Net Health Systems, Inc, Pittsburgh, PA; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Arch Phys Med Rehabil. 2021 Aug;102(8):1576-1587. doi: 10.1016/j.apmr.2021.02.005. Epub 2021 Mar 5.
To calibrate the Lower Extremity Functional Scale (LEFS) items into a regional lower extremity physical function (LEPF) item bank and assess reliability, validity, and efficiency of computerized adaptive test (CAT) and short form (SF) administration modes.
Retrospective cohort.
Data were collected from patients treated in outpatient rehabilitation clinics for musculoskeletal impairments of the hip, knee, foot, and ankle that responded to all 20 LEFS items at intake.
Patients aged 14 years or older who started an episode of care during January 2016-October 2019 and identified the lower extremity region as the source of a primary musculoskeletal complaint. Total cohort included 78,186 patients (mean age, 53±19y, range, 14-89y).
Not applicable.
Item response theory (IRT) model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were studied. LEPF-CAT- and LEPF-SF-generated scores were evaluated.
An 18-item solution was supported for its unidimensionality and fit to the IRT model, with reliability estimates >0.9 for all administration modes. No DIF impact on LEPF scores was identified. Scores discriminated between multiple patient groups in clinically logical ways and were highly responsive to change, with negligible floor or ceiling effects. CAT scores were generated using an average of 4.9 items (median, 4).
The LEPF scores were reliable, valid, and efficient for assessing perceived physical function of patients with musculoskeletal impairments of the hip, knee, foot, and ankle; thus, it was found suitable for research and routine clinical administration. These findings are limited to the type of patients included in this study, with further validation needed to assess their generalizability.
将下肢功能量表（LEFS）项目校准为区域下肢物理功能（LEPF）项目库，并评估计算机自适应测试（CAT）和简短形式（SF）管理模式的可靠性、有效性和效率。
回顾性队列研究。
数据来自于在门诊康复诊所接受治疗的肌肉骨骼髋关节、膝关节、足部和踝关节损伤的患者，这些患者在入组时对所有 20 个 LEFS 项目均有反应。
年龄在 14 岁及以上，在 2016 年 1 月至 2019 年 10 月期间开始接受治疗，并将下肢区域确定为主要肌肉骨骼抱怨的来源的患者。总队列包括 78186 名患者（平均年龄 53±19 岁，范围 14-89 岁）。
不适用。
研究了项目反应理论（IRT）模型的单维性、局部项目独立性、项目拟合和存在差异项目功能（DIF）的假设。评估了 LEPF-CAT 和 LEPF-SF 生成的分数。
支持 18 项解决方案，因为它具有单维性和与 IRT 模型的拟合度，所有管理模式的可靠性估计值均>0.9。未发现 LEPF 分数存在 DIF 影响。分数以临床合理的方式区分了多个患者群体，并且对变化高度敏感，几乎没有地板或天花板效应。CAT 分数使用平均 4.9 个项目生成（中位数为 4）。
LEPF 评分对于评估髋、膝、足和踝肌肉骨骼损伤患者的感知身体功能是可靠、有效和高效的；因此，它被发现适合于研究和常规临床管理。这些发现仅限于本研究中包含的患者类型，需要进一步验证以评估其普遍性。
