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Creating a Computer Adaptive Test Version of the Late-Life Function and Disability Instrument

¹ Health & Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts.
² CREcare, LLC, Boston, Massachusetts.

Address correspondence to Alan M. Jette, PhD, PT, Health & Disability Research Institute, Boston University School of Public Health, 580 Harrison Ave., 2nd Floor, Boston, MA 02118. E-mail: ajette{at}bu.edu

Background. This study applied item response theory (IRT) and computer adaptive testing (CAT) methodologies to develop a prototype function and disability assessment instrument for use in aging research. Herein, we report on the development of the CAT version of the Late-Life Function and Disability Instrument (Late-Life FDI) and evaluate its psychometric properties.

Methods. We used confirmatory factor analysis, IRT methods, validation, and computer simulation analyses of data collected from 671 older adults residing in residential care facilities. We compared accuracy, precision, and sensitivity to change of scores from CAT versions of two Late-Life FDI scales with scores from the fixed-form instrument. Score estimates from the prototype CAT versus the original instrument were compared in a sample of 40 older adults.

Results. Distinct function and disability domains were identified within the Late-Life FDI item bank and used to construct two prototype CAT scales. Using retrospective data, scores from computer simulations of the prototype CAT scales were highly correlated with scores from the original instrument. The results of computer simulation, accuracy, precision, and sensitivity to change of the CATs closely approximated those of the fixed-form scales, especially for the 10- or 15-item CAT versions. In the prospective study, each CAT was administered in <3 minutes and CAT scores were highly correlated with scores generated from the original instrument.

Conclusions. CAT scores of the Late-Life FDI were highly comparable to those obtained from the full-length instrument with a small loss in accuracy, precision, and sensitivity to change.

Key Words: Outcome assessment (Health Care) • Geriatrics • Rehabilitation