Network Aging Research, Heidelberg University, Heidelberg, Germany.
Medical Faculty, Heidelberg University, Heidelberg, Germany.
J Geriatr Phys Ther. 2022;45(3):134-144. doi: 10.1519/JPT.0000000000000303. Epub 2021 Mar 12.
The Patient-Specific Functional Scale (PSFS) is an individualized patient-reported outcome measure designed to assess the limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI).
The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients-83.0 (6.4) years-with and without CI (Mini-Mental State Examination [MMSE] score 18-23, n = 52, and MMSE ≥24, n = 68, respectively) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (rs) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects.
The PSFS showed fair to moderate correlations with all construct variables in patients with CI (rs = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (rs = |0.27 to 0.36|), but low for the SPPB and DEMMI (rs =-0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in either subgroup.
The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment.
患者特定功能量表（PSFS）是一种个体化的患者报告结局测量工具，旨在评估急性护理环境中对老年患者最重要的自我决定的功能活动的限制和变化。然而，其临床计量学特性尚未在这些患者中得到评估。本研究旨在调查 PSFS 在伴有和不伴有认知障碍（CI）的急性住院老年患者中的构念效度、重测信度、变化敏感性和可行性。
通过对一项前瞻性观察队列研究中评估急性住院老年患者身体活动和移动性的二次数据分析，调查 PSFS 的临床计量学特性。在该分析中，纳入了 120 名年龄较大的患者（83.0（6.4）岁），伴有和不伴有 CI（简易精神状态检查[MMSE]评分 18-23 分，n=52 和 MMSE≥24 分，n=68），在急性护理中接受早期多学科老年康复治疗。构念效度通过与活动特异性平衡信心量表（ABC-6）、简短跌倒效能国际量表（Short FES-I）、欧洲五维健康量表（EQ-5D）、简短体能测试电池（SPPB）、德莫顿移动指数（DEMMI）和巴氏指数（BI）的斯皮尔曼相关系数（rs）进行评估；在 24 小时内通过组内相关系数（ICC）进行重测信度评估；通过计算治疗效果的标准化反应均值（SRM）来评估变化敏感性；通过完成率/时间和地板/天花板效应评估可行性。
PSFS 在伴有 CI 的患者中与所有结构变量呈中等至中度相关（rs=0.31 至 0.53）。在不伴有 CI 的患者中，与 ABC-6、FES-I、EQ-5D 和 BI 的相关性中等（rs=|0.27 至 0.36|），但与 SPPB 和 DEMMI 的相关性较低（rs=-0.04 至 0.14）。在两个亚组中，重测信度（均 ICC=0.76）和变化敏感性（CI：SRM=1.10，非 CI：SRM=0.89）均非常好。在两个亚组中，均记录到较高的完成率（>94%）、较短的完成时间（<8 分钟）和无地板/天花板效应，表明可行性极好。
PSFS 具有评估伴有和不伴有 CI 的急性住院老年患者特定功能限制和变化的适当临床计量学特性。它可能是传统功能量表的一个合适补充，可增强临床老年评估中的以患者为中心。
