Development and Evaluation of a Computer Adaptive Test to Assess Anxiety in Cardiovascular Rehabilitation Patients

Objective: To develop and evaluate a computer adaptive test for the assessment of anxiety in cardiovascular rehabilitation patients (ACAT-cardio) that tailors an optimal test for each patient and enables precise and time-effective measurement. Design: Simulation study, validation study (against the anxiety subscale of the Hospital Anxiety and Depression Scale and the physical component summary scale of the 12-Item Short-Form Health Survey), and longitudinal study (beginning and end of rehabilitation). Setting: Cardiac rehabilitation centers. Participants: Cardiovascular rehabilitation patients: simulation study sample (n=106; mean age, 57.8y; 25.5% women) and validation and longitudinal study sample (n=138; mean age, 58.6 and 57.9y, respectively; 16.7% and 12.1% women, respectively). Interventions: Not applicable. Main Outcome Measures: Hospital Anxiety and Depression Scale, 12-Item Short-Form Health Survey, and ACAT-cardio. Results: The mean number of items was 9.2 with an average processing time of 1:13 minutes when an SE <=.50 was used as a stopping rule; with an SE <=.32, there were 28 items and a processing time of 3:47 minutes. Validity could be confirmed via correlations between .68 and .81 concerning convergent validity (ACAT-cardio vs Hospital Anxiety and Depression Scale anxiety subscale) and correlations between -.47 and -.30 concerning discriminant validity (ACAT-cardio vs 12-Item Short-Form Health Survey physical component summary scale). Sensitivity to change was moderate to high with standardized response means between .45 and .82. Conclusions: The ACAT-cardio shows good psychometric properties and provides the opportunity for an innovative and time-effective assessment of anxiety in cardiovascular rehabilitation. A more flexible stopping rule might further improve the ACAT-cardio. Additionally, testing in other cardiovascular populations would increase generalizability. Archives of Physical Medicine and Rehabilitation 2013;94:2433-9 (C) 2013 by the American Congress of Rehabilitation Medicine