Computerized Adaptive Testing in Pediatric Brain Tumor Clinics

Jin Shei Lai*, Jennifer L. Beaumont, Cindy J. Nowinski, David Cella, William F. Hartsell, John Han-Chih Chang, Peter E. Manley, Stewart Goldman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Context Monitoring of health-related quality of life and symptoms of patients with brain tumors is needed yet not always feasible. This is partially due to lack of brief-yet-precise assessments with minimal administration burden that are easily incorporated into clinics. Dynamic computerized adaptive testing (CAT) or static fixed-length short forms, derived from psychometrically sound item banks, are designed to fill this void. Objective This study evaluated the comparability of scores obtained from CATs and short forms. Methods Patients (ages 7–22 years) were recruited from brain tumor clinics and completed Patient-Reported Outcome Measurement Information System CATs and short forms (Fatigue, Mobility, Upper Extremity, Depressive Symptoms, Anxiety, and Peer Relationships). Pearson correlations, paired t-tests, and Cohen's d were used to evaluate the relationship, significant differences, and the magnitude of the difference between these two scores, respectively. Results Data from 161 patients with brain tumors were analyzed. Patients completed each CAT within 2 minutes. Scores obtained from CATs and short forms were highly correlated (r = 0.95–0.98). Significantly different CAT vs. short-form scores were found on 4 (of 6) domains yet with negligible effect sizes (|d| < 0.09). These relationships varied across patients with different levels of reported symptoms, with the strongest association at the worst or best symptom scores. Conclusions This study demonstrated the comparability of scores from CATs and short forms. Yet the agreement between these two varied across degrees of symptom severity which was a result of the ceiling effects of static short forms. We recommend CATs to enable individualized assessment for longitudinal monitoring.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - Sep 2017


  • Children
  • brain tumor
  • computerized adaptive testing (CAT)
  • patient-centered outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Nursing(all)


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