Accepted Manuscript Computer-Adaptive Balance Testing Improves Discrimination Between CommunityDwelling Elderly Fallers and Non-Fallers Poonam K. Pardasaney, ScD Pengsheng Ni, MD Mary D. Slavin, PhD Nancy K. Latham, PhD Robert C. Wagenaar, PhD Jonathan Bean, MD Alan M. Jette, PhD PII:
S0003-9993(14)00220-2
DOI:
10.1016/j.apmr.2014.03.013
Reference:
YAPMR 55783
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 22 January 2014 Revised Date:
8 March 2014
Accepted Date: 14 March 2014
Please cite this article as: Pardasaney PK, Ni P, Slavin MD, Latham NK, Wagenaar RC, Bean J, Jette AM, Computer-Adaptive Balance Testing Improves Discrimination Between Community-Dwelling Elderly Fallers and Non-Fallers, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2014), doi: 10.1016/j.apmr.2014.03.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Running head: Computer-adaptive balance testing
RI PT
COMPUTER-ADAPTIVE BALANCE TESTING IMPROVES DISCRIMINATION BETWEEN COMMUNITY-DWELLING ELDERLY FALLERS AND NON-FALLERS
M AN U
Pengsheng Ni, MD2
SC
Poonam K. Pardasaney, ScD1,2*
Mary D. Slavin, PhD2
Nancy K. Latham, PhD2
TE D
Robert C. Wagenaar, PhD3,4** Jonathan Bean, MD5
of Rehabilitation Sciences, Sargent College of Health & Rehabilitation
AC C
1Department
EP
Alan M. Jette, PhD2
Sciences, Boston University 2Health
& Disability Research Institute, School of Public Health, Boston University
3Department
of Physical Therapy and Athletic Training, Sargent College of Health &
Rehabilitation Sciences, Boston University
Page 1 of 2
ACCEPTED MANUSCRIPT
4Rudolf
Magnus Institute of Neuroscience & Department of Rehabilitation, Nursing Sciences
and Sports, University Medical Center Utrecht, Utrecht, the Netherlands of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital
RI PT
5Department
Network, Harvard Medical School
* RTI International, 1440 Main Street, Suite 337, Waltham, MA 02451
SC
** Dr. Robert C. Wagenaar passed away on February 13, 2013, prior to manuscript
M AN U
submission.
Dr. Pardasaney was supported by the Dudley Allen Sargent Research Fund from Sargent College of Health & Rehabilitation Sciences, Boston University. Drs. Slavin and Jette were
TE D
supported by an R24 award (1R24HD065688-02) from the National Institutes of Health National Center for Medical Rehabilitation Research. Dr. Bean was supported by K23 (K23AG019663-01A2) and K24 (K24HD070966-02) awards from the National Institutes of
EP
Health.
AC C
Corresponding author: Poonam K. Pardasaney, ScD RTI International, 1440 Main Street, Suite 337, Waltham, MA 02451 Email: [email protected]; [email protected] Business: 781 434 1711; Mobile: 857 928 4349
Reprint requests to Dr. Poonam K. Pardasaney.
Page 2 of 2
ACCEPTED MANUSCRIPT
1
COMPUTER-ADAPTIVE BALANCE TESTING IMPROVES DISCRIMINATION BETWEEN
2
COMMUNITY-DWELLING ELDERLY FALLERS AND NON-FALLERS
RI PT
3
ABSTRACT
4
SC
5
Objective: To build an item response theory based computer-adaptive balance test (CAT)
7
from three traditional, fixed-form balance measures: Berg Balance Scale (BBS),
8
Performance-Oriented Mobility Assessment (POMA), and Dynamic Gait Index (DGI); and
9
examine whether CAT psychometric performance exceeded that of individual measures.
M AN U
6
Design: Secondary analysis combining two existing datasets.
11
Setting: Community-based.
12
Participants: 187 community-dwelling older adults, 65 years or older, mean age 75.2±6.8
13
years, 69% female.
14
Interventions: Not applicable.
15
Main Outcome Measure(s): BBS, POMA, and DGI items were compiled into an initial 38-
16
item bank. Rasch Partial Credit Model was used for final item bank calibration. CAT
17
simulations were conducted to identify the ideal CAT. CAT score accuracy, reliability, floor
18
and ceiling effects, and validity were examined. Floor and ceiling effects and validity of CAT
19
and individual measures were compared.
AC C
EP
TE D
10
Page 1 of 28
ACCEPTED MANUSCRIPT
Results: A 23-item bank met model expectations. A 10-item CAT was selected, showing
21
very strong association with full item bank scores (r=0.97), and good overall reliability
22
(0.78). Reliability was better in low- to mid-balance ranges due to better item targeting to
23
balance ability, compared with highest balance ranges. No floor effect was noted. CAT
24
ceiling effect (11.2%) was significantly lower than POMA (40.1%) and DGI (40.3%) ceiling
25
effects (p
S0003-9993(14)00220-2
DOI:
10.1016/j.apmr.2014.03.013
Reference:
YAPMR 55783
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 22 January 2014 Revised Date:
8 March 2014
Accepted Date: 14 March 2014
Please cite this article as: Pardasaney PK, Ni P, Slavin MD, Latham NK, Wagenaar RC, Bean J, Jette AM, Computer-Adaptive Balance Testing Improves Discrimination Between Community-Dwelling Elderly Fallers and Non-Fallers, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2014), doi: 10.1016/j.apmr.2014.03.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Running head: Computer-adaptive balance testing
RI PT
COMPUTER-ADAPTIVE BALANCE TESTING IMPROVES DISCRIMINATION BETWEEN COMMUNITY-DWELLING ELDERLY FALLERS AND NON-FALLERS
M AN U
Pengsheng Ni, MD2
SC
Poonam K. Pardasaney, ScD1,2*
Mary D. Slavin, PhD2
Nancy K. Latham, PhD2
TE D
Robert C. Wagenaar, PhD3,4** Jonathan Bean, MD5
of Rehabilitation Sciences, Sargent College of Health & Rehabilitation
AC C
1Department
EP
Alan M. Jette, PhD2
Sciences, Boston University 2Health
& Disability Research Institute, School of Public Health, Boston University
3Department
of Physical Therapy and Athletic Training, Sargent College of Health &
Rehabilitation Sciences, Boston University
Page 1 of 2
ACCEPTED MANUSCRIPT
4Rudolf
Magnus Institute of Neuroscience & Department of Rehabilitation, Nursing Sciences
and Sports, University Medical Center Utrecht, Utrecht, the Netherlands of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital
RI PT
5Department
Network, Harvard Medical School
* RTI International, 1440 Main Street, Suite 337, Waltham, MA 02451
SC
** Dr. Robert C. Wagenaar passed away on February 13, 2013, prior to manuscript
M AN U
submission.
Dr. Pardasaney was supported by the Dudley Allen Sargent Research Fund from Sargent College of Health & Rehabilitation Sciences, Boston University. Drs. Slavin and Jette were
TE D
supported by an R24 award (1R24HD065688-02) from the National Institutes of Health National Center for Medical Rehabilitation Research. Dr. Bean was supported by K23 (K23AG019663-01A2) and K24 (K24HD070966-02) awards from the National Institutes of
EP
Health.
AC C
Corresponding author: Poonam K. Pardasaney, ScD RTI International, 1440 Main Street, Suite 337, Waltham, MA 02451 Email: [email protected]; [email protected] Business: 781 434 1711; Mobile: 857 928 4349
Reprint requests to Dr. Poonam K. Pardasaney.
Page 2 of 2
ACCEPTED MANUSCRIPT
1
COMPUTER-ADAPTIVE BALANCE TESTING IMPROVES DISCRIMINATION BETWEEN
2
COMMUNITY-DWELLING ELDERLY FALLERS AND NON-FALLERS
RI PT
3
ABSTRACT
4
SC
5
Objective: To build an item response theory based computer-adaptive balance test (CAT)
7
from three traditional, fixed-form balance measures: Berg Balance Scale (BBS),
8
Performance-Oriented Mobility Assessment (POMA), and Dynamic Gait Index (DGI); and
9
examine whether CAT psychometric performance exceeded that of individual measures.
M AN U
6
Design: Secondary analysis combining two existing datasets.
11
Setting: Community-based.
12
Participants: 187 community-dwelling older adults, 65 years or older, mean age 75.2±6.8
13
years, 69% female.
14
Interventions: Not applicable.
15
Main Outcome Measure(s): BBS, POMA, and DGI items were compiled into an initial 38-
16
item bank. Rasch Partial Credit Model was used for final item bank calibration. CAT
17
simulations were conducted to identify the ideal CAT. CAT score accuracy, reliability, floor
18
and ceiling effects, and validity were examined. Floor and ceiling effects and validity of CAT
19
and individual measures were compared.
AC C
EP
TE D
10
Page 1 of 28
ACCEPTED MANUSCRIPT
Results: A 23-item bank met model expectations. A 10-item CAT was selected, showing
21
very strong association with full item bank scores (r=0.97), and good overall reliability
22
(0.78). Reliability was better in low- to mid-balance ranges due to better item targeting to
23
balance ability, compared with highest balance ranges. No floor effect was noted. CAT
24
ceiling effect (11.2%) was significantly lower than POMA (40.1%) and DGI (40.3%) ceiling
25
effects (p
