Computerized Adaptive Testing: A Modern Approach to Patient-Reported Outcome Measurement in Orthopedic Surgery (Motivated by the Study on PROMIS CATs and Legacy Measures in Total Hip Arthroplasty Patients by Braaksma et al.)

Computerized adaptive testing represents a significant advancement in the measurement of patient-reported outcomes (PROs), offering a personalized, efficient, and psychometrically robust alternative to traditional fixed-form instruments. This report examines the implementation and performance of adaptive testing in orthopedic surgery, with a focus on individuals undergoing total hip replacement (THR). Drawing on data from a recent evaluation of computerized adaptive tests and legacy instruments, the analysis demonstrates that adaptive testing offers superior responsiveness, reduced measurement error, and lower floor and ceiling effects. These benefits translate into more precise assessments of functional recovery, especially in diverse populations with varying health trajectories. The report includes key tables and visualizations comparing score distributions, test responsiveness, and the performance of adaptive versus traditional measures. Findings support the conclusion that adaptive testing enhances measurement precision while reducing patient burden. The case study reinforces the clinical value of adaptive approaches in tracking post-surgical outcomes and supports their use in both observational research and routine care. Limitations related to item bank calibration and generalizability are addressed, and future directions highlight opportunities for broader integration into health systems, mobile platforms, and decision-support tools. This report underscores the essential role of adaptive testing in shaping the future of patient-centered outcomes research.