Adaptive Questionnaires

The CAT-5D-QOL is a modern, adaptive (dynamic), generic measure of health-related quality of life (HRQOL). It provides scores for 5 domains of HRQOL (Walking, Handling Objects, Daily Activities, Pain or Discomfort, and Feelings) and an overall, multi-attribute health utility (MAHU) score (dead=0 and perfect health=1) derived from a standard-gamble experiment. Domain-specific scores are presented either as a percentage of maximum score (0-100) or a difference from the population mean in standard deviation units (mean=50 and SD=10).

The adaptive nature of the CAT-5D-QOL means that different respondents answer different questions, depending on their level of HRQOL. A computer selects the questions dynamically from a large pool of questions (item bank), depending on the previous responses. For each domain, the item bank has been calibrated using the methods of item response theory (IRT). As a result, even though different respondents answer different questions, the IRT-based scores are perfectly comparable.

The main advantage of CAT over conventional questionnaires is the ability to achieve the same (or greater) accuracy, precision and responsiveness with fewer questions. In fact, highly accurate scores, with little or no ceiling/floor effect, can be obtained with 5 questions per domain. The CAT-5D-QOL is usually self-administered via the Internet, but can also be administered by an interviewer with Internet access, either by phone or in person. The instrument has been thoroughly validated and used in several research projects.

The PAT-5D-QOL is a novel “semi-adaptive”, paper-and-pencil measure of HRQOL. It uses items from the CAT-5D-QOL item banks and measures the same 5 domains. For each domain, respondents are initially classified into 4 functional levels. Depending on the level, they respond to a different set of 5 questions. IRT-based scores for each domain and overall health utility (MAHU) scores are provided. The instrument has been validated empirically and tested against CAT-5D-QOL and a “fixed” IRT-based instrument in a simulation study. Measurement properties of the PAT-5D-QOL are intermediate between a fixed questionnaire and a CAT-based questionnaire of the same length.

An advantage of the PAT-5D-QOL is that it does not require a computer for questionnaire administration or special IRT software for scoring. Domain-specific and MAHU scores are obtained using a simple spreadsheet that is provided with the questionnaire. While the PAT-5D-QOL is designed to be administered as a paper-and-pencil questionnaire, it can also be administered on a computer using simple skip logic available in most online survey systems.

Journal Articles

1. Kopec JA, Sayre EC, Rogers P, Davis AM, Badley EM, Anis AH, Abrahamowicz M, Russell L, Rahman MM, Esdaile JM. Multiattribute health utility scoring for the computerized adaptive measure CAT-5D-QOL was developed and validated. J Clin Epidemiol. 2015;pii: S0895-4356(15)00167-5.

2. Kopec JA, Sayre EC, Davis AM, Badley EM, Abrahamowicz M, Pouchot J, Sherlock L, Esdaile JM. Development of a paper-and-pencil semi-adaptive questionnaire for 5 domains of health-related quality of life (PAT-5D-QOL). Qual Life Res. 2013;22(10):2829-42.

3. Davis EM, Lynd LD, Grubisic M, Kopec JA, Sayre EC, Cibere J, Esdaile J, Marra CA. Responsiveness of health state utility values in knee osteoarthritis. J Rheumatol. 2013;40(12):2075-82.

4. Kopec JA, Badii M, McKenna M, Lima VD, Sayre EC, Dvorak M. Computerized adaptive testing in back pain: Validation of the CAT-5D-QOL. Spine 2008;33(12):1384-90.

5. Kopec JA, Sayre EC, Davis AM, Badley EM, Abrahamowicz M, Sherlock L, Williams JI, Anis A, Esdaile JM. Assessment of health-related quality of life in arthritis: Conceptualization and development of five item banks using item response theory. Health Qual Life Outcomes 2006;4(1):33.

Conference Presentations

1. Kopec JA, Sayre EC, Russell L, Rahman MM. Validation of the CAT-5D-QOL multi-attribute health utility (MAHU) score. Annual Conference of the International Society for Quality of Life Research (ISOQOL), Miami, FL, USA, October 9-12, 2013.

2. Sawatzky R, Kopec JA, Sayre EC, Zumbo BD. Do people interpret and respond to questions about their pain in a comparable manner? Annual Conference of the International Society for Quality of Life Research (ISOQOL), London, UK, October 27-30, 2010.

3. Sawatzky R, Kopec JA, Sayre EC, Zumbo BD. The use of latent variable mixture modeling to examine the extent to which people are consistent in their responses to questions about their emotional wellbeing. Annual Conference of the International Society for Quality of Life Research (ISOQOL), Florence, Italy, July 19-23, 2009.

4. Kang W, Sayre EC, Steininger G, Doerfling P, Ratzlaff C, Esdaile J, Kopec J. Validation of the multi-attribute health utility (MAHU) derived from a computer adaptive instrument, CAT-5D-QOL, in osteoarthritis. Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Orlando, FL, USA, May 16-20, 2009.

5. Kang W, Sayre EC, Steininger G, Doerfling P, Ratzlaff C, Sawatzky R, Esdaile J, Kopec JA. Cross-sectional validity of a computer adaptive questionnaire in osteoarthritis. Annual General Assembly and Scientific Meeting of the Japan College of Rheumatology (JCR) / International Rheumatology Symposium, Tokyo, Japan, April 23-25, 2009.

6. Sayre EC, Kopec JA, Marra C, Abrahamowicz M, Anis AH, Badley EM, Davis AM, Esdaile JM. Performance of the item response theory scoring of the Computerized Adaptive Test in Five Domains of Quality of Life: a simulation study. Annual Conference

7. Marra C, Kopec JA, Sayre EC, Grindrod K, Oteng B, Gastonguay L, Soon J, Cibere J, Esdaile JM. The PAT-5D-QOL: An adaptive, IRT-based questionnaire to assess health-related quality of life in arthritis. Annual Conference

8. Kopec JA, Rahman MM, Doerfling P, Sayre EC, Cibere J, MacIntyre D, Wilson D, Liang MH, Esdaile JM. Adaptive assessment of health-related quality of life in persons with hip and knee pain. Annual Meeting of the Osteoarthritis Research Society International (OARSI), Ft. Lauderdale, FL, USA, December 6-9, 2007

9. Sayre EC, Kopec JA, Abrahamowicz M, Anis AH, Badley EM, Davis AM, Esdaile JM. Modeling multi-attribute health utility from five domain-specific IRT scores. Annual Conference

10. Kopec JA, Badii M, McKenna M, Sayre EC, Lima VD, Rogers P, Dvorak MF. A comparison of adaptive and standard questionnaires in patients with back pain. Annual Conference

11. Kopec JA, Pouchot J, Dias Lima V, Sayre EC, Al-Harthy F, Marra C, Anis AH, Chalmers A, Esdaile JM. Validation of an adaptive measure of health-related quality of life in rheumatoid arthritis. Annual Conference of the International Society for Quality of Life Research, San Francisco, October 19-22, 2005.

12. Pouchot J, Kopec JA, Latteier J, Sayre EC, Al-Harthy F, Garbuz G, Greidanus N, Anis A, Esdaile JM. Validity of a new adaptive measure of health-related quality of life in arthritis. Annual Conference of the International Society for Quality of Life Research, Hong Kong, October 16-19, 2004.

13. Kopec JA, Sayre EC, Abrahamowicz M, Anis AH, Badley EM, Davis AM, Williams JI, Esdaile JM. Integrating IRT and utility-based assessment of health: overview of methodology. Annual Conference of the International Society for Quality of Life Research, Prague, November 12-15, 2003.

14. Sayre EC, Kopec JA, Abrahamowicz M, Anis AH, Badley EM, Davis AM, Williams JI, Esdaile JM. A comparison of additive and multiplicative models for a new preference-based questionnaire in patients with musculoskeletal conditions. Annual Conference of the International Society for Quality of Life Research, Prague, Czech Republic, November 12-15, 2003

15. Kopec JA. Abrahamowicz M, Badley EM, Davis AM, Williams JI, Sayre EC, Esdaile JM. Adaptive assessment of musculoskeletal health: A novel approach based on item response theory. Annual Scientific Meeting of the American College of Rheumatology, New Orleans, October 26-29, 2002.