Development and evaluation of a computer adaptive test to assess anxiety in cardiovascular rehabilitation patients

Abstract

Objective: To develop and evaluate a computer adaptive test for the assessment of anxiety in cardiovascular rehabilitation patients (ACAT-cardio) that tailors an optimal test for each patient and enables precise and time-effective measurement.

Design: Simulation study, validation study (against the anxiety subscale of the Hospital Anxiety and Depression Scale and the physical component summary scale of the 12-Item Short-Form Health Survey), and longitudinal study (beginning and end of rehabilitation).

Setting: Cardiac rehabilitation centers.

Participants: Cardiovascular rehabilitation patients: simulation study sample (n=106; mean age, 57.8y; 25.5% women) and validation and longitudinal study sample (n=138; mean age, 58.6 and 57.9y, respectively; 16.7% and 12.1% women, respectively).

Interventions: Not applicable.

Main outcome measures: Hospital Anxiety and Depression Scale, 12-Item Short-Form Health Survey, and ACAT-cardio.

Results: The mean number of items was 9.2 with an average processing time of 1:13 minutes when an SE ≤.50 was used as a stopping rule; with an SE ≤.32, there were 28 items and a processing time of 3:47 minutes. Validity could be confirmed via correlations between .68 and .81 concerning convergent validity (ACAT-cardio vs Hospital Anxiety and Depression Scale anxiety subscale) and correlations between -.47 and -.30 concerning discriminant validity (ACAT-cardio vs 12-Item Short-Form Health Survey physical component summary scale). Sensitivity to change was moderate to high with standardized response means between .45 and .82.

Conclusions: The ACAT-cardio shows good psychometric properties and provides the opportunity for an innovative and time-effective assessment of anxiety in cardiovascular rehabilitation. A more flexible stopping rule might further improve the ACAT-cardio. Additionally, testing in other cardiovascular populations would increase generalizability.

Keywords: 12-Item Short-Form Health Survey; ACAT-cardio; AIB-cardio; Anxiety; CAT; CVD; Cardiovascular diseases; Computers; HADS; Hospital Anxiety and Depression Scale; ICD-10; IRT; International Statistical Classification of Diseases and Related Health Problems, 10th revision; RehaCAT-Cardio; Rehabilitation; SF-12; SRM; anxiety item bank for cardiovascular patients; cardiovascular disease; computer adaptive test; computer adaptive test for cardiac patients undergoing rehabilitation; computer adaptive test for the assessment of anxiety in cardiovascular rehabilitation patients; item response theory; standardized response mean.