Development of a computerized adaptive testing system of the Functional Assessment of Stroke

Publication date: Available online 16 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Gong-Hong Lin, Yi-Jing Huang, Shih-Chieh Lee, Sheau-Ling Huang, Ching-Lin Hsieh
ObjectiveTo develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living (BADL) with optimal efficiency and without sacrificing psychometric properties in patients with stroke.DesignSimulation study using the data from a previous study. Participants were assessed with the UE/LE subscales of the Fugl-Meyer Assessment (UE-FM/LE-FM), Postural Assessment Scale for Stroke patients (PASS), and Barthel Index (BI) at 14- and 30-day after stroke.SettingOne rehabilitation unit in a medical center.ParticipantsA total of 301 and 262 participants were assessed at 14 and 30 days after stroke, respectively.InterventionsNot applicable.Main Outcome MeasuresThe UE-FM, LE-FM, PASS, and BIResultsThe CAT-FAS adopting the optimal stopping rule (limited reliability increased < 0.010) had good Rasch reliability across the 4 domains (0.88–0.93) and needed few items for the whole administration (8.5 items on average). The concurrent validity (CAT-FAS vs. the original tests, Pearson's r = 0.91–0.95) and responsiveness (standardized response mean = 0.65–0.76) of the CAT-FAS were good in patients with stroke.ConclusionWe developed the CAT-FAS, and our results support that the CAT-FAS has sufficient efficiency, reliability, concurrent validity, and responsiveness in patients with stroke. The CAT-FAS can be used to simultaneously assess patients' functions of UE, LE, postural control, and BADL using, on average, no more than 10 items; this efficiency is very useful for reducing the assessment burdens of both clinicians and patients.



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