Wang Ying-Chih, Hart Dennis L, Stratford Paul W, Mioduski Jerome E
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior St, Ste 1406, Chicago, IL 60611-2654 USA.
Phys Ther. 2009 Sep;89(9):957-68. doi: 10.2522/ptj.20080359. Epub 2009 Jul 23.
The increasing use of computerized adaptive tests (CATs) to generate outcome measures during rehabilitation has prompted questions concerning score interpretation.
The purpose of this study was to describe meaningful interpretations of functional status (FS) outcome measures estimated with a body part-specific CAT developed from the Lower-Extremity Functional Scale (LEFS).
This investigation was a prospective cohort study of 8,714 people who had hip impairments and were receiving physical therapy in 257 outpatient clinics in 31 states (United States) between January 2005 and June 2007.
Four approaches were used to clinically interpret outcome data. First, the standard error of the estimate was used to construct the 90% confidence interval for each CAT-generated score estimate. Second, percentile ranks were applied to FS scores. Third, 2 threshold approaches were used to define individual subject-level change: statistically reliable change and clinically important change. The fourth approach was a functional staging method.
The precision of a single score was estimated from the FS score +/-4. On the basis of the score distribution, 25th, 50th, and 75th percentile ranks corresponded to intake FS scores of 40, 48, and 59 and discharge FS scores of 50, 61, and 75, respectively. The reliable change index supported the conclusion that changes in FS scores of 7 or more units represented statistically reliable change, and receiver operating characteristic analyses supported the conclusion that changes in FS scores of 6 or more units represented minimal clinically important improvement. Participants were classified into 5 hierarchical levels of FS using a functional staging method.
Because this study was a secondary analysis of prospectively collected data via a proprietary database management company, generalizability of results may be limited to participating clinics.
The results demonstrated how outcome measures generated from the hip LEFS CAT can be interpreted to improve clinical meaning. This finding might facilitate the use of patient-reported outcomes by clinicians during rehabilitation services.
在康复过程中，越来越多地使用计算机自适应测试（CAT）来生成结果测量值，这引发了有关分数解释的问题。
本研究的目的是描述对功能状态（FS）结果测量值的有意义解释，这些测量值是通过从下肢功能量表（LEFS）开发的特定身体部位CAT估计得出的。
本调查是一项前瞻性队列研究，研究对象为2005年1月至2007年6月期间在美国31个州的257家门诊诊所接受物理治疗的8714名髋部损伤患者。
使用四种方法对结果数据进行临床解释。首先，估计标准误差用于为每个CAT生成的分数估计构建90%置信区间。其次，百分等级应用于FS分数。第三，使用两种阈值方法来定义个体受试者水平的变化：统计上可靠的变化和临床上重要的变化。第四种方法是功能分期法。
根据FS分数±4估计单个分数的精度。根据分数分布，第25、50和75百分等级分别对应于入院时FS分数40、48和59以及出院时FS分数50、61和75。可靠变化指数支持以下结论：FS分数变化7个或更多单位代表统计上可靠的变化，而受试者操作特征分析支持以下结论：FS分数变化6个或更多单位代表最小的临床重要改善。使用功能分期法将参与者分为FS的5个层次水平。
由于本研究是通过一家专有数据库管理公司对前瞻性收集的数据进行的二次分析，结果的可推广性可能仅限于参与研究的诊所。
结果表明如何解释从髋部LEFS CAT生成的结果测量值以提高临床意义。这一发现可能有助于临床医生在康复服务期间使用患者报告的结果。
