Customizing CAT Administration of the PROMIS Misuse of Prescription Pain Medication Item Bank for Patients with Chronic Pain

Objective. The 22-item PROMIS (R)-Rx Pain Medication Misuse item bank (Bank-22) imposes a high response burden. This study aimed to characterize the performance of the Bank-22 in a computer adaptive testing (CAT) setting based on varied stopping rules. Methods. The 22 items were administered to 288 patients. We performed a CAT simulation using default stopping rules (CAT(PROMIS)). In 5 other simulations, a "best health" response rule was added to decrease response burden. This rule stopped CAT administration when a participant selected "never" to a specified number of initial Bank-22 items (2-6 in this study, designated CAT(Alt2-Alt6)). The Bank-22 and 7-item short form (SF-7) scores were compared to scores based on CAT(PROMIS), and the 5 CAT variations. Results. Bank-22 scores correlated highly with the SF-7 and CAT(PROMIS, Alt5, Alt6) scores (r=0.87-0.95) and moderately with CAT(Alt2- Alt4) scores (r=0.63-0.74). In all CAT conditions, the greatest differences with Bank-22 scores were at the lower end of misuse T-scores. The smallest differences with Bank-22 and CAT(PROMIS) scores were observed with CAT(Alt5) and CAT(Alt6). Compared to the SF-7, CAT(Alt5) and CAT(Alt6) reduced overall response burden by about 42%. Finally, the correlations between PROMIS-Rx Misuse and Anxiety T-scores remained relatively unchanged across the conditions (r=0.31-0.43, Ps < .001). Conclusions. Applying a stopping rule based on number of initial "best health" responses reduced response burden for respondents with lower levels of misuse. The tradeoff was less measurement precision for those individuals, which could be an acceptable tradeoff when the chief concern is in discriminating higher levels of misuse.