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. 2023 Jun 25;21(1):61.
doi: 10.1186/s12955-023-02152-8.

Applying multidimensional computerized adaptive testing to the MSQOL-54: a simulation study

Andrea Giordano  1   2 , Silvia Testa  3 , Marta Bassi  4 , Sabina Cilia  5 , Antonio Bertolotto  6 , Maria Esmeralda Quartuccio  7 , Erika Pietrolongo  8 , Monica Falautano  9 , Monica Grobberio  10 , Claudia Niccolai  11 , Beatrice Allegri  12 , Rosa Gemma Viterbo  13 , Paolo Confalonieri  14 , Ambra Mara Giovannetti  1   14 , Eleonora Cocco  15   16 , Maria Grazia Grasso  17 , Alessandra Lugaresi  18   19 , Elisa Ferriani  20 , Ugo Nocentini  21   22 , Mauro Zaffaroni  23 , Alysha De Livera  24   25 , George Jelinek  25 , Alessandra Solari  26 , Rosalba Rosato  2
Affiliations

Applying multidimensional computerized adaptive testing to the MSQOL-54: a simulation study

Andrea Giordano et al. Health Qual Life Outcomes. .

Abstract

Background: The Multiple Sclerosis Quality of Life-54 (MSQOL-54) is one of the most commonly-used MS-specific health-related quality of life (HRQOL) measures. It is a multidimensional, MS-specific HRQOL inventory, which includes the generic SF-36 core items, supplemented with 18 MS-targeted items. Availability of an adaptive short version providing immediate item scoring may improve instrument usability and validity. However, multidimensional computerized adaptive testing (MCAT) has not been previously applied to MSQOL-54 items. We thus aimed to apply MCAT to the MSQOL-54 and assess its performance.

Methods: Responses from a large international sample of 3669 MS patients were assessed. We calibrated 52 (of the 54) items using bifactor graded response model (10 group factors and one general HRQOL factor). Then, eight simulations were run with different termination criteria: standard errors (SE) for the general factor and group factors set to different values, and change in factor estimates from one item to the next set at < 0.01 for both the general and the group factors. Performance of the MCAT was assessed by the number of administered items, root mean square difference (RMSD), and correlation.

Results: Eight items were removed due to local dependency. The simulation with SE set to 0.32 (general factor), and no SE thresholds (group factors) provided satisfactory performance: the median number of administered items was 24, RMSD was 0.32, and correlation was 0.94.

Conclusions: Compared to the full-length MSQOL-54, the simulated MCAT required fewer items without losing precision for the general HRQOL factor. Further work is needed to add/integrate/revise MSQOL-54 items in order to make the calibration and MCAT performance efficient also on group factors, so that the MCAT version may be used in clinical practice and research.

Keywords: Bifactor model; Health-related quality of life; Item response theory; MSQOL-54; Multidimensional computerized adaptive test; Multiple sclerosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest. AL has received personal compensation for consulting, serving on a scientific advisory board, speaking or other activities from Alexion, Bristol Myers Squib, Janssen, Biogen, Merck Serono, Novartis, Sanofi/Genzyme. Her institutions have received research grants from Novartis.

Figures

Fig. 1
Fig. 1
Test information curve of the general health-related quality of life (HRQOL) factor
Fig. 2
Fig. 2
Relationship between number of items administered and level of health-related quality of life (formula image) in simulation 3
See this image and copyright information in PMC

References

    1. Greenhalgh J. The applications of PROs in clinical practice: what are they, do they work, and why? Qual Life Res. 2009;18(1):115–23. doi: 10.1007/s11136-008-9430-6. - DOI - PubMed
    1. Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353–67. doi: 10.2147/PROM.S156279. - DOI - PMC - PubMed
    1. Revicki DA, Osoba D, Fairclough D, et al. Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Qual Life Res. 2000;9(8):887–900. doi: 10.1023/A:1008996223999. - DOI - PubMed
    1. Fayers PM, Hays R. Assessing quality of life in clinical trials: methods and practice. 2. Oxford: Oxford University Press; 2005.
    1. Solari A. Role of health-related quality of life measures in the routine care of people with multiple sclerosis. Health Qual Life Outcomes. 2005;3:16. doi: 10.1186/1477-7525-3-16. - DOI - PMC - PubMed