TY  - JOUR
AU  - Harrison, Conrad
AU  - Apon, Inge
AU  - Ardouin, Kenny
AU  - Sidey-Gibbons, Chris
AU  - Klassen, Anne
AU  - Cano, Stefan
AU  - Wong Riff, Karen
AU  - Pusic, Andrea
AU  - Versnel, Sarah
AU  - Koudstaal, Maarten
AU  - Allori, Alexander C
AU  - Rogers-Vizena, Carolyn
AU  - Swan, Marc C
AU  - Furniss, Dominic
AU  - Rodrigues, Jeremy
PY  - 2023
DA  - 2023/4/27
TI  - The Development, Deployment, and Evaluation of the CLEFT-Q Computerized Adaptive Test: A Multimethods Approach Contributing to Personalized, Person-Centered Health Assessments in Plastic Surgery
JO  - J Med Internet Res
SP  - e41870
VL  - 25
KW  - cleft lip
KW  - cleft palate
KW  - patient-reported outcome measures
KW  - outcome assessment
KW  - CLEFT-Q
KW  - computerized adaptive test
KW  - CAT
AB  - Background: Routine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) may improve care in a range of surgical conditions. However, most available CATs are neither condition-specific nor coproduced with patients and lack clinically relevant score interpretation. Recently, a PROM called the CLEFT-Q has been developed for use in the treatment of cleft lip or palate (CL/P), but the assessment burden may be limiting its uptake into clinical practice. Objective: We aimed to develop a CAT for the CLEFT-Q, which could facilitate the uptake of the CLEFT-Q PROM internationally. We aimed to conduct this work with a novel patient-centered approach and make source code available as an open-source framework for CAT development in other surgical conditions. Methods: CATs were developed with the Rasch measurement theory, using full-length CLEFT-Q responses collected during the CLEFT-Q field test (this included 2434 patients across 12 countries). These algorithms were validated in Monte Carlo simulations involving full-length CLEFT-Q responses collected from 536 patients. In these simulations, the CAT algorithms approximated full-length CLEFT-Q scores iteratively, using progressively fewer items from the full-length PROM. Agreement between full-length CLEFT-Q score and CAT score at different assessment lengths was measured using the Pearson correlation coefficient, root-mean-square error (RMSE), and 95% limits of agreement. CAT settings, including the number of items to be included in the final assessments, were determined in a multistakeholder workshop that included patients and health care professionals. A user interface was developed for the platform, and it was prospectively piloted in the United Kingdom and the Netherlands. Interviews were conducted with 6 patients and 4 clinicians to explore end-user experience. Results: The length of all 8 CLEFT-Q scales in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set combined was reduced from 76 to 59 items, and at this length, CAT assessments reproduced full-length CLEFT-Q scores accurately (with correlations between full-length CLEFT-Q score and CAT score exceeding 0.97, and the RMSE ranging from 2 to 5 out of 100). Workshop stakeholders considered this the optimal balance between accuracy and assessment burden. The platform was perceived to improve clinical communication and facilitate shared decision-making. Conclusions: Our platform is likely to facilitate routine CLEFT-Q uptake, and this may have a positive impact on clinical care. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs. 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e41870
UR  - https://doi.org/10.2196/41870
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37104031
DO  - 10.2196/41870
ID  - info:doi/10.2196/41870
ER  -