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

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posted on 2024-02-09, 05:07 authored by Andrea Giordano, Silvia Testa, Marta Bassi, Sabina Cilia, Antonio Bertolotto, Maria Esmeralda Quartuccio, Erika Pietrolongo, Monica Falautano, Monica Grobberio, Claudia Niccolai, Beatrice Allegri, Rosa Gemma Viterbo, Paolo Confalonieri, Ambra Mara Giovannetti, Eleonora Cocco, Maria Grazia Grasso, Alessandra Lugaresi, Elisa Ferriani, Ugo Nocentini, Mauro Zaffaroni, Alysha De LiveraAlysha De Livera, George Jelinek, Alessandra Solari, Rosalba Rosato
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.


This work was partially supported by the Italian Ministry of Health (RRC 2023).


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Health and Quality of Life Outcomes



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Springer Nature



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