Send to

Choose Destination
See comment in PubMed Commons below
J Clin Epidemiol. 2009 Mar;62(3):278-87, 287.e1-3. doi: 10.1016/j.jclinepi.2008.03.003. Epub 2008 Jul 18.

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception.

Author information

  • 1Clinic for Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany.



This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction.


Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria.


The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations.


The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk