Working mechanism of a multidimensional computerized adaptive test for fatigue in rheumatoid arthritis

Health and Quality of Life Outcomes

Mart AFJ van de Laar⁴  Cees AW Glas³  Harald E Vonkeman⁴  Erik Taal²  Christina Bode²  Stephanie Nikolaus¹ 

[1] Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands;Department of Psychology, Health and Technology, University of Twente, Enschede, 7500 AE, The Netherlands;Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, 7500 AE, The Netherlands;Medical Spectrum Twente, Department of Rheumatology and Clinical Immunology, Enschede, 7500 KA, The Netherlands

关键词: Rheumatoid arthritis;    Item selection;    Multidimensional computerized adaptive test;    Fatigue;    Multidimensional item response theory;   

Others  :  1133801
DOI  :  10.1186/s12955-015-0215-7

 received in 2014-06-12, accepted in 2015-01-24,  发布年份 2015

【 摘 要 】

Background

This paper demonstrates the mechanism of a multidimensional computerized adaptive test (CAT) to measure fatigue in patients with rheumatoid arthritis (RA). A CAT can be used to precisely measure patient-reported outcomes at an individual level as items are consequentially selected based on the patient’s previous answers. The item bank of the CAT Fatigue RA has been developed from the patients’ perspective and consists of 196 items pertaining to three fatigue dimensions: severity, impact and variability of fatigue.

Methods

The CAT Fatigue RA was completed by fifteen patients. To test the CAT’s working mechanism, we applied the flowchart-check-method. The adaptive item selection procedure for each patient was checked by the researchers. The estimated fatigue levels and the measurement precision per dimension were illustrated with the selected items, answers and flowcharts.

Results

The CAT Fatigue RA selected all items in a logical sequence and those items were selected which provided the most information about the patient’s individual fatigue. Flowcharts further illustrated that the CAT reached a satisfactory measurement precision, with less than 20 items, on the dimensions severity and impact and to somewhat lesser extent also for the dimension variability. Patients’ fatigue scores varied across the three dimensions; sometimes severity scored highest, other times impact or variability. The CAT’s ability to display different fatigue experiences can improve communication in daily clinical practice, guide interventions, and facilitate research into possible predictors of fatigue.

Conclusions

The results indicate that the CAT Fatigue RA measures precise and comprehensive. Once it is examined in more detail in a consecutive, elaborate validation study, the CAT will be available for implementation in daily clinical practice and for research purposes.

【 授权许可】

   
2015 Nikolaus et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, et al.: Patients’ perceptions of fatigue in rheumatoid arthritis: Overwhelming, uncontrollable, ignored. Arthritis Care Res 2005, 53:697-702.
• [2]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, et al.: 2010 Rheumatoid Arthritis Classification Criteria - An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis Rheum 2010, 62(9):2569-81.
• [3]Belza Tack B: Fatigue in rheumatoid arthritis. Conditions, strategies, and consequences. Arthritis Care Res 1990, 3:65-70.
• [4]Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T: Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud 2008, 45:995-1002.
• [5]Nikolaus S, Bode C, Taal E, van de Laar MAFJ: New insights into the experience of fatigue among patients with rheumatoid arthritis: a qualitative study. Ann Rheum Dis 2010, 69:895-7.
• [6]Dittner AJ, Wessely SC, Brown RG: The assessment of fatigue. A practical guide for clinicians and researchers. J Psychosom Res 2004, 56:157-70.
• [7]Hewlett S, Dures E, Almeida C: Measures of fatigue. Arthritis Care Res 2011, 63:S263-86.
• [8]Hambleton RK, Swaminathan H, Rogers HJ: Fundamentals of Item response theory. Sage, Thousand Oaks; 1991.
• [9]Walter OB: Adaptive tests for measuring anxiety and depression. In Elements of adaptive testing. Edited by Linden WJ, Glas CAW. Springer, New York; 2010:123-36.
• [10]Norweg A, Ni P, Garshick E, O’Connor G, Wilke K, Jette AM: A multidimensional computer adaptive test approach to dyspnea assessment. Arch Phys Med Rehabil 2011, 92:1561-9.
• [11]Petersen MA, Groenvold M, Aaronson N, Fayers P, Sprangers M, Bjorner JB: Multidimensional computerized adaptive testing of the EORTC QLQ-C30: basic developments and evaluations. Qual Life Res 2006, 15:315-29.
• [12]Cella D, Lai J-S, Stone A: Self-reported fatigue: one dimension or more? Lessons from the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire. Support Care Canc 2011, 19:1441-50.
• [13]Nicklin J, Cramp F, Kirwan J, Greenwood R, Urban M, Hewlett S: Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional questionnaire, visual analogue scales, and numerical rating scales. Arthritis Care Res 2010, 62:1559-68.
• [14]Reeve BB, Fayers P: Applying item response theory modelling for evaluating questionnaire item and scale properties. In Assessing quality of life in clinical trials: Methods and practice. Edited by Fayers PM, Hays RD. Oxford University Press, Oxford; 2005:55-73.
• [15]Segall DO: Principles of Multidimensional Adaptive Testing. In Elements of adaptive testing. Edited by Linden WJ, Glas CAW. Springer, New York; 2010:57-75.
• [16]Nikolaus S, Bode C, Taal E, Oostveen JCM, Glas CAW, van de Laar MAFJ: Items and dimensions for the construction of a multidimensional computerized adaptive test to measure fatigue in patients with rheumatoid arthritis. J Clin Epidemiol 2013, 66:1175-83.
• [17]Nikolaus S, Bode C, Taal E, van de Laar MAFJ: Four different patterns of fatigue in rheumatoid arthritis patients: results of a Q-sort study. Rheumatology 2010, 49(11):2191-9.
• [18]Nikolaus S, Bode C, Taal E, van de Laar MAFJ: Selection of items for a computer-adaptive test to measure fatigue in patients with rheumatoid arthritis – A Delphi approach. Qual Life Res 2012, 21(5):863-72.
• [19]Nikolaus S, Bode C, Taal E, van de Laar MAFJ: Which dimensions of fatigue should be measured in patients with rheumatoid arthritis? – A Delphi study. Musculoskel Care 2012, 10(1):13-7.
• [20]Nikolaus S, Bode C, Taal E, van de Laar MAFJ: Experts’ evaluations of fatigue questionnaires used in rheumatoid arthritis – A Delphi study among patients, nurses and rheumatologists in the Netherlands. Clin Exp Rheumatol 2012, 30(1):79-84.
• [21]Wainer H, Dorans NJ, Flaugher R, Green BF, Mislevy RJ, Steinberg L, et al.: Computerized adaptive testing: A primer. Lawrence Erlbaum Associates, Hillsdale NJ; 1990.
• [22]Fliege H, Becker J, Walter OB, Rose M, Bjorner JB, Klapp BF: Evaluation of a computer-adaptive test for the assessment of depression (D-CAT) in clinical application. Int J Methods Psychiatr Res 2009, 18(1):23-36.
• [23]Kocalevent RD, Rose M, Becker J, Walter OB, Fliege H, Bjorner JB, et al.: An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception. J Clin Epidemiol 2009, 62:278-87.
• [24]Fayers PM, Machin D: Multi-item scales. In Quality of life—assessment, analysis and interpretation. Edited by Fayers PM, Machin D. Wiley, Chichester; 2000:72-89.