Computerized Adaptive Testing System of Functional Assessment of Stroke

Summary

Here, we present a protocol to develop the computerized adaptive testing system of the functional assessment of stroke (CAT-FAS). The CAT-FAS can simultaneously assess four functions (two motor functions [upper and lower extremities], postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency.

Abstract

The computerized adaptive testing system of the functional assessment of stroke (CAT-FAS) can simultaneously assess four functions (motor functions of the upper and lower extremities, postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency. CAT, a modern measurement method, aims to provide a reliable estimate of the examinee's level of function rapidly. CAT administers only a few items whose item difficulties match an examinee's level of function and, thus, the administered items of CAT can provide sufficient information to reliably estimate the examinee's level of function in a short time. The CAT-FAS was developed through four steps: (1) determining the item bank, (2) determining the stopping rules, (3) validating the CAT-FAS, and (4) establishing a platform of online administration. The results of this study indicate that the CAT-FAS has sufficient administrative efficiency (average number of items = 8.5) and reliability (group-level Rasch reliability: 0.88 - 0.93; individual-level Rasch reliability: ≥70% of patients had Rasch reliability score ≥0.90) to simultaneously assess four functions in patients with stroke. In addition, because the CAT-FAS is a computer-based test, the CAT-FAS has three additional advantages: the automatic calculation of scores, the immediate storage of data, and the easy exporting of data. These advantages of the CAT-FAS will be beneficial to data management for clinicians and researchers.

Introduction

Dysfunctions of the upper and lower extremities (UE and LE), postural control, and basic activities of daily living (BADL) are major sequelae of stroke^1,2,3. The assessment of these four functions in patients with stroke is fundamental for clinicians to evaluate patients' levels of dysfunctions, set treatment goals and plans, and monitor the longitudinal trajectories of these functions.

The Fugl-Meyer Assessment (FM),⁴ the Postural Assessment Scale for Stroke patients (PASS),⁵ and the Barthel Index (B....

Protocol

This study protocol was approved by a local institutional review board, and all patients gave informed consent.

1. Development of the CAT-FAS

1. Retrieve the secondary and encrypted data from the FAS study¹⁴ to conduct simulations (Supplementary File 1: Appendix 2).
   NOTE: In the study, a total of 301 patients were recruited froma rehabilitation ward of a medical center and assessed at 14 d after stroke onset. Among the 301 patients, 262 patients were repeatedly assessed at 30 d after stroke onset. The study recruited patients who had (1) a diagnosis of stroke, (2) first onset of strok....

Results

The results of the simulation showed that the 10 candidate sets of stopping rules had sufficient average Rasch reliability (0.86 - 0.95) and varied administrative efficiency (the average number of items = 6.4 - 17.5). Considering the trade-off between reliability and administrative efficiency, the set of LRI < 0.010 was selected as the optimal set of stopping rules for the CAT-FAS because of its sufficient average Rasch reliability (0.88 - 0.93, see Table 1

Discussion

The results presented here showed that the CAT-FAS administered about 10% of the items in the original tests (the average number of items used in the CAT-FAS: 8.5 items vs. the original tests: 72 items). These findings indicate that the CAT-FAS has good administrative efficiency. The results were in line with previous studies, which reported that a CAT administered only about 10 items or less to assess social function, balance, or activities of daily living in patients with stroke^10,.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Computer	Any		Compatible with software listed below
MATLAB software	The MathWorks Inc.	http://www.mathworks.com/products/matlab/	Numerical computing software, which is used in the Protocol Section 1 (Step 1.3)
Java Development Kit	Oracle	https://www.oracle.com/java/	Programming language, which is used in the Protocol Section 1 (Step 1.5)