Suitability of the animated activity questionnaire for use as computer adaptive test: establishing the AAQ-CAT

Gregor Liegl*, Leo D. Roorda, Caroline B. Terwee, Martijn Steultjens, Ewa M. Roos, Francis Guillemin, Maria Grazia Benedetti, Hanne Dagfinrud, Alessandra de Carvalho Bastone, Wilfred F. Peter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: The animated activity questionnaire (AAQ) is a computer-based measure of activity limitations. To answer a question, patients choose the animation of a person performing an activity that matches their own level of limitation. The AAQ has not yet been tested for suitability to be applied as computer-adaptive test (CAT). Thus, the objective of this study was to develop and evaluate an AAQ-based CAT to facilitate the application of the AAQ in daily clinical care. Methods: Patients (n = 1408) with hip/knee osteoarthritis from Brazil, Denmark, France, The Netherlands, Norway, Spain, and the UK responded to all 17 AAQ items. Assumptions of item-response theory (IRT) modelling were investigated. To establish item parameters for the CAT, a graded response model was estimated. To evaluate the performance of post-hoc simulated AAQ-based CATs, precision, test length, and construct validity (correlations with well-established measures of activity limitations) were evaluated. Results: Unidimensionality (CFI = 0.95), measurement invariance (R 2-change < 2%), and IRT item fit (S-X 2p >.003) of the AAQ were supported. Performing simulated CATs, the mean test length was more than halved (≤ 8 items), while the range of precise measurement (standard error ≤ 0.3) was comparable to the full AAQ. The correlations between original AAQ scores and three AAQ-CAT versions were ≥ 0.95. Correlations of AAQ-CAT scores with patient-reported and performance measures of activity limitations were ≥ 0.60. Conclusion: The almost non-verbal AAQ-CAT is an innovative and efficient tool in patients with hip/knee osteoarthritis from various countries, measuring activity limitations with lower respondent burden, but similar precision and construct validity compared to the full AAQ.

Original languageEnglish
JournalQuality of Life Research
Early online date2023
Publication statusE-pub ahead of print - 2023

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