Vanderbilt University School of Medicine, 2215 Garland Avenue (Light Hall), Nashville, TN 37232 USA.
Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614 USA.
Perioper Med (Lond). 2016 Jul 13;5:18. doi: 10.1186/s13741-016-0041-4. eCollection 2016.
Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity.
Patients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)-Short Form 12a-Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of <4 metabolic equivalents of task (METs) or ≥4 METs. Patients also evaluated the usability of the questionnaires.
After IRB approval, 204 patients were enrolled and completed both DASI and PROMIS questionnaires. Clinicians assessed functional capacity at <4 METs for 109 patients (53.4 %) compared to 18 (8.8 %) patient self-assessments <4 METs as estimated by DASI. These results represent a significant discrepancy between assessments (Fisher's exact, two-tailed P value <0.0001). The standard T-score of PROMIS estimates of functional capacity correlated with DASI estimates (R (2) 0.76). The mean and standard deviation for PROMIS T-scores were 43.3 and 9.86, respectively (mean 50.0; SD 10.0 for the general population). Of the 203 patients who completed the entire study survey, 192 (94.6 %) stated that they did not require assistance from another person, and 187 (94 %) responded either "agree" or "strongly agree" to the DASI questionnaire being "easy to understand" and "easy to complete;" 186 (93 %) and 188 (94 %), respectively, responded similarly to the PROMIS questionnaire.
While both electronic questionnaires were easy to understand and complete for most study participants, there was a significant discrepancy between clinician assessments and patient self-assessments of functional capacity. Further study is needed to determine if either patient self-triage by means of activity questionnaires or clinician evaluation is valid and reliable in the preoperative setting.
术前对功能能力的评估对于指导心脏评估决策是必要的，并且可以帮助识别围手术期并发症高危患者。患者对功能能力的自我分诊对于辨别哪些患者需要在手术日前到术前评估中心接受临床医生评估可能是有用的。我们评估了术前患者对功能能力的自我分诊的可行性。
患者在术前评估时立即接受招募。研究参与者完成了电子版的杜克活动状态指数（DASI）和患者报告的结果测量系统（PROMIS）-简短形式 12a-身体功能。对 DASI 和 PROMIS 问卷的回答进行评分，并评估与临床医生评估的功能能力的相关性。相关性围绕<4 代谢当量（METs）或≥4 METs 的二分结果进行分析。患者还评估了问卷的可用性。
在获得机构审查委员会批准后，204 名患者入组并完成了 DASI 和 PROMIS 问卷。与 18 名（8.8%）患者自我评估的<4 METs相比，临床医生评估的<4 METs患者的功能能力为 109 名患者（53.4%）。这些结果代表了评估之间的显著差异（Fisher 确切检验，双侧 P 值<0.0001）。PROMIS 估计的功能能力的标准 T 分数与 DASI 估计相关（R (2) 0.76）。PROMIS T 分数的平均值和标准差分别为 43.3 和 9.86（平均值为 50.0；总体人群的标准差为 10.0）。在完成整个研究调查的 203 名患者中，192 名（94.6%）表示他们不需要其他人的帮助，187 名（94%）对 DASI 问卷“易于理解”和“易于完成”表示“同意”或“强烈同意”；分别有 186（93%）和 188（94%）对 PROMIS 问卷表示类似的回答。
尽管对于大多数研究参与者来说，两个电子问卷都易于理解和完成，但临床医生评估和患者对功能能力的自我评估之间存在显著差异。需要进一步的研究来确定活动问卷的患者自我分诊或临床医生评估在术前环境中是否有效和可靠。
