Richard C. Gershon, PhD.

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1 Richard C. Gershon, PhD.

2 Collectively PROMIS and the NIH Toolbox consist of over 250 measures. This particular presentation is limited to describing the benefits of these measurement systems only relevant to work requirements and is otherwise not representative of the use of the measures across the age span and for numerous other purposes

3 The NIH seeks proposals for innovative approaches to measuring patient-reported outcomes (PROs) that will meet the needs of clinical researchers across a wide variety of chronic disorders and diseases. Develop and test a large bank of items measuring PROs Create a computerized adaptive testing system that will allow for efficient, psychometrically robust assessment of PROs in clinical research involving a wide range of chronic diseases Create a publicly-available system that will allow clinical researchers to access a common repository of items and CAT. NIH Roadmap, 2003

4 Develop unified/integrated of multiple indicators (cognitive, emotional, motor, sensory) of neural and behavioral health functioning for use in large cohort studies and clinical trials Could be used as a form of common currency across diverse study designs and populations Would maximize yield from large, expensive studies with minimal increment in subject burden and cost NIH Neuroscience Blueprint, 2006

5 Clinician/researchers wanted measures which were: Psychometrically sound Brief, easy to use Intellectual Property Free Available in multiple languages

6 BUT most legacy measures failed to make the grade: Psychometrically sound NOT ALWAYS Brief, easy to use RARELY Applicable in variety of settings SOMETIMES Available in multiple languages SOMETIMES, (and if so, rarely with the same meaning!)

7 What is Computerized Adaptive Testing? Shorter Targeting Computerized Algorithm

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12 1 100

13 1 100

14 Low Pass High?

15 Low Pass High?

16 Low Pass High PASS!

17 Low Pass High FAIL

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26 Physical Health Symptoms Function Self- Reported Health Global Health Mental Health Affect Behavior Cognition Social Health Relationships Function

27 Physical Health Physical Function Upper Extremity Pain Interference Mental Health Depression Anxiety Applied Cognition Social Health

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29 80 Institutions 256 Scientists & Staff 20,000 Subjects 5,000 Person Norming Sample Four 30-minute domain-level batteries (English and Spanish) Fully normed for ages Instruments in total

30 Since October institutions 73 primary articles published Cited in 579 articles

31 Toolbox Domains Cognition Emotion Motor Sensation

32 Executive Function Working Memory Attention Processing Speed Episodic Memory Language

33 A set of mental processes that serve to translate thought into symbols (words, gestures) that can be shared among individuals for purposes of communication The respondent hears the word, is presented with four images on screen, and must select the image that most closely represents the meaning of the word. Administered in computer-adaptive format. Initial item difficulty based on age/education. IRT-based ability score provided. Separate English and Spanish forms developed Total Time: 4 minutes

34 Executive Function-Set Shifting NIHTB Dimensional Change Card Sort Test (DCCS) Set shifting, or the capacity for switching among multiple aspects of a strategy or task Two target pictures are presented that vary along two dimensions (e.g., shape and color). Examinees are asked to match a series of bivalent test pictures (e.g., blue squares and yellow circles) to target pictures, first according to one dimension (e.g., color) and then, according to the other dimension (e.g., shape). Finally, there is a mixed condition trial, where the matching dimension will change from trial to trial. Scoring is based on reaction time and accuracy.

35 Motor Dexterity Endurance Strength Locomotion Balance

36 Strength is central to the ability to move against gravity and provide enough force movements with or without resistance.

37 Locomotion An act of moving from one place to the other place, reflecting ambulation ability including walking distance, velocity, and quality of the gait under different environments and ground surfaces 20-Foot Walk Test This self-paced walk test measures how quickly a person can walk (without running) a prescribed route. Score is time, in seconds, of best of two trials.

38 Cardiopulmonary and muscle endurance are important components of physical fitness. Distance in feet and inches walked in 2 minutes.

39 Dexterity is a central component of hand function.

40 Balance allows people to orient their body in space and maintain an upright posture under a variety of conditions.

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42 The ability to detect sound and use it functionally. English version (Wilson, 2003) and Spanish version (McArdle et al, 2009) Hearing Threshold Test Automated Audiometry for the NIH Toolbox (AANT)

43 Static Visual Acuity

44 Cognition (Page 1)

45 For use in-clinic and other data collections sites (not a take-home tool) Tailored for the ipad Also Features selected PROMIS CATs, Global, PROMIS-29 Separate apps available for English and Spanish patients (administrative shell is in English for both) (in the itunes store search for NIH Toolbox Annual subscription fee for use on up to 10 ipads

46 Richard C. Gershon, PhD.

NIH Toolbox. Scoring and Interpretation Guide. September 18, 2012

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