Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.
We reviewed the literature and evaluated existing data to discuss the potential of CATs for use in ambulatory monitoring outside clinical facilities.
Computerized adaptive tests are not being used for ambulatory monitoring, but initial results from their use in health care research allow for discussion of some issues relevant to ambulatory care. Evidence shows that CATs can capture the most relevant health outcomes as well as established static tools, with substantially decreased respondent burden. They can be more precise than static tools of similar length and can reduce floor and ceiling effects. Computerized adaptive tests can reliably measure a construct over time with different items, which yields the potential of introducing item exposure control in ambulatory monitoring. Studies have shown that CATs can be at least as valid as well-designed static tools in group comparisons, but further investigation is needed to determine whether psychometric advantages lead to increased responsiveness of CATs.
Ambulatory monitoring of PROs demands short, yet very precise measurements, which can be repeated up to many times a day. Computerized adaptive tests may address several present shortcomings in ambulatory monitoring of PROs efficiently. However, most CAT developments have primarily focused on psychometric improvements. To use the full potential of CATs for ambulatory monitoring purposes, content must also be carefully considered.
= anxiety CAT
ADL = activities of daily living
CAT = computerized adaptive test
D-CAT = depression CAT
GAD-7 = Generalized Anxiety Disorder scale
ICD-10 = International Classification of Diseases 10th Edition
IRT = item response theory
ISR = ICD-10 Symptom Rating
PDA = personal digital assistant
PHQ-9 = Patient Health Questionnaire – Depression scale
PRO = patient-reported outcome
PROMIS = Patient-Reported Outcomes Measurement Information System
SF-36 = 36-Item Short Form Health Survey