J Orthop Sports Phys Ther. 2019 Dec;49(12):875-886. doi: 10.2519/jospt.2019.8862. Epub 2019 Jul 10.
Clinical interpretation of patient-reported outcome measures is an essential step in patient-centered care. Interpretation of scores derived from the Neck Functional Status Computerized Adaptive Test (NFS-CAT) has not been studied.
To (1) assess the reliability of point estimates and improvement scores, (2) determine thresholds of minimal clinically important improvement (MCII), and (3) develop a functional staging model to facilitate clinical interpretation of NFS-CAT scores.
A secondary retrospective cohort analysis was performed using data from patients aged 14 to 89 years who started an episode of care for neck impairments during 2016-2017 and completed the NFS-CAT at admission. The reliability of point estimates and of improvement scores was derived from the NFS-CAT standard error of measurement. The MCII was estimated by combining distribution- and anchor-based approaches. A functional staging model was developed to describe clinical meaningfulness of the quantitative scores provided by the NFS-CAT.
Of 250 741 patients who completed the NFS-CAT at admission (mean ± SD age, 54 ± 16 years; 65% female), 169±039 (67%) also completed the NFS-CAT at discharge. The standard error of measurement was stable across the measurement continuum, ranging from 3.7 to 3.9 NFS-CAT points. Minimal detectable improvement was 6.8 points at the 90% confidence level. The estimate of the MCII was 8.1 points, with more change points needed to achieve the MCII for patients with lower baseline scores. Large rates of functional staging change during treatment were observed, demonstrating responsiveness of the functional staging model.
This study demonstrated how the NFS-CAT can be interpreted to better assist clinicians and patients with neck impairments during outpatient rehabilitation.
Therapy, level 2b. .
患者报告结局测量的临床解读是患者为中心护理的重要步骤。尚未对源自颈部功能状态计算机自适应测试（NFS-CAT）的评分进行解读。
（1）评估点估计和改善评分的可靠性，（2）确定最小临床重要改善（MCII）的阈值，以及（3）制定功能分期模型以促进 NFS-CAT 评分的临床解读。
使用 2016-2017 年期间因颈部功能障碍开始治疗且在入院时完成 NFS-CAT 的 14 至 89 岁患者的回顾性队列分析数据进行二次分析。点估计和改善评分的可靠性由 NFS-CAT 测量标准误差得出。MCII 是通过分布和基于锚定的方法相结合来估计的。开发了一个功能分期模型，以描述 NFS-CAT 提供的定量评分的临床意义。
在完成入院时 NFS-CAT（平均 ± 标准差年龄，54 ± 16 岁；65%为女性）的 250741 例患者中，有 169±039 例（67%）在出院时也完成了 NFS-CAT。测量连续体的测量标准误差是稳定的，范围从 3.7 到 3.9 NFS-CAT 点。90%置信水平下最小可检测改善为 6.8 点。MCII 的估计值为 8.1 点，基线评分较低的患者需要更多的变化点才能达到 MCII。在治疗过程中观察到功能分期的大量变化，表明功能分期模型的反应性。
本研究展示了如何解读 NFS-CAT，以更好地帮助门诊康复期间有颈部功能障碍的临床医生和患者。
治疗，2b 级。
