For diagnostics and outcome measurement in clinical rehabilitation a multitude of questionnaires is used. In order to gain comparability of the diagnostic findings, generally, the same information is gathered of all patients, regardless of their state of health or how severely ill they are, by using identical groups of items. In this kind of assessment it is, however, problematic that (a) the assessment instrument usually only allows for adequate and reliable diagnostics of patients who suffer from injuries or illnesses of medium severity, and (b) that an uneconomic data collection is required because of an extensive set of items which may in individual cases be uninformative and unnecessary. This article shows how data assessment can be adjusted to the individual handicaps of the patient by using adaptive or tailored testing. Thus it can be ensured that the testing becomes more economical and results more precise. Furthermore, a high acceptance by the patients participating in the data collection can be achieved, as the test items submitted fit the ability of the patients adequately. Yet, adaptive test systems require a complex and very careful psychometrical development of the assessment procedure in such a way that in spite of presenting different items to patients, diagnostic outcomes are comparable between patients and for different points in time (e. g., pre-post comparison). This article shows the steps of development that have to be accomplished in order to set up a psychometrically sound adaptive test procedure. Moreover, it shows how its usage in the area of medical rehabilitation can be profitable for handlers and patients.

Hypothesis / aims of study According to some studies, it is estimated that approximately 49% of men who undergo a radical prostatectomy experience stress urinary incontinence, making it one of the most pervasive side effects of the surgery. One non-invasive intervention aimed at improving stress urinary incontinence after radical prostatectomy is physiotherapy, which can aid an individual in regaining continence by strengthening and increasing endurance of the pelvic floor muscles. Physiotherapy has been observed to decrease the severity of stress urinary incontinence, shorten the duration of symptoms after surgery, and improve quality of life. However, to the best of our knowledge, there has yet to be a rigorous, peer-reviewed study as to whether physiotherapy differentially effects men who undergo an open versus robotic-assisted radical prostatectomy. Thus, the purpose of our study was to determine whether the benefits of physiotherapy on stress urinary incontinence significantly differ between those men who had open versus robotic-assisted laparoscopic radical prostatectomy. Study design, materials and methodsThis study conducted a retrospective analysis of data collected from a prostate cancer rehabilitation clinic, offering free physiotherapy sessions to men who have undergone a radical prostatectomy. Data was collected from participating men at several points in time: approximately three weeks, or less, prior to their radical prostatectomy; at three-and nine-months post-surgery; and on an annual basis for four-years post-surgery. Pre-surgery and three-months post-surgery, a full clinical assessment is done by a trained nurse. Patient-reported outcomes PROs are collected at all time points. This study examined all men who undertook physiotherapy by the nine-month post-surgery follow-up. The primary outcome of interest was the severity of stress urinary incontinence symptoms at two-years post-surgery, the secondary outcome of interest the severity of overactive bladder symptoms at the same end point. Symptom severity was measured by the ICIQ-UI, overactive bladder was measured by the OAB-V8. A multivariate time series was used to compare the changes longitudinally, from three-months post-surgery to two-years postsurgery. ResultsData from 2,431 men was reviewed. Of those, 119 had a radical prostatectomy and attended physiotherapy. This group was nearly evenly split between treatment types: 51% (n = 61) had an open radical prostatectomy, and 49% (n = 58) had a roboticassisted prostatectomy. These subgroups significantly differed in terms of their age at time of surgery; men who had undergone robotic radical prostatectomy were significantly older than men who had undergone open radical prostatectomy (mean age = open: 62 years, robotic: 64 years; p = 0.03).There were no significant differences between these groups in terms of severity of self-reported stress urinary incontinence symptoms (ICIQ-UI mean score = open: 1.9, robotic: 3.0; p = 0.08); or overactive bladder symptoms (OAB-V8 mean score = open: 8.9, roboti...

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