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Optimized questionnaire item selection for tracking the progression of motor symptoms in Parkinson's disease
Stockholm University, Faculty of Social Sciences, Department of Statistics.
Stockholm University, Faculty of Social Sciences, Department of Statistics.ORCID iD: 0000-0003-0528-0083
Stockholm University, Faculty of Social Sciences, Department of Statistics. Department of Computer and Information Science, Linköping University, Sweden.ORCID iD: 0000-0003-4161-7851
(English)Manuscript (preprint) (Other academic)
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 [en]
MDS-UPDRS, Parkinson's disease, Longitudinal Item Response Theory, Item selection, Test efficiency, Adaptive testing
National Category
Medical Biostatistics
Research subject
Statistics
Identifiers
URN: urn:nbn:se:su:diva-249765OAI: oai:DiVA.org:su-249765DiVA, id: diva2:2014834
Available from: 2025-11-19 Created: 2025-11-19 Last updated: 2025-12-19
In thesis
1. Latent state estimation with longitudinal and adaptive measurements
Open this publication in new window or tab >>Latent state estimation with longitudinal and adaptive measurements
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Latent variables are useful constructs for modeling states that cannot be directly observed, such as skills, attitudes and health states. Tests designed to measure latent scores often take the form of questionnaires. The developer of such a test aims to assemble a set of items that measures a latent state with good precision. A challenge is that the best set of items depends on the respondent’s true latent score, so a test optimized to give good precision for some respondents may be less precise for others. This dissertation explores statistical methods to optimize the measuring instrument through simulation studies and empirical applications to diverse populations.

The papers included here evaluate adaptive methods that select items based on current knowledge about the respondent. Paper 1 proposes an adaptive method for selecting one item at a time in a Voting Advice Application. With a test that continuously selects the most informative next item, the respondent can conclude the session without answering all items and still get a result that is sufficiently accurate. The proposed method relies on Item Response Theory and a multidimensional latent construct.

In Paper 2, we explored an adaptive model to measure the health states of patients evaluated for symptoms of Parkinson's disease. We compared this adaptive model to optimized static item sets designed for good population-average precision. The Parkinson's dataset consisted of repeated measurements across multiple timepoints, which required a longitudinal approach. In both Papers 1 and 2, the purpose of the methods was to enable more time-efficient versions of tests to increase usage.

Papers 3 and 4 evaluate methods for tracking abilities that change over time. Unlike the Parkinson's scenario with a full test repeated at multiple timepoints, here we have only one observation per time point. In these settings, it is common to abandon traditional statistical models and instead rely on computationally inexpensive algorithms. Of these algorithms, the Elo rating system stands out as the most prominent. This rating system, developed to rate chess players, now has widespread use in many competitive sports and also in education.

We identified limitations associated with the Elo method, and proposed extensions to remedy these. In Paper 3, we developed a hybrid approach that combines standard Elo with statistical modeling to incorporate group-level information. In Paper 4, we demonstrated that in a closed system in which students improve in ability, and where item difficulties are estimated in real time, the Elo method produces increasingly deflated ability estimates. We proposed a method to quantify and offset this system-level deflation.

Place, publisher, year, edition, pages
Stockholm: Department of Statistics, Stockholm University, 2026. p. 31
Keywords
Longitudinal latent models, Ability tracking, Dynamic ability growth, Elo algorithm, Growth model, MDS-UPDRS, Parkinson's disease, Item selection, Test efficiency, Adaptive testing
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:su:diva-249769 (URN)978-91-8107-482-6 (ISBN)978-91-8107-483-3 (ISBN)
Public defence
2026-03-06, lärosal 32, hus 4, Campus Albano, Albanovägen 12, Stockholm, 10:00 (English)
Opponent
Supervisors
Available from: 2026-02-11 Created: 2025-12-19 Last updated: 2026-01-23Bibliographically approved

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Sigfrid, KarlFackle-Fornius, EllinorMiller, Frank

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