation, can be administered using computerized adaptive tests (CATs) or short forms (SFs). The study objectives are: 1.) examine the psychometric properties of the PEDISCI AM item banks and 10-item CATs); 2.) develop and evaluate the psychometric properties of PEDI-SCI AM SFs. Setting U.S. Shriners Hospitals for Children (California, Illinois and Pennsylvania). Methods Calibration data from a convenience sample of 381 children and adolescents with SCI and 322 parents or caregivers were used to examine PEDI-SCI AM item banks, 10-item CATs and SF scores. We calculated group reliability, internal consistency (Cronbach's alpha), and interclass coefficients (ICCs) to assess agreement between 10-item CATs, SFs and item banks. The percent of the sample with highest (ceiling) and lowest (floor) scores was also determined. An expert panel selected items for 14 SFs. Results PEDI-SCI item banks, 10-item CATs and SFs demonstrate acceptable group reliability (0.73-0.96) and internal consistency (0.77-0.98). ICC values show strong agreement with item banks for 10-item CATs (0.72-0.99) and SFs. Floor effects are minimal (

Research studies that measure health-related quality of life (HRQOL) in both children and adults and longitudinal studies that follow children into adulthood need measures that can be compared across these age groups. This study links the PROMIS pediatric and adult emotional distress measures using data from participants with diverse health conditions and disabilities. Analyses were conducted and compared in two separate samples to confirm the stability of results. One sample (n = 874) included individuals aged 14–20 years with special health care needs and who require health services. The other sample (n = 641) included individuals aged 14–25 years who have a physical or cognitive disability. Participants completed both PROMIS pediatric and adult measures. Item response theory-based scores were linked using the linear approximation to calibrated projection. The estimated latent-variable correlation between pediatric and adult PROMIS measures ranged from 0.87 to 0.94. Regression coefficients β 0 (intercept) and β 1 (slope), and mean squared error are provided to transform scores from the pediatric to the adult measures, and vice versa. This study used a relatively new linking method, calibrated projection, to link PROMIS pediatric and adult measure scores, thus expanding the use of PROMIS measures to research that includes both populations.

Objective To use item response theory (IRT) data simulations to construct and perform initial psychometric testing of a newly developed instrument, the Social Security Administration Behavioral Health Function (SSA-BH) instrument, that aims to assess behavioral health functioning relevant to the context of work. Design Cross-sectional survey followed by IRT calibration data simulations. Setting Community. Participants Sample of individuals applying for Social Security Administration disability benefits: claimants (n=1015) and a normative comparative sample of U.S. adults (n=1000). Interventions None. Main Outcome Measure SSA-BH measurement instrument. Results IRT analyses supported the unidimensionality of 4 SSA-BH scales: mood and emotions (35 items), self-efficacy (23 items), social interactions (6 items), and behavioral control (15 items). All SSA-BH scales demonstrated strong psychometric properties including reliability, accuracy, and breadth of coverage. High correlations of the simulated 5- or 10-item computer adaptive tests with the full item bank indicated robust ability of the computer adaptive testing approach to comprehensively characterize behavioral health function along 4 distinct dimensions. Conclusions Initial testing and evaluation of the SSA-BH instrument demonstrated good accuracy, reliability, and content coverage along all 4 scales. Behavioral function profiles of Social Security Administration claimants were generated and compared with age- and sex-matched norms along 4 scales: mood and emotions, behavioral control, social interactions, and self-efficacy. Using the computer adaptive test-based approach offers the ability to collect standardized, comprehensive functional information about claimants in an efficient way, which may prove useful in the context of the Social Security Administration's work disability programs.

Objectives To develop and test an instrument to assess physical function for Social Security Administration (SSA) disability programs, the SSA-Physical Function (SSA-PF) instrument. Item response theory (IRT) analyses were used to (1) create a calibrated item bank for each of the factors identified in prior factor analyses, (2) assess the fit of the items within each scale, (3) develop separate computer-adaptive testing (CAT) instruments for each scale, and (4) conduct initial psychometric testing. Design Cross-sectional data collection; IRT analyses; CAT simulation. Setting Telephone and Internet survey. Participants Two samples: SSA claimants (n=1017) and adults from the U.S. general population (n=999). Interventions None. Main Outcome Measures Model fit statistics, correlation, and reliability coefficients. Results IRT analyses resulted in 5 unidimensional SSA-PF scales: Changing & Maintaining Body Position, Whole Body Mobility, Upper Body Function, Upper Extremity Fine Motor, and Wheelchair Mobility for a total of 102 items. High CAT accuracy was demonstrated by strong correlations between simulated CAT scores and those from the full item banks. On comparing the simulated CATs with the full item banks, very little loss of reliability or precision was noted, except at the lower and upper ranges of each scale. No difference in response patterns by age or sex was noted. The distributions of claimant scores were shifted to the lower end of each scale compared with those of a sample of U.S. adults. Conclusions The SSA-PF instrument contributes important new methodology for measuring the physical function of adults applying to the SSA disability programs. Initial evaluation revealed that the SSA-PF instrument achieved considerable breadth of coverage in each content domain and demonstrated noteworthy psychometric properties.

To evaluate the accuracy of computer adaptive tests (CATs) of daily routines for child- and parent-reported outcomes following pediatric spinal cord injury (SCI) and to evaluate the validity of the scales.One hundred ninety-six daily routine items were administered to 381 youths and 322 parents. Pearson correlations, intraclass correlation coefficients (ICC), and 95% confidence intervals (CI) were calculated to evaluate the accuracy of simulated 5-item, 10-item, and 15-item CATs against the full-item banks and to evaluate concurrent validity. Independent samples t tests and analysis of variance were used to evaluate the ability of the daily routine scales to discriminate between children with tetraplegia and paraplegia and among 5 motor groups.ICC and 95% CI demonstrated that simulated 5-, 10-, and 15-item CATs accurately represented the full-item banks for both child- and parent-report scales. The daily routine scales demonstrated discriminative validity, except between 2 motor groups of children with paraplegia. Concurrent validity of the daily routine scales was demonstrated through significant relationships with the FIM scores.Child- and parent-reported outcomes of daily routines can be obtained using CATs with the same relative precision of a full-item bank. Five-item, 10-item, and 15-item CATs have discriminative and concurrent validity.

OBJECTIVE Item response theory and computerized adaptive testing methods allow the development of a large calibrated item bank from which different subsets of questions can be selected for administration and scored on a common scale. The objective of this study was to develop an outpatient rehabilitation self-report short form for the Activity Measure for Post-Acute Care Applied Cognition item bank. DESIGN Using data from a convenience sample of 235 rehabilitation outpatients, item content and item response theory-based test information function parameters were used in item selection. Internal consistency reliability, intraclass correlation coefficient (ICC), and percentage at the lowest (floor) and highest (ceiling) scores were evaluated for the short form and full item bank. RESULTS A 15-item short form was developed. The internal consistency of the short form was 0.86. The ICC3,1 for the short form and item bank was 0.97 (95% confidence interval, 0.94-0.98). No floor effects were noted, and ceiling effects were 27.66% (short form) and 26.38% (full item bank). CONCLUSIONS The Applied Cognition outpatient short form demonstrated acceptable psychometric properties and provides a bridge to item response theory-based measurement for settings where point-of-care computing is not available.

The Pediatric Evaluation of Disability Inventory (PEDI) was originally developed to provide a parent/clinician-reported functional test that was normed on children up to the age of 7 ½ years.1 The PEDI has a long history of application in developmental medicine, serving as a functional outcome measure for clinical research and practice.2 The original PEDI was a fixed-format test in which all items needed to be administered in order to derive a score. In addition to some finding the administration of all PEDI items potentially burdensome, the restriction of norms to only young children also limited its use.3 The purpose of this article is to report on the revision of the PEDI into a series of computer-adaptive tests (CAT) that cover the 0 to 21 year age range. CATs are being promoted as the next logical step to more efficient health outcome assessments.4 To employ a CAT, Item Response Theory (IRT) modeling is used to express the association between an individual’s response to an item and the outcome domain. IRT measurement models are a class of statistical procedures used to develop measurement scales. The measurement scales are comprised of items with a known relationship between item responses and positions on an underlying functional continuum. Using this approach, probabilities of children scoring a particular response on an item at various functional ability levels can be modeled. These probability estimates are used to determine the child’s most likely position along the functional dimension. When assumptions of a particular IRT model are met, estimates of a child’s functional ability do not strictly depend on a particular fixed set of items. This scaling feature allows one to compare persons along a functional outcome dimension even if they have not completed the identical set of functional items. CAT also optimizes the items administered, providing items most likely to yield the greatest information for score estimation. CATs will generally require fewer items than a comparable length fixed form instrument to achieve similar precision, although the gains in efficiency may not be uniform throughout the full scale.5 Early work has highlighted the possible benefits of using CAT in the assessment of children’s functioning, including improved efficiency with minimal loss of precision.6–9 We have shown that the original PEDI can be successfully engineered into efficient CAT programs.8, 10 The North American Shriners Orthopedic Hospitals have recently developed a series of parent- and child-reported CAT measures of physical functioning and participation for their network with promising results.11–15 The aims of this project were to build and test new PEDI-CAT item banks for an age range of 0 to 21 years and use simulations based on the combined normative and disability calibration samples to assess the accuracy and precision of the PEDI-CAT.

Haley SM, Ni P, Lai J-S, Tian F, Coster WJ, Jette AM, Straub D, Cella D. Linking the Activity Measure for Post Acute Care and the Quality of Life Outcomes in Neurological Disorders. Objective To use item response theory (IRT) methods to link physical functioning items in the Activity Measure for Post Acute Care (AM-PAC) and the Quality of Life Outcomes in Neurological Disorders (Neuro-QOL). Design Secondary data analysis of the physical functioning items of AM-PAC and Neuro-QOL. We used a nonequivalent group design with 36 core items common to both instruments and a test characteristic curve transformation method for linking AM-PAC and Neuro-QOL scores. Linking was conducted so that both raw and scaled AM-PAC and Neuro-QOL scores (mean ± SD converted-logit scores, 50±10) could be compared. Setting AM-PAC items were administered to rehabilitation patients in post–acute care (PAC) settings. Neuro-QOL items were administered to a community sample of adults through the Internet. Participants PAC patients (N=1041) for the AM-PAC sample and community-dwelling adults (N=549) for the Neuro-QOL sample. Interventions Not applicable. Main Outcome Measures Mobility (N=25) and activity of daily living (ADL) items (N=11) common to both instruments were included in analysis. Results Neuro-QOL items were linked to the AM-PAC scale by using the generalized partial credit model. Mobility and ADL subscale scores from the 2 instruments were calibrated to the AM-PAC metric. Conclusions An IRT-based linking method placed AM-PAC and Neuro-QOL mobility and ADL scores on a common metric. This linking allowed estimation of AM-PAC mobility and ADL subscale scores based on Neuro-QOL mobility and ADL subscale scores and vice versa. The accuracy of these results should be validated in a future sample in which participants respond to both instruments.

Objective: To evaluate the effectiveness of a 14-week aquatic exercise programme for children with autism spectrum disorders (ASD).Design: Non-randomized control trial.Methods: Twelve children participated in this pilot study with seven participants in the aquatic exercise group and five in the control group. The programme was held twice per week for 40 minutes per session. Swimming skills, cardiorespiratory endurance, muscular endurance, mobility skills and participant and parent satisfaction were measured before and after the intervention.Results: No significant between-group changes were found. Within-group improvements for swimming skills were found for the intervention group. Programme attendance was high. Parents and children were very satisfied with the programme activities and instructors.Conclusions: This pilot programme was feasible and showed potential for improving swimming ability in children with ASD. Exercise intensity was low for some participants, most likely contributing to a lack of sig...

This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized measures: Pediatric Outcomes Data Collection Instrument and Functional Independence Measure for Children. The UE CAT correlated strongly with the upper extremity component of these measures and had greater precision when describing individual functional ability. The UE item bank has wider range with items populating the lower end of the ability spectrum. This new UE item bank and CAT have the capability to quickly assess children of all ages and abilities with good precision and, most importantly, with items that are meaningful and appropriate for their age and level of physical function.

The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options were reviewed by clinician experts and examined at parent and clinician focus groups. Eleven parents participated in 32 cognitive interviews to examine content, format, and comprehension of items and responses. A set of 76 self-care, 78 mobility, and 64 social function items with pictures and a four-point "Difficulty" scale were developed. The PEDI's Caregiver Assistance scale was replaced by a "Responsibility Scale" with 53 items. Content validity was established incorporating input from clinicians and parents. The new item bank covers a broad range of functional activities for children of all ages and abilities.

Aim The aim of this study was to determine the psychometric properties, content range, and measurement precision of a lower extremity physical functioning and mobility skills item bank (LE85) in children with cerebral palsy (CP). Method Lower extremity functioning and mobility skill items were administered to 308 parents of children (169 males, 139 females; mean age 10y 8mo, SD 4y) with spastic CP (145 diplegia, 73 hemiplegia, 89 quadriplegia; [for one person type of CP was unknown]) classified using the Gross Motor Function Classification System (75 level I, 91 level II, 79 level III, 37 level IV, 26 level V). Additional legacy measures were administered to assess concurrent validity. Psychometric characteristics, differential item functioning, content range, and score precision were examined. Results The LE85 had acceptable psychometric properties. Content range matched the ability range of the sample population and exceeded legacy measures with minimal differential item functioning. The LE85 had good correlation with the Paediatric Outcomes Data Collection Instrument, Functional Independence Measure for Children, Gillette Functional Assessment Questionnaire, and Paediatric Quality of Life Inventory – CP module (range r=0.63–0.86). Precision of the LE85 and 10-item simulated computer adaptive test scores outperformed legacy measures. Interpretation The LE85 appears to be suitable to administer as a computer adaptive test to measure lower extremity physical functioning and mobility in children with CP.

The specific aims of this study were to (1) examine the psychometric properties (unidimensionality, differential item functioning, scale coverage) of an item bank of upper-extremity skills for children and adolescents with cerebral palsy (CP); (2) evaluate a simulated computer-adaptive test (CAT) using this item bank; (3) examine the concurrent validity of the CAT with the Pediatric Outcomes Data Collection Instrument (PODCI) upper-extremity core scale; and (4) determine the discriminant validity of the simulated CAT with Manual Ability Classification System (MACS) levels and CP type (i.e. diplegia, hemiplegia, or quadriplegia). Parents (n=180) of children and adolescents with CP (spastic diplegia 49%, hemiplegia 22%, or quadriplegia 28%) consisting of 102 males and 78 females with a mean age of 10 years 6 months (SD 4y 1mo, range 2-21y), and MACS levels I through V participated in calibration of an item pool and completed the PODCI. Confirmatory factor analyses supported a unidimensional model using 49 of the 53 upper-extremity items. Simulated CATs of 5, 10, and 15 items demonstrated excellent accuracy (intraclass correlation coefficient [ICCs] >0.93) with the full item bank, had high correlations with the PODCI upper-extremity core scale score (ICC 0.79), and discriminated among MACS levels. The simulated CATs demonstrated excellent overall content coverage over a wide age span and severity of upper-extremity involvement. The future development and refinement of CATs for parent report of physical function in children and adolescents with CP is supported by our work.

Objective To develop and evaluate a prototype measure (OA-DISABILITY-CAT) for osteoarthritis research using item response theory (IRT) and computer-adaptive test (CAT) methodologies. Study Design and Setting We constructed an item bank consisting of 33 activities commonly affected by lower extremity (LE) osteoarthritis. A sample of 323 adults with LE osteoarthritis reported their degree of limitation in performing everyday activities, and completed the Health Assessment Questionnaire-II (HAQ-II). We used confirmatory factor analyses to assess scale unidimensionality and IRT methods to calibrate the items and examine the fit of the data. Using CAT simulation analyses, we examined the performance of OA-DISABILITY-CATs of different lengths compared with the full-item bank and the HAQ-II. Results One distinct disability domain was identified. The 10-item OA-DISABILITY-CAT demonstrated a high degree of accuracy compared with the full-item bank ( r = 0.99). The item bank and the HAQ-II scales covered a similar estimated scoring range. In terms of reliability, 95% of OA-DISABILITY reliability estimates were over 0.83 vs. 0.60 for the HAQ-II. Except at the highest scores, the 10-item OA-DISABILITY-CAT demonstrated superior precision to the HAQ-II. Conclusion The prototype OA-DISABILITY-CAT demonstrated promising measurement properties compared with the HAQ-II, and is recommended for use in LE osteoarthritis research.

Computerized adaptive testing (CAT) item banks may need to be updated, but before new items can be added, they must be linked to the previous CAT. The purpose of this study was to evaluate 41 pretest items prior to including them into an operational CAT.We recruited 6,882 patients with spine, lower extremity, upper extremity, and nonorthopedic impairments who received outpatient rehabilitation in one of 147 clinics across 13 states of the USA. Forty-one new Daily Activity (DA) items were administered along with the Activity Measure for Post-Acute Care Daily Activity CAT (DA-CAT-1) in five separate waves. We compared the scoring consistency with the full item bank, test information function (TIF), person standard errors (SEs), and content range of the DA-CAT-1 to the new CAT (DA-CAT-2) with the pretest items by real data simulations.We retained 29 of the 41 pretest items. Scores from the DA-CAT-2 were more consistent (ICC = 0.90 versus 0.96) than DA-CAT-1 when compared with the full item bank. TIF and person SEs were improved for persons with higher levels of DA functioning, and ceiling effects were reduced from 16.1% to 6.1%.Item response theory and online calibration methods were valuable in improving the DA-CAT.

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). 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. 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. 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.

Objective: To evaluate the readability, comprehension and response processes of test items designed to measure activity performance and participation by children with spinal cord injury (SCI).Methods: Eleven parents and 33 children participated. Descriptive statistics were used to calculate frequency of problems based on age, grade, domain and response scale. Agreement was evaluated by weighted kappa coefficient values.Results: Most (54%) of the problems were due to reading/comprehension, with the majority by children 8 years of age or younger (56%) who had not completed 2nd grade (51%). Agreement between child–parent reports ranged from poor–good, with strongest agreement for mobility items and weak agreement for chores, self-care and participation.Conclusion: Children with SCI 8 years of age and older who have competed 2nd grade are able to read, understand and respond to items associated with activity performance and participation.

To generate consensus on the reasons why children with airway support transfer between acute and post-acute care; develop a minimum data set to transmit between care settings; and examine transfer reports to determine the frequency of data set content.Two consensus development meetings were conducted of acute and post-acute care professionals to identify reasons for transfer and develop the minimum data set. A content analysis was used to generate the frequency of inclusion of minimum data set elements in the narrative reports of 15 acute to post-acute and 15 post-acute to acute transfer summaries. The observed frequencies were compared with the expected frequencies (95%), as were frequencies between the two groups.Advanced diagnostic assessment and unexpected changes in medical, surgical and mental health conditions were the primary reasons for transfer from post-acute to acute care. For transfers in both directions, 20 of the 34 data elements were present in75% of the cases and were statistically different than the pre-set 95% standard. No statistical difference in the occurrence of data elements between transfer directions existed.A minimum data set has the potential to reduce redundancy, improve safety and optimize care co-ordination between facilities for children with airway support.

Objective: The purpose of this article is to provide paediatric rehabilitation providers with a review of self-report physical function outcome measures that have been used for children with spinal cord injury (SCI).Review process: A literature review was conducted to identify self-report physical function measures for children with SCI. Further searching of reference lists and textbooks was also completed.Outcomes: Eight measures were identified, but limitations exist in these current tools. There are few reports of psychometrics, in addition to a lack of accommodation for wheelchair use, limited item content for supported ambulation and minimal variation in content for a wide age-range.Conclusion: A comprehensive yet practical self-report measure applicable for all ages with items suitable for a child with a complete or incomplete injury is needed. The best means to achieve effective and efficient outcome monitoring may be computerized adaptive testing.

To describe an adaptive ice skating programme designed by paediatric therapists.Twenty-two children, ages 5-12 years, with developmental disabilities participated in this once per week skating programme lasting 6 weeks. Ice skating instructors led the group lessons, while university student coaches provided individualized assistance to the children. The programme was evaluated using a summative evaluation design. Outcomes included participant attendance, incidence of injuries, skating skills and parent and student coach survey data.On average, participants attended 83% of the sessions and one minor injury was reported. Participants' parents were very satisfied with the programme and reported improvements in their child's skating skills, leg strength, endurance, balance, self-esteem/confidence and ability to participate in a group. Student coaches also reported high levels of satisfaction with this programme and reported similar improvements in the children they coached.The programme appeared promising, but may require minor modifications.

The effectiveness and safety of a group aquatic aerobic exercise program on cardiorespiratory endurance for children with disabilities was examined using an A-B study design. Sixteen children (11 males, five females) age range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice-per-week program lasting 14 weeks. The children's diagnoses included autism spectrum disorder, myelomeningocele, cerebral palsy, or other developmental disability. More than half of the children ambulated independently without aids. Children swam laps and participated in relay races and games with a focus of maintaining a defined target heart rate zone. The strengthening component consisted of exercises using bar bells, aquatic noodles, and water resistance. The following outcomes were measured: half-mile walk/run, isometric muscle strength, timed floor to stand 3-meter test, and motor skills. Complaints of pain or injury were systematically collected. Significant improvements in the half-mile walk/run were observed, but not for secondary outcomes of strength or motor skills. The mean program attendance was 80%, and no injury was reported. Children with disabilities may improve their cardiorespiratory endurance after a group aquatic aerobic exercise program with a high adult:child ratio and specific goals to maintain training heart rates.

Objective 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.

Retrospective descriptive analysis. The purpose of this study was to report the functional ability of children with spinal cord injury (SCI) as recorded on motor items of the functional independence measure (FIM) and to examine the factors associated with FIM motor admission and post-discharge gain scores. Scores on FIM motor items were analyzed from 941 children (age range: 0–21 years; mean: 13 years 4 months; s.d.: 4 years 8 months) admitted in acute-to-chronic time periods post-SCI to Shriners Hospitals for Children (USA). FIM motor scores at admission and gains at discharge were examined along with neurological level, completeness of injury, age, etiology of injury, and length of time between injury and admission and admission and discharge. The FIM motor scores at admission were negatively correlated with age, neurological level and completeness of injury. Gain in FIM motor scores was significant across neurological levels, and was associated with lower admission FIM motor scores, lower neurological level, incomplete injury, traumatic injury and less time between injury and admission. The motor function of children after pediatric SCI depends on neurological level and completeness of injury, among other factors. FIM motor scores can improve with intervention even several years after the injury.

Coster WJ, Haley SM, Ni P, Dumas HM, Fragala-Pinkham MA. Assessing self-care and social function using a computer adaptive testing version of the Pediatric Evaluation of Disability Inventory. Objective To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. Design Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. Setting Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children's homes. Participants Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). Interventions Not applicable. Main Outcome Measures Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden. Results Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration ( r range, .94–.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales. Conclusions Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time.

Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test.Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items.Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains.Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.

Background and PurposeThe purpose of this study was to prospectively evaluate the practical and psychometric adequacy of the Activity Measure for Post-Acute Care (AM-PAC) “item bank” and computerized adaptive testing (CAT) assessment platform (AM-PAC-CAT) when applied within orthopedic outpatient physical therapy settings.MethodThis was a prospective study with a convenience sample of 1,815 patients with spine, lower-extremity, or upper-extremity impairments who received outpatient physical therapy in 1 of 20 outpatient clinics across 5 states. The authors conducted an evaluation of the number of items used and amount of time needed to complete the CAT assessment; evaluation of breadth of content coverage, item exposure rate, and test precision; as well as an assessment of the validity and sensitivity to change of the score estimates.ResultsOverall, the AM-PAC-CAT's Basic Mobility scale demonstrated excellent psychometric properties while the Daily Activity scale demonstrated less adequate psychometric properties when applied in this outpatient sample. The mean length of time to complete the Basic Mobility scale was 1.9 minutes, using, on average, 6.6 items per CAT session, and the mean length of time to complete the Daily Activity scale was 1.01 minutes, using on average, 6.8 items.Background and ConclusionOverall, the findings are encouraging, yet they do reveal several areas where the AM-PAC-CAT scales can be improved to best suit the needs of patients who are receiving outpatient orthopedic physical therapy of the type included in this study.

A consecutive series of 106 children and adolescents (mean age 10 years, 6 months; SD 4 years, 8 months) with recent traumatic brain injury admitted to a regional hospital-based rehabilitation program was assessed to determine the rate of walking recovery, and characteristics that distinguish between independent walkers, non-walkers, and device-assisted walkers at hospital discharge. Data were collected through a retrospective medical record review of patients admitted between 1994 and 2001. Mean hospital stays were 66.7 days (SD 88.5, range 7 to 140 days). All children (72 male, 34 female) had recent injuries (from 1 to 8 weeks after onset of traumatic brain injury) and were independent walkers before injury. Sixty-four children (60.4%) were discharged as independent walkers, 13 (12.3%) walked with the assistance of a device, and 29 (27.3%) were non-walkers. Non-walkers had a higher proportion of prolonged loss of consciousness, lower-extremity injury, impaired responsiveness, and lower-extremity spasticity than independent walkers. In addition, non-walkers had poorer discharge mobility and social function scores, longer average hospital stays, and a greater proportion of non-community discharges. Device-only walkers were older, more likely to be male, and had a higher proportion of lower-extremity injuries than independent walkers. Results highlight several demographic, clinical, and outcome variables that distinguish independent walkers from device-assisted walkers and non-walkers. These variables might help to determine the prognosis for ambulation, resource needs, and discharge plans for children and adolescents with traumatic brain injury after episodes of inpatient rehabilitation.

The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self-care and mobility domains) of children and adolescents using computer-adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child's ability level, based on previous responses. Using a CAT algorithm, a simulation study was used to determine the number of items necessary to approximate the score of a full-length assessment. We built simulated CAT (5-, 10-, 15-, and 20-item versions) for self-care and mobility domains and tested their accuracy in a normative sample (n=373; 190 males, 183 females; mean age 6y 11mo [SD 4y 2m], range 4mo to 14y 11mo) and a sample of children and adolescents with Pompe disease (n=26; 21 males, 5 females; mean age 6y 1mo [SD 3y 10mo], range 5mo to 14y 10mo). Results indicated that comparable score estimates (based on computer simulations) to the full-length tests can be achieved in a 20-item CAT version for all age ranges and for normative and clinical samples. No more than 13 to 16% of the items in the full-length tests were needed for any one administration. These results support further consideration of using CAT programs for accurate and efficient clinical assessments of physical functioning.

The purpose of this article is threefold: (1) to describe the development, reliability, and validity of a revised physical performance measure for individuals with mucopolysaccharidosis type I (MPS I); (2) to standardize the test on a normal sample; and (3) to compare results from a selected sample of individuals with MPS I with age-based centiles. The MPS Physical Performance Measure (MPS-PPM) is composed of eight timed functional tasks (FT-8) and two endurance tasks with a modified Energy Expenditure Index for comfortable walking (CW) and fast walking (FW) speeds. Age norms were derived from a convenience sample of 150 typically developing children and adolescents (75 males, 75 females; mean age 11y 2mo [SD 4y 5mo]; range 5-22y). Using a Rasch model for speed tests and confirmatory factor analysis, we established the unidimensionality of the FT-8. Interrater reliability of the FT-8 (intraclass correlation [ICC]=0.98) and test-retest reliability of the FT-8 (ICC=0.96), CW (ICC=0.91), and FW (ICC=0.83) were good. Results of the age-based profiles in 10 individuals with MPS I (five males, five females; mean age 14y 2mo [SD 7y 6mo]; range 6-29y) indicate that the amount of time needed to perform functional tasks is severely affected by the disease, and most individuals were at or below the fifth centile for their age. The patterns of limitations in endurance were more varied. These results suggest the utility of using this revised MPS-PPM to identify the extent of limitation in age-expected physical performance. Implications for using the MPS-PPM for monitoring physical performance changes during clinical interventions are discussed.

OBJECTIVE With the increased use of standardized outcome instruments in rehabilitation, questions frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments. This article uses examples drawn from the Activity Measure for Post Acute Care to illustrate 4 different data analysis and presentation strategies that can be used to yield meaningful outcome data for use in rehabilitation research and practice. DESIGN A prospective cohort study in patients recruited at the point of discharge from a large acute care hospital or on admission to 1 of 2 rehabilitation hospitals after discharge from an acute care hospital in the greater Boston, MA region. SAMPLE A total of 516 subjects in the Rehabilitation Outcome Study. RESULTS Four distinct approaches to analyzing and reporting outcome data are described to derive more meaningful outcome measurements: interpreting a single scale score; interpreting clinical significance of score changes; a percentile ranking method; and a functional staging approach. The first 3 methods focus on interpreting the numeric property of individual measurements and are best suited to assess individual outcomes and for detecting change. The fourth, a functional staging approach, provides an attractive feature of interpreting the clinical meaning provided by a particular quantitative score without sacrificing the inherent value of a quantitative scale for tracking change over time. CONCLUSION Users are encouraged to consider the range of analysis and presentation strategies available to them to evaluate a standardized scale score, both from a quantitative and a content perspective.

Background The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide patient-reported outcome measures that are designed as being universally relevant across health conditions, low burden, and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS, the research questions for this study were "How do PROMIS pediatric computer adaptive tests and short forms detect change in children with CP following elective musculoskeletal surgery?" and "How do PROMIS instruments compare to the Pediatric Quality of Life Inventory Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG), and the Gross Motor Functional Measure (GMFM)." Methods PROMIS Pediatric computer adaptive tests and short forms and the PedsQL, PODCI, TUG, and GMFM were administered before and after surgery. Effect size (ES) and standardized response mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS item banks were examined. Results ES and SRM for all PROMIS Pediatric Measures were nonsignificant. PedsQL CP detected significant, positive change in mobility at 6 (ES=0.26; SRM=0.31) and 12 (ES=0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES=-0.20; SRM=-0.26), GMFM (ES=-0.13; SRM=-0.24), and TUG (ES=-0.29; SRM=-0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS Mobility item bank was limited. Conclusions PROMIS measures were less able to detect change than other measures. PROMIS measures may be improved by tailoring start/stop rules or by adding items to include content appropriate for children with mobility impairments. Level of evidence Level III-diagnostic study.

To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital.Cohort study.Postacute care.Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age +/- standard deviation of participants was 68+/-14 years; 49% were women and 92% were white.Not applicable.Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care.Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers (P.01) was associated with less social and home participation; whereas greater community mobility barriers (P.01) and more social support (P.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates.This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term.

Haley SM, Ni P, Coster WJ, Black-Schaffer R, Siebens H, Tao W: Agreement in functional assessment: graphic approaches to displaying respondent effects. Am J Phys Med Rehabil 2006;85:747–755. The objective of this study was to examine the agreement between respondents of summary scores from items representing three functional content areas (physical and mobility, personal care and instrumental, applied cognition) within the Activity Measure for Postacute Care (AM-PAC). We compare proxy vs. patient report in both hospital and community settings as represented by intraclass correlation coefficients and two graphic approaches. The authors conducted a prospective, cohort study of a convenience sample of adults (n = 47) receiving rehabilitation services either in hospital (n = 31) or community (n = 16) settings. In addition to using intraclass correlation coefficients (ICC) as indices of agreement, we applied two graphic approaches to serve as complements to help interpret the direction and magnitude of respondent disagreements. We created a “mountain plot” based on a cumulative distribution curve and a “survival-agreement plot” with step functions used in the analysis of survival data. ICCs on summary scores between patient and proxy report were physical and mobility ICC = 0.92, personal care and instrumental ICC = 0.93, and applied cognition ICC = 0.77. Although combined respondent agreement was acceptable, graphic approaches helped interpret differences in separate analyses of clinician and family agreement. Graphic analyses allow for a simple interpretation of agreement data and may be useful in determining the meaningfulness of the amount and direction of interrespondent variation.

Haley SM, Ni P, Ludlow LH, Fragala-Pinkham MA. Measurement precision and efficiency of multidimensional computer adaptive testing of physical functioning using the Pediatric Evaluation of Disability Inventory. Objective To compare the measurement efficiency and precision of a multidimensional computer adaptive testing (M-CAT) application to a unidimensional CAT (U-CAT) comparison using item bank data from 2 of the functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). Design Using existing PEDI mobility and self-care item banks, we compared the stability of item calibrations and model fit between unidimensional and multidimensional Rasch models and compared the efficiency and precision of the U-CAT– and M-CAT–simulated assessments to a random draw of items. Setting Pediatric rehabilitation hospital and clinics. Participants Clinical and normative samples. Interventions Not applicable. Main Outcome Measures Not applicable. Results The M-CAT had greater levels of precision and efficiency than the separate mobility and self-care U-CAT versions when using a similar number of items for each PEDI subdomain. Equivalent estimation of mobility and self-care scores can be achieved with a 25% to 40% item reduction with the M-CAT compared with the U-CAT. Conclusions M-CAT applications appear to have both precision and efficiency advantages compared with separate U-CAT assessments when content subdomains have a high correlation. Practitioners may also realize interpretive advantages of reporting test score information for each subdomain when separate clinical inferences are desired.

Objective To examine the sensitivity of the Short Form Activity Measure for Post-Acute Care (AM-PAC) in comparison to the Functional Independence Measure (FIM) across a 12-month period after discharge from rehabilitation hospital. Design Prospective longitudinal study. Patients were recruited while receiving inpatient services from facilities in the north-east USA and interviewed 1, 6 and 12 months thereafter. Patients Convenience sample of 516 patients at baseline (65% retention at the final follow-up) receiving rehabilitation services for neurological, lower extremity orthopedic, or complex medical conditions. Mean age 68.3 years; 47% male. Main outcome measures AM-PAC Physical and Movement, Personal Care and Instrumental, and Applied Cognitive Activity scales; FIM Motor and Cognitive scales. Results All 3 AM-PAC scales were sensitive to both positive and negative change across the follow-up period. Standardized response means for the AM-PAC were consistently larger than for the FIM across patient and severity groups. A greater percentage of patients showed positive change that exceeded the minimal detectable change on the AM-PAC than on the FIM both 6- and 12-month follow-ups. Conclusion The short-form AM-PAC scales are more sensitive measures of change in functional activity performance over time in the general population of persons who receive inpatient rehabilitation services compared to the FIM. Thus, the AM-PAC offers a short, comprehensive, and sensitive measure of positive and/or negative change in patients' ability to perform important activities of daily life.

Suspended particulate matter (SPM) is a key component regulating the biogeochemistry of natural and contaminant moieties in estuaries. Individual particle analyses can complement conventional bulk analyses of SPM, but are rarely undertaken. This study used scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS) of particles to quantify a range of elements in the reference estuarine sediment PACS-2. This approach was compared with a bulk SPM analysis based on inductively coupled plasma-atomic emission spectrometry (ICP-AES). The median concentrations of Al, Fe, Mg, and Ca for the two approaches were similar, and accuracy for both methods was good. SEM-EDS analysis was also satisfactory for K. Agreement was poorer for Mn and Ti, which were present at trace concentrations. Increasing the number of particles examined by SEM-EDS should improve the analysis. SEM-EDS analysis of SPM from the Tamar Estuary, UK, revealed marked geochemical differences between particle sub-populations.

Over the past decade, the methods and science used to describe changes in outcomes of physical therapy services have become more refined. Recently, emphasis has been placed not only on changes beyond expected measurement error, but also on the identification of changes that make a real difference in the lives of patients and families. This article will highlight a case example of how to determine and interpret “clinically significant change” from both of these perspectives. The authors also examine how to use item maps within an item response theory model to enhance the interpretation of change at a content level. Recommendations are provided for physical therapists who are interpreting changes in the context of clinical practice, case reports, and intervention research. These recommendations include a greater application of indexes that help interpret the meaning of clinically significant change to multiple clinical, research, consumer, and payer communities.

Purpose This study examined the feasibility, safety, and effectiveness of a community-based group fitness program for children with disabilities. Methods Twenty-eight children with neuromuscular and developmental disabilities, 6 to 14 years of age, participated. The 16-week community-based program, held twice weekly, consisted of strengthening, aerobic conditioning, and flexibility exercises. A pretest-posttest design was used, and the following outcomes were measured: isometric muscle strength of the knee extensors, hip abductors, and ankle plantarflexors, walking energy expenditure, functional mobility, and fitness. Falls and injury data also were collected. Results Mean program attendance was 75.3%, and no injuries were reported. Improvements in all clinical outcomes were observed. The most clinically meaningful improvement was in functional mobility with a large effect size (0.87). Conclusions Physical therapists partnering with community centers may feasibly and safely shift group fitness programs for school-aged children with disabilities from the medical setting to the community.

To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities.Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented.No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar.Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

Jette AM, Keysor J, Coster W, Ni P, Haley S. Beyond function: predicting participation in a rehabilitation cohort. Objectives To monitor participation in a rehabilitation cohort and to identify determinants of change during a 12-month period posthospitalization following the onset of one of several major disabling conditions. Design Cohort study. Setting Postacute care rehabilitation settings. Participants Adults (N=435) aged 18 years and older with complex medical, lower-extremity orthopedic, and major neurologic impairments. Interventions Not applicable. Main Outcome Measures At 1-, 6-, and 12-month follow-ups, community participation and social and home participation were assessed by personal interviews using the Participation Measure for Post-Acute Care. Information on potential determinants was abstracted from the medical chart and by personal interview using standardized instruments. Results On average, rehabilitation patients achieved modest improvements in their levels of community participation during the first 6 months after acute hospitalization. In contrast, these same patients displayed a modest loss in social and home participation levels during the follow-up period. Activity limitations were the dominant factors that explained much of the variance in the extent of community participation achieved by patients. Personal and social environmental factors played a major role in predicting levels of social and home participation. Conclusions The focus of rehabilitation interventions aimed at achieving posthospital participation requires careful consideration of the specific domain of participation that is being targeted.

Background and Purpose. This case report describes a fitness program for children with disabilities and provides preliminary information about the safety and feasibility of the program. Case Description. Nine children, 5 to 9 years of age with physical or other developmental disabilities, participated in a 14-week group exercise program held 2 times per week followed by a 12-week home exercise program. Energy expenditure index, leg strength (force-generating capacity of muscle), functional skills, fitness, self-perception, and safety were measured before intervention, after the group exercise program, and again after the home exercise program. Outcomes. No injuries occurred, and improvements in many of the outcome measures were observed. More improvements were observed after the group exercise program than after the home program, and adherence was better during the group exercise program. Discussion. This case report demonstrates that a group exercise program of strength and endurance training may be a safe and feasible option for children with disabilities. Further research is needed to evaluate the effectiveness of a group fitness program and optimal training parameters.

We reviewed the cases of 11 children

To describe the percentage of children with central auditory processing disorders (CAPD) and examine the recovery patterns of social functional skills in children with and without CAPD admitted to inpatient rehabilitation following an acquired brain injury (ABI).Retrospective, descriptive.Repeated measures ANOVAs were used to examine overall differences in social functioning between groups, within groups and interaction effects for the Paediatric Evaluation of Disability Inventory (PEDI) Social Functional Skills and Caregiver Assistance scales for 31 children admitted to inpatient rehabilitation following ABI.Significant overall effects were found in group differences and test occasions, but no significant interaction for either PEDI scale. Both groups showed significant intra-group changes between admission and discharge on both scales.Children with and without CAPD recovered social functional skills during inpatient rehabilitation. Children with CAPD were admitted and discharged with lower Social Function scores but demonstrated greater changes. The identification of CAPD during inpatient rehabilitation allows for appropriate discharge recommendations and realistic recovery expectations.

Objectives: To assess the concurrent and predictive validity of the Late-Life Function and Disability Instrument (LLFDI). Design: Cross-sectional. Setting: University-based human physiology laboratory. Participants: One hundred one men and women aged 80.8±0.4. Measurements: A short physical performance battery (SPPB) and a self-paced 400-m walk (400-m W) were used as performance tests of lower extremity function. The LLFDI was used to assess self-reported function and physical disability. Partial correlations adjusted for age and body mass index were used to determine the concurrent and predictive validity of the LLFDI. Statistical significance was accepted at P

Haley SM, Andres PL, Coster WJ, Kosinski M, Ni P, Jette AM. Short-form Activity Measure for Post-Acute Care. Arch Phys Med Rehabil 2004;85:649–660. Objective To develop a comprehensive set of short forms using item response theory (IRT) and item pooling procedures for the purpose of monitoring postacute care functional recovery. Design Prospective study. Setting Six postacute health care networks in the greater Boston area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. Participants A convenience sample of 485 adult volunteers who were currently receiving skilled rehabilitation services. Interventions Not applicable. Main outcome measures We developed a set of 6 short forms across 3 activity domains from new items and items from existing postacute care instruments. Results Inpatient- and community-based short forms were developed for each of 3 activity domains: physical & movement, applied cognition, and personal care & instrumental. Items were selected for inclusion on the short forms to maximize content coverage and information value of items across the range of content and to minimize ceiling and floor effects. We were able to match the distribution of sample scores with very good item precision for 1 of the constructs (physical & movement); the other 2 domains (personal care & instrumental, applied cognition) were more challenging because of the variability in patient recovery and ceiling effects. Conclusions ITR methods and item pooling procedures were valuable in developing paired sets of short-form instruments for inpatient and community rehabilitation that provided estimates of functioning along a common metric for use across postacute care settings.

Current functional assessment instruments in stroke rehabilitation are often setting-specific and lack precision, breadth, and/or feasibility. Computer adaptive testing (CAT) offers a promising potential solution by providing a quick, yet precise, measure of function that can be used across a broad range of patient abilities and in multiple settings. CAT technology yields a precise score by selecting very few relevant items from a large and diverse item pool based on each individual’s responses. We demonstrate the potential usefulness of a CAT assessment model with a cross-sectional sample of persons with stroke from multiple rehabilitation settings.