Item usage in a multidimensional computerized adaptive test (MCAT) measuring health-related quality of life

Examining item usage is an important step in evaluating the performance of a computerized adaptive test (CAT). We study item usage for a newly developed multidimensional CAT which draws items from three PROMIS domains, as well as a disease-specific one. The multidimensional item bank used in the current study contained 194 items from four domains: the PROMIS domains fatigue, physical function, and ability to participate in social roles and activities, and a disease-specific domain (the COPD-SIB). The item bank was calibrated using the multidimensional graded response model and data of 795 patients with chronic obstructive pulmonary disease. To evaluate the item usage rates of all individual items in our item bank, CAT simulations were performed on responses generated based on a multivariate uniform distribution. The outcome variables included active bank size and item overuse (usage rate larger than the expected item usage rate). For average theta-values, the overall active bank size was 9-10%; this number quickly increased as theta-values became more extreme. For values of -2 and +2, the overall active bank size equaled 39-40%. There was 78% overlap between overused items and active bank size for average theta-values. For more extreme theta-values, the overused items made up a much smaller part of the active bank size: here the overlap was only 35%. Our results strengthen the claim that relatively short item banks may suffice when using polytomous items (and no content constraints/exposure control mechanisms), especially when using MCAT.