Some recommendations for developing multidimensional computerized adaptive tests for patient-reported outcomes

Niels Smits (Lead / Corresponding author), Muirne C. S. Paap, Jan R. Böhnke

    Research output: Contribution to journalComment/debatepeer-review

    12 Citations (Scopus)
    189 Downloads (Pure)


    Purpose: Multidimensional item response theory and computerized adaptive testing (CAT) are increasingly used in mental health, quality of life (QoL), and patient-reported outcome measurement. Although multidimensional assessment techniques hold promises, they are more challenging in their application than unidimensional ones. The authors comment on minimal standards when developing multidimensional CATs.

    Methods: Prompted by pioneering papers published in QLR, the authors reflect on existing guidance and discussions from different psychometric communities, including guidelines developed for unidimensional CATs in the PROMIS project.

    Results: The commentary focuses on two key topics: (1) the design, evaluation, and calibration of multidimensional item banks and (2) how to study the efficiency and precision of a multidimensional item bank. The authors suggest that the development of a carefully designed and calibrated item bank encompasses a construction phase and a psychometric phase. With respect to efficiency and precision, item banks should be large enough to provide adequate precision over the full range of the latent constructs. Therefore CAT performance should be studied as a function of the latent constructs and with reference to relevant benchmarks. Solutions are also suggested for simulation studies using real data, which often result in too optimistic evaluations of an item bank's efficiency and precision.

    Discussion: Multidimensional CAT applications are promising but complex statistical assessment tools which necessitate detailed theoretical frameworks and methodological scrutiny when testing their appropriateness for practical applications. The authors advise researchers to evaluate item banks with a broad set of methods, describe their choices in detail, and substantiate their approach for validation.

    Original languageEnglish
    Pages (from-to)1055-1063
    Number of pages9
    JournalQuality of Life Research
    Issue number4
    Early online date23 Feb 2018
    Publication statusPublished - Apr 2018


    • Computerized adaptive testing
    • Item bank
    • Multidimensional item response theory
    • Patient-reported outcomes
    • Quality of life

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health


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