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A computer adaptive testing approach for assessing physical functioning in children and adolescents

The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self‐care and mobility domains) of children and adolescents using computer‐adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child's ability level, based on previous responses. Using a CAT algorithm, a simulation study was used to determine the number of items necessary to approximate the score of a full‐length assessment. We built simulated CAT (5‐, 10‐, 15‐, and 20‐item versions) for self‐care and mobility domains and tested their accuracy in a normative sample (n=373; 190 males, 183 females; mean age 6y 11mo [SD 4y 2m], range 4mo to 14y 11mo) and a sample of children and adolescents with Pompe disease (n=26; 21 males, 5 females; mean age 6y 1mo [SD 3y 10mo], range 5mo to 14y 10mo). Results indicated that comparable score estimates (based on computer simulations) to the full‐length tests can be achieved in a 20‐item CAT version for all age ranges and for normative and clinical samples. No more than 13 to 16% of the items in the full‐length tests were needed for any one administration. These results support further consideration of using CAT programs for accurate and efficient clinical assessments of physical functioning.