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Abstract [en]
Long questionnaires increase the response burden for patients and healthcare workers. In the treatment of Parkinson's disease, the MDS-UPDRS questionnaire to track disease progression may be underutilized due to time requirements. While reduced item sets have been studied using Fisher information from Item Response Theory (IRT) models, optimal selection methods remain unclear.
We compared three methods for selecting an optimal subset of items, with the aim of minimizing the uncertainty in the estimates of the disease severity: Ranking by Fisher information, coordinate descent local search to directly minimize estimate uncertainty, and adaptive selection based on prior estimates.
Whereas item ranking based on the expected Fisher information outperformed random choice of items, we saw further gains with the coordinate descent algorithm that directly minimizes the uncertainty of the disease severity estimate. An adaptive algorithm that selects items based on a previous estimate gave an additional slight gain compared to the coordinate descent method. For a 5-item subset, the ranked Fisher information method reduced the expected standard deviation by 14 percent compared to random item selection. The corresponding reductions for coordinate descent and adaptive selection were 26 percent and 34 percent respectively.
More sophisticated selection methods substantially improved estimate accuracy for small item sets, with diminishing returns for larger subsets. The choice of method entails a trade-off between methodological complexity and precision, where coordinate descent optimization offers a practical balance between simplicity and accuracy for real-world implementation.
Keywords
MDS-UPDRS, Parkinson's disease, Longitudinal Item Response Theory, Item selection, Test efficiency, Adaptive testing
National Category
Medical Biostatistics
Research subject
Statistics
Identifiers
urn:nbn:se:su:diva-249765 (URN)
2025-11-192025-11-192025-11-19