Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes

Objectives: To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length Surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness. Design: Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later. Setting: Follow-up interviews conducted in patient's home setting. Participants: Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions. Interventions: Not applicable. Main Outcome Measures: Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53). Results: The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass Correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53. Conclusions: Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden.