Hung Man, Baumhauer Judith F, Brodsky James W, Cheng Christine, Ellis Scott J, Franklin Jeremy D, Hon Shirley D, Ishikawa Susan N, Latt L Daniel, Phisitkul Phinit, Saltzman Charles L, SooHoo Nelson F, Hunt Kenneth J
1 University of Utah, Salt Lake City, UT, USA.
2 University of Rochester, Rochester, NY, USA.
Foot Ankle Int. 2014 Jun;35(6):592-599. doi: 10.1177/1071100714528492.
Selecting optimal patient-reported outcome (PRO) instruments is critical to improving the quality of health care. The purpose of this study was to compare the reliability, responsiveness, and efficiency of three PRO measures: the Foot and Ankle Ability Measure-Activity of Daily Living subscale (FAAM_ADL), the Foot Function Index 5-point verbal rating scale (FFI-5pt), and the PROMIS Physical Function computerized adaptive test (PF CAT).
Data were aggregated from 10 clinical sites in the AOFAS's National Orthopaedic Foot and Ankle Research (OFAR) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle. Patients were administered the FAAM_ADL, FFI-5pt, and PF CAT at their preoperative visit and at 6 months after surgery. Reliabilities were evaluated using a Rasch model. Responsiveness was calculated using paired samples t test and efficiency was recorded as number of seconds to complete the instrument.
Similar reliabilities were found for the three instruments. Item reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were all .99. Pearson reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were .95, .93, and .96, respectively. On average, patients completed the FAAM_ADL in 179 seconds, the FFI-5pt in 194 seconds, and the PF CAT in 44 seconds, ( P < .001). The PF CAT and FAAM_ADL showed significant improvement ( P = .01 and P = .001, respectively) in patients' physical function after treatment; the FFI-5pt did not show improvement.
Overall, the PF CAT performed best in terms of reliability, responsiveness, and efficiency in this broad sample of foot and ankle patients. It can be a potential replacement for the conventional PRO measures, but further validation is needed in conjunction with the PROMIS Pain instruments.
Level I, prospective comparative outcome study.
选择最佳的患者报告结局（PRO）工具对于提高医疗质量至关重要。本研究的目的是比较三种PRO测量方法的可靠性、反应性和效率：足踝能力测量-日常生活活动分量表（FAAM_ADL）、足部功能指数5点言语评定量表（FFI-5pt）和PROMIS身体功能计算机自适应测试（PF CAT）。
汇总了美国足踝外科协会（AOFAS）国家足踝研究（OFAR）网络中10个临床站点的311例因足踝疾病接受择期手术患者的数据。患者在术前访视时以及术后6个月接受FAAM_ADL、FFI-5pt和PF CAT测试。使用Rasch模型评估可靠性。使用配对样本t检验计算反应性，并记录完成工具所需的秒数作为效率。
三种工具的可靠性相似。FAAM_ADL、FFI-5pt和PF CAT的项目可靠性均为0.99。FAAM_ADL、FFI-5pt和PF CAT的皮尔逊可靠性分别为0.95、0.93和0.96。平均而言，患者完成FAAM_ADL用时179秒，完成FFI-5pt用时194秒，完成PF CAT用时44秒（P < 0.001）。治疗后，PF CAT和FAAM_ADL在患者身体功能方面显示出显著改善（分别为P = 0.01和P = 0.001）；FFI-5pt未显示出改善。
总体而言，在这个广泛的足踝患者样本中，PF CAT在可靠性、反应性和效率方面表现最佳。它可能是传统PRO测量方法的潜在替代品，但需要结合PROMIS疼痛工具进行进一步验证。
I级，前瞻性比较结局研究。
