Article

An efficient and precise measure of balance is needed to improve
administration efficiency and to reduce the assessment burden for patients. The purpose of this study was to develop a computerized adaptive
testing (CAT) system for assessing balance function in an efficient, reliable,
and valid fashion in patients with stroke. DESIGN: Two cross-sectional
prospective studies were conducted. SETTING:
This study was conducted in the
departments of physical medicine and rehabilitation in 6 hospitals. PATIENTS: The
participants were inpatients and outpatients who were receiving rehabilitation.
MEASUREMENTS: A balance item pool (41 items) was developed on the basis of
predefined balance concepts, expert opinions, and field testing. The items were
administered by 5 raters to 764 patients. An item response theory model was fit
to the data, and the item parameters were estimated. A simulation study was used
to determine the performance (eg, reliability, efficiency) of the Balance CAT.
The Balance CAT and the Berg Balance Scale (BBS) then were tested on another
independent sample of 56 patients to determine the concurrent validity and time
needed for administration. RESULTS: Seven items did not meet the model's
expectations and were excluded from further analysis. The remaining 34 items
formed the item bank of the Balance CAT. Two stopping rules (ie, reliability
coefficient > 0.9 or < or = 6 items) were set for the CAT. The simulation study
showed that the patients' balance scores estimated by the CAT had an average
reliability value of .94. The scores obtained from the CAT were closely
associated with those of the full item set (Pearson r=.98). The scores of the
Balance CAT were highly correlated with those of the BBS (Pearson r=.88). The
average time needed to administer the Balance CAT (83 seconds) was only 18% of
that of the BBS. LIMITATIONS: The convenience sampling of both samples may limit
the generalization of the results. Further psychometric investigation of the
Balance CAT is needed. CONCLUSION: The results provide strong evidence that the
Balance CAT is efficient and has reliability and validity for patients with stroke.

Langue : ANGLAIS