Evolution of rehabilitation outcomes now incorporates a higher caliber of science compared to 12-15 years ago. The current level of science is firmly entrenched in computer adaptive testing (CAT). This process is far different than what happened in the past. I'm willing to bet many stakeholders in the rehabilitation industry sway away from CAT due to a combination of unfamiliarity with the process and lack of trust.
How is CAT different than the traditional method using fixed form testing for obtaining rehabilitation outcomes?
1. CAT depends upon a far larger amount of items from which a patient can respond. The foundation for most measures using CAT methodology did originate from known valid and reliable measures that many rehabilitation professionals are familiar. The item bank then grew from there.
2. CAT is more efficient than a fixed form test. CAT does not depend on a patient responding to every item within the large bank of items within the test.
3. CAT allows for a highly individualized and targeted score for the patient. Many who are unfamiliar with the process complain about patients being provided functional activities that are unrealistic to perform. This will definitely happen and should happen. The CAT experience begins with a moderately difficult item at the very start of the test. CAT immediately adjusts what next item will be presented to the patient for a response based on the patient's previous response. The goal of CAT is to quickly hone in and target the patient's functional ability.
4. The internal framework/design of CAT is flexible in the sense that if more items need to be built into the original bank of items, this can be done. The science of CAT allows for future growth of the test by adding more items.
5. Because CAT requires a large amount of items and has a built in algorithm knowing the level of difficulty of each item, a CAT has the advantage of providing much more than a score. Rehabilitation CAT results will provide not only a score but also functional staging. Functional staging looks like this:
Just as the music industry has evolved from 45's to 8 tracks to cassette tapes to CDs to options like Spotify and iTunes, the rehabilitation industry has also evolved. Fixed form, paper and pencil based methodology for capturing rehabilitation outcomes was a fantastic solution in the late 1900's to early 2000's. With the current level of science and technology available, the fixed form option is outdated.