電腦化適性測驗在日常生活活動功能量表上之應用

Clinical Assessments on Activities of Daily Living (ADL) Function via Computerized Adaptive Testing

臨床上對病患的許多評估量表，皆需全部作答完成，然後將評估分數予以加總，作為評量病患身心或是體能狀況的依據。電腦化適性測驗(CAT)不必多作答不必要的題目，只需傳統測驗的1/2〜1/3題數就能達到相同的測量精準度。邇來醫院紛紛投入行動護理站的推動，病患床邊量表資料蒐集的效率化，藉助電腦化適性測驗予以實現，以減輕病患及護理人員的負擔。本研究利用合併巴氏量表(BI)及芙蘭切活動量表(FAI)的23道符合Rasch模式單向性與局部獨立性假定之日常生活活動功能量表之試題建立題庫，以微軟VBA程式撰作CAT的Excel模組，進行：(1)評估是否較傳統測驗節省1/2~1/3題數的效率？(2)示範床邊多媒體生活品質功能量表的資料蒐集；(3)應用試題反應理論(IRT) Rasch模式的非預期模式偏離反應指標，及時偵測出病患誤答或輸入可能錯誤的訊息提示。結果顯示CAT（M= 13.42題）較傳統全部作答23題而簡短少42％，模擬1000人平均值與變異數的t檢定顯示二者的能力估計值沒有統計上的顯著差異，說明CAT有較傳統全部作答來得有效率。CAT的Excel模組可協助行動護理蒐集到更真確的資訊。

Many clinical functional measures require patients to respond to all items so that sum scores can be used to assess their physical and/or mental status. In contrast, computerized adaptive testing (CAT) needs only 1/3 ~ 1/2 of test items to achieve the same precision as the whole test. Many hospitals in Taiwan recently have taken great efforts on the development of computer on wheels in wards to render mobile nursing services along bedside of patients. The aim of this study is to verify the effectiveness and efficacy of saving time and burden for patients and nurses through CAT. We took 23 items from the Barthel Index (BI) and the Frenchay Activities Index (FAI) that meet the Rasch model's expectation to form the item bank, and programmed a VBA-Excel CAT module, so as to: (a) ascertain whether CAT can save 1/2 of test length to achieve the same precision? (b) illustrate CAT data collection with hand-on tablet PC for clinical functional measures, and (c) detect in real time unexpected response patterns that might be due to error in data entry or unusual patients. A series of simulations showed that CAT only took 42% of test length to achieve practically identical precision than administering the whole test. The programmed VBA-Excel CAT module can reduce nurses' burden and save time than traditional paper-and-pencil testing appraisals.