University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA.
Foot Ankle Int. 2012 Aug;33(8):621-6. doi: 10.3113/FAI.2012.0621.
Accurately measuring, reporting and comparing outcomes is essential for improving health care delivery. Current challenges with available health status scales include patient fatigue, floor/ceiling effects and validity/reliability.
This study compared Patient Reported Outcomes Measurement Information System (PROMIS)-based Lower Extremity Physical Function Computerized Adaptive Test (LE CAT) and two legacy scales -the Foot and Function Index (FFI) and the sport module from the Foot and Ankle Ability Measure (spFAAM) -for 287 patients scheduled for elective foot and ankle surgery. We documented the time required by patients to complete the instrument, instrument precision, and the extent to which each instrument covered the full range of physical functioning across the patient sample.
Average time of test administration: 66 seconds for LE CAT, 130 seconds for spFAAM and 239 seconds for FFI. All three instruments were fairly precise at intermediate physical functioning levels (i.e., Standard Error of Measurement < 0.35), were relatively less precise at the higher trait levels and the LE CAT maintained precision in the lower range while the spFAAM and FFI's had decreased precision. The LE CAT had less floor/ceiling effects than the FFI and the spFAAM.
The LE CAT showed considerable advantage compared to legacy scales for measuring patient-reported outcomes in orthopaedic patients with foot and ankle problems.
A paradigm shift to broader use of PROMIS-based CATs should be considered to improve precision and reduce patient burden with patient-reported outcome measuremen foot and ankle patients.
准确测量、报告和比较结果对于改善医疗服务至关重要。目前，现有健康状况量表存在患者疲劳、地板/天花板效应以及有效性/可靠性等问题。
本研究比较了基于患者报告结局测量信息系统（PROMIS）的下肢物理功能计算机自适应测试（LE CAT）以及两种传统量表——足部和功能指数（FFI）和足部和踝关节能力测量（FAAM）中的运动模块（spFAAM），共纳入 287 例计划接受足部和踝关节手术的患者。我们记录了患者完成仪器所需的时间、仪器的精度以及每个仪器在患者样本中涵盖整个身体功能范围的程度。
测试管理的平均时间：LE CAT 为 66 秒，spFAAM 为 130 秒，FFI 为 239 秒。三种仪器在中等身体功能水平上都相当精确（即，测量误差<0.35），在较高特质水平上相对不太精确，而 LE CAT 在较低范围内保持精度，而 spFAAM 和 FFI 的精度则降低。LE CAT 的地板/天花板效应比 FFI 和 spFAAM 少。
与传统量表相比，LE CAT 在测量足部和踝关节问题的骨科患者的患者报告结局方面具有明显优势。
应考虑广泛使用基于 PROMIS 的 CAT 来提高精度并减轻患者的负担，以进行足部和踝关节患者的患者报告结局测量。
