Simulated computerized adaptive test for patients with lumbar spine impairments was efficient and produced valid measures of function

OBJECTIVE: To equate physical functioning (PF) items with Back Pain Functional Scale (BPFS) items, develop a computerized adaptive test (CAT) designed to assess lumbar spine functional status (LFS) in people with lumbar spine impairments, and compare discriminant validity of LFS measures (theta(IRT)) generated using all items analyzed with a rating scale Item Response Theory model (RSM) and measures generated using the simulated CAT (theta(CAT)). METHODS: We performed a secondary analysis of retrospective intake rehabilitation data. RESULTS: Unidimensionality and local independence of 25 BPFS and PF items were supported. Differential item functioning was negligible for levels of symptom acuity, gender, age, and surgical history. The RSM fit the data well. A lumbar spine specific CAT was developed that was 72% more efficient than using all 25 items to estimate LFS measures. theta(IRT) and theta(CAT) measures did not discriminate patients by symptom acuity, age, or gender, but discriminated patients by surgical history in similar clinically logical ways. theta(CAT) measures were as precise as theta(IRT) measures. CONCLUSION: A body part specific simulated CAT developed from an LFS item bank was efficient and produced precise measures of LFS without eroding discriminant validity.