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Open Access Research article

Reliability, validity and administrative burden of the community reintegration of injured service members computer adaptive test (CRIS-CAT)”

Linda Resnik12*, Matthew Borgia1, Pensheng Ni3, Paul A Pirraglia1 and Alan Jette4

Author Affiliations

1 Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA

2 Department of Health Services, Policy and Practice, Brown University, 121 South Main Street, Providence, RI, 02903, USA

3 Health & Disability Research Institute, Boston University School of Public Health, 580 Harrison Avenue, Boston, MA, 02118, USA

4 Department of Health Policy and Management, Health & Disability Research Institute, Boston University School of Public Health, 580 Harrison Avenue, Boston, MA, 02118, USA

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BMC Medical Research Methodology 2012, 12:145  doi:10.1186/1471-2288-12-145

Published: 17 September 2012

Abstract

Background

The Computer Adaptive Test version of the Community Reintegration of Injured Service Members measure (CRIS-CAT) consists of three scales measuring Extent of, Perceived Limitations in, and Satisfaction with community integration. The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT.

The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT.

Methods

This was a three-part study that included a 1) a cross-sectional field study of 517 homeless, employed, and Operation Enduring Freedom / Operation Iraqi Freedom (OEF/OIF) Veterans; who completed all items in the CRIS item set, 2) a cohort study with one year follow-up study of 135 OEF/OIF Veterans, and 3) a 50-person study of CRIS-CAT administration. Conditional reliability of simulated CAT scores was calculated from the field study data, and concurrent validity and known group validity were examined using Pearson product correlations and ANOVAs. Data from the cohort were used to examine the ability of the CRIS-CAT to predict key one year outcomes. Data from the CRIS-CAT administration study were used to calculate ICC (2,1) minimum detectable change (MDC), and average number of items used during CAT administration.

Results

Reliability scores for all scales were above 0.75, but decreased at both ends of the score continuum. CRIS-CAT scores were correlated with concurrent validity indicators and differed significantly between the three Veteran groups (P < .001). The odds of having any Emergency Room visits were reduced for Veterans with better CRIS-CAT scores (Extent, Perceived Satisfaction respectively: OR = 0.94, 0.93, 0.95; P < .05). CRIS-CAT scores were predictive of SF-12 physical and mental health related quality of life scores at the 1 year follow-up. Scales had ICCs >0.9. MDCs were 5.9, 6.2, and 3.6, respectively for Extent, Perceived and Satisfaction subscales. Number of items (mn, SD) administered at Visit 1 were 14.6 (3.8) 10.9 (2.7) and 10.4 (1.7) respectively for Extent, Perceived and Satisfaction subscales.

Conclusion

The CRIS-CAT demonstrated sound measurement properties including reliability, construct, known group and predictive validity, and it was administered with minimal respondent burden. These findings support the use of this measure in assessing community reintegration.