Advances in Measuring Patient-Reported Outcomes: Use of Item Response Theory and Computer Adaptive Tests

  • Andrew D. LynchEmail author
  • Adam J. Popchak
  • James J. Irrgang


Well-designed patient-reported outcomes are capable of measuring information important to both patients and clinicians. Including these outcomes in research reports provides a consistent, comparable outcome in research studies. However, classic measures of a reasonable fixed-length survey only measure part of the spectrum of function, and more comprehensive measures of function are too burdensome to complete regularly. Modern measurement techniques, including item response theory and computer adaptive tests, can drastically reduce the number of items to administer while improving the overall precision of the measurement. The following chapter provides the basic information needed to select and use these modern measurement techniques. Considering the rapid development of measures, the reader will need to review all of the available options.


  1. 1.
    Beleckas CM, Padovano A, Guattery J, Chamberlain AM, Keener JD, Calfee RP. Performance of patient-reported outcomes measurement information system (PROMIS) upper extremity (UE) versus physical function (PF) computer adaptive tests (CATs) in upper extremity clinics. J Hand Surg Am. 2017;42:867–74. Scholar
  2. 2.
    Bernholt D, Wright RW, Matava MJ, Brophy RH, Bogunovic L, Smith MV. Patient reported outcomes measurement information system scores are responsive to early changes in patient outcomes following arthroscopic partial meniscectomy. Arthroscopy. 2018;34:1113–7. Scholar
  3. 3.
    Bruce B, Fries J, Lingala B, Hussain YN, Krishnan E. Development and assessment of floor and ceiling items for the PROMIS physical function item bank. Arthritis Res Ther. 2013;15:R144. Scholar
  4. 4.
    Bruce B, Fries JF, Ambrosini D, Lingala B, Gandek B, Rose M, Ware JE Jr. Better assessment of physical function: item improvement is neglected but essential. Arthritis Res Ther. 2009;11:R191. Scholar
  5. 5.
    Cella D, Chang CH. A discussion of item response theory and its applications in health status assessment. Med Care. 2000;38:II66–72.CrossRefGoogle Scholar
  6. 6.
    Cella D, et al. The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010;63:1179–94. Scholar
  7. 7.
    DeWalt DA, Rothrock N, Yount S, Stone AA, PROMIS Cooperative Group. Evaluation of item candidates: the PROMIS qualitative item review. Med Care. 2007;45:S12–21. Scholar
  8. 8.
    Fries JF, Bruce B, Cella D. The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes. Clin Exp Rheumatol. 2005;23:S53–7.PubMedGoogle Scholar
  9. 9.
    Haley SM, Ni P, Hambleton RK, Slavin MD, Jette AM. Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank. J Clin Epidemiol. 2006;59:1174–82. Scholar
  10. 10.
    Haley SM, Ni P, Jette AM, Tao W, Moed R, Meyers D, Ludlow LH. Replenishing a computerized adaptive test of patient-reported daily activity functioning. Qual Life Res. 2009;18:461–71. Scholar
  11. 11.
    Haley SM, Ni P, Ludlow LH, Fragala-Pinkham MA. Measurement precision and efficiency of multidimensional computer adaptive testing of physical functioning using the pediatric evaluation of disability inventory. Arch Phys Med Rehabil. 2006;87:1223–9. Scholar
  12. 12.
    Haskell A, Kim T. Implementation of patient-reported outcomes measurement information system data collection in a private orthopaedic surgery practice. Foot Ankle Int. 2018;39:517–21. Scholar
  13. 13.
    Hays RD, Morales LS, Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care. 2000;38:II28–42.CrossRefGoogle Scholar
  14. 14.
    Jette AM, Haley SM. Contemporary measurement techniques for rehabilitation outcomes assessment. J Rehabil Med. 2005;37:339–45. Scholar
  15. 15.
    Lee AC, Driban JB, Price LL, Harvey WF, Rodday AM, Wang C. Responsiveness and minimally important differences for 4 patient-reported outcomes measurement information system short forms: physical function, pain interference, depression, and anxiety in knee osteoarthritis. J Pain. 2017;18:1096–110. Scholar
  16. 16.
    Liu H, Cella D, Gershon R, Shen J, Morales LS, Riley W, Hays RD. Representativeness of the patient-reported outcomes measurement information system internet panel. J Clin Epidemiol. 2010;63:1169–78. Scholar
  17. 17.
    McHorney CA, Cohen AS. Equating health status measures with item response theory: illustrations with functional status items. Med Care. 2000;38:II43–59.CrossRefGoogle Scholar
  18. 18.
    Minoughan CE, Schumaier AP, Fritch JL, Grawe BM. Correlation of PROMIS physical function upper extremity computer adaptive test with American shoulder and elbow surgeons shoulder assessment form and simple shoulder test in patients with shoulder arthritis. J Shoulder Elb Surg. 2018;27:585–91. Scholar
  19. 19.
    Rose M, Bjorner JB, Gandek B, Bruce B, Fries JF, Ware JE Jr. The PROMIS physical function item bank was calibrated to a standardized metric and shown to improve measurement efficiency. J Clin Epidemiol. 2014;67:516–26. Scholar
  20. 20.
    Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach. Arch Phys Med Rehabil. 2008;89:1046–53. Scholar
  21. 21.
    Zdziarski-Horodyski L, et al. An integrated-delivery-of-care approach to improve patient reported physical function and mental wellbeing after orthopaedic trauma: study protocol for a randomized controlled trial. Trials. 2018;19:32. Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Andrew D. Lynch
    • 1
    Email author
  • Adam J. Popchak
    • 1
  • James J. Irrgang
    • 1
  1. 1.Departments of Physical Therapy and Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA

Personalised recommendations