JMIR Publications

ABSTRACT

Background:

There is a need for assessment procedures of shorter lengths that capture patient questionnaire data while attaining high data quality without undue response burden for patients. Computerized Adaptive Testing (CAT) and Classification and Regression Trees (CART) methods have the potential to meet these needs and can offer an attractive option to shorten questionnaires

Objective:

We aimed to test which method, CAT or CART, is best suited to reduce the number of questionnaire items in multiple domains (anxiety, depression, quality of life and social support) used for a needs assessment procedure (NAP) within the field of cardiac rehabilitation (CR), without loss of data quality.

Methods:

NAP data of 2837 CR patients of a multicentre CARDDS Online program was used. Patients use an online portal, MYCARDDS to provide their data. CAT and CART were assessed on their performances in shortening the NAP procedure and in terms of sensitivity and specificity.

Results:

With CAT and CART, an overall reduction of 36 % and 72% of NAP questionnaires length could be realized respectively with a mean sensitivity and specificity of 0.765 and 0.817 for CAT, 0.777 and 0.877 for Classification Trees, and 0.743 and 0.40 for Regression Trees respectively.

Conclusions:

Both CAT and CART can be used to shorten the questionnaires of the NAP used within the field of CR. CART yet showed the best performance with overall an about twice as large decrease in questionnaire items of the NAP, and the highest sensitivity and specificity. To our knowledge, our study is thus the first assessing differences in performance between CAT and CART for shortening questionnaires lengths. One example for future research is to administer varied assessments of patients over time to monitor their progress in multiple domains. For CR professionals, CART integrated with MYCARDDS would provide a feedback loop that informs the rehabilitation progress of their patients by providing real-time patient measurements.