Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing

James F. Fries, David Cella, Matthias Rose, Eswar Krishnan, Bonnie Bruce

Research output: Contribution to journalArticlepeer-review

163 Scopus citations

Abstract

Objective. Assessing self-reported physical function/disability with the Health Assessment Questionnaire Disability Index (HAQ) and other instruments has become central in arthritis research. Item response theory (IRT) and computerized adaptive testing (CAT) techniques can increase reliability and statistical power. IRT-based instruments can improve measurement precision substantially over a wider range of disease severity. These modern methods were applied and the magnitude of improvement was estimated. Methods. A 199-item physical function/disability item bank was developed by distilling 1865 items to 124, including Legacy Health Assessment Questionnaire (HAQ) and Physical Function-10 items, and improving precision through qualitative and quantitative evaluation in over 21,000 subjects, which included about 1500 patients with rheumatoid arthritis and osteoarthritis. Four new instruments, (A) Patient-Reported Outcomes Measurement Information (PROMIS) HAQ, which evolved from the original (Legacy) HAQ; (B) "best" PROMIS 10; (C) 20-item static (short) forms; and (D) simulated PROMIS CAT, which sequentially selected the most informative item, were compared with the HAQ. Results. Online and mailed administration modes yielded similar item and domain scores. The HAQ and PROMIS HAQ 20-item scales yielded greater information content versus other scales in patients with more severe disease. The "best" PROMIS 20-item scale outperformed the other 20-item static forms over a broad range of 4 standard deviations. The 10-item simulated PROMIS CAT outperformed all other forms. Conclusion. Improved items and instruments yielded better information. The PROMIS HAQ is currently available and considered validated. The new PROMIS short forms, after validation, are likely to represent further improvement. CAT-based physical function/disability assessment offers superior performance over static forms of equal length. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)2061-2066
Number of pages6
JournalJournal of Rheumatology
Volume36
Issue number9
DOIs
StatePublished - Sep 2009

Keywords

  • Computerized adaptive testing
  • Health Assessment Questionnaire Disability Index
  • Item response theory
  • PROMIS

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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