245855 Development of an innovative informative system of Computerized Adaptive Test to assess balance function

Monday, October 31, 2011

Wen-Hsuan Hou , Department of Physical Medicine and Rehabilitation, E-Da Hospital and I-Shou University, Taiwan, Kaohsiung City, Taiwan
Ching-Lin Hsieh , School of Occupational Therapy, College of Medicine, National Taiwan University and Department of Physical Medicine and Rehabilitation, Taipei City, Taiwan
Background Poor balance function is the most common risk factors of fall in elderly, patients with stroke, or other neurological problems. Measuring balance is important to determine the severity of disease, select the most appropriate training strategy, and evaluate the outcomes for people with high risk of fall. We develop a novel tailored measure to enhance administration efficiency and to reduce the assessment burden. Objective/Purpose: The purpose of this study was to develop an internet-based computerized adaptive testing (CAT) system for assessing balance function in an efficient, reliable, valid and responsive fashion in patients with stroke. Methods: First, 764 patients were administered to fit an item response theory model and a simulation study to determine the optimal 34-items for the item bank of the Balance CAT. Second, we tested another independent sample of 85 patients to determine the psychometric properties of Balance CAT. Results: We set 2 stopping rules (i.e., reliability coefficient > 0.9 or ≤ 6 items) for the CAT (available in the website as The scores were highly correlated with those of Berg Balance Scale (BBS) (Person r = 0.88), supporting the concurrent validity. The internal responsiveness (effect size = 0.90) and predictive validity for Barthel Index (rho = 0.58 ) were satisfactory. The average time needed to administer (83 second) was only 18% of BBS. Discussion/Conclusions: Since our Balance CAT program was installed on a web-based server, only a personal computer, digital device (iPod touch), or cell phone was used to administer. We can obtain instant health status reports to improve decision making and saved the results immediately for further data banking and sharing. In conclusion, our results provide strong evidence that the performance-based Balance CAT is individualized, efficient, reliable, valid, and responsive to improve interventions for fall prevention.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
1. Development a web-based computer adaptive testing (CAT) which chooses items tailored to an individual patient and skips items apparently too easy or too hard 2. Demonstrate a performance-based HIIT flexibility adjusted for participants with different, more relevant items on the basis of userís needed at different assessment points 3. Explain the benefit of reducing burden of balance assessment to improve the implications of fall prevention in public health settings

Keywords: Health Information Systems, Technology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: oversee the assessment and organize
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.