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 journalArticlepeer-review

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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 (R2-change < 2%), and IRT item fit (S-X2p >.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
Pages (from-to)2403-2413
Number of pages11
JournalQuality of Life Research
Issue number8
Early online date3 Apr 2023
Publication statusPublished - Aug 2023


  • Computer-adaptive testing
  • Hip and knee osteoarthritis
  • Item-response theory
  • Patient reported outcomes
  • Performance outcomes
  • Physical function

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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