Computerized adaptive testing of psychological factors: relation to upper-extremity disability.

BACKGROUND Psychological factors are important mediators of the differences between impairment and disability. The most commonly used measures of disability and psychological factors are lengthy and are usually administered as paper questionnaires. The aim of this study was to assess the correlation between perceived disability and psychological factors with use of the user-friendly, web-based Patient Reported Outcomes Measurement Information System initiative, and to compare its correlation with a frequently used, paper-based, pain self-efficacy questionnaire. METHODS A cohort of 213 patients completed a web-based version of the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), the pain self-efficacy questionnaire, the Patient Reported Outcomes Measurement Information System-based computerized adaptive testing Pain Interference questionnaire, and the Patient Reported Outcomes Measurement Information System-based computerized adaptive testing Depression questionnaire. Bivariate and multivariable analyses measured the correlation of these psychological measures with QuickDASH. RESULTS There was large correlation between QuickDASH and the Pain Interference computerized adaptive testing (r = 0.74; p < 0.001), between the Pain Interference computerized adaptive testing and the pain self-efficacy questionnaire (r = -0.72; p < 0.001), and between QuickDASH and the pain self-efficacy questionnaire (r = -0.76; p < 0.001). The Depression computerized adaptive testing showed a medium correlation both with QuickDASH (r = 0.37; p < 0.001) and with the Pain Interference computerized adaptive testing (r = 0.40; p < 0.001). The best multivariable model for QuickDASH included the Pain Interference computerized adaptive testing, prior treatment received, and smoking, and accounted for 57% of the variability. Fifty-one percent of the variability in the QuickDASH was explained by pain interference alone. CONCLUSIONS Maladaptive responses to upper-extremity pain are accurately measured by the relatively user-friendly Patient Reported Outcomes Measurement Information System-based computerized adaptive testing questionnaire.