使用 PROMIS 计算机自适应测试评估接受肾脏替代治疗的患者的疲劳情况。

Assessing Fatigue in Patients Receiving Kidney Replacement Therapy Using PROMIS Computer Adaptive Testing.

机构信息

Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario.

Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, Ontario; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario.

出版信息

Am J Kidney Dis. 2023 Jul;82(1):33-42.e1. doi: 10.1053/j.ajkd.2022.12.018. Epub 2023 Mar 9.

DOI:10.1053/j.ajkd.2022.12.018

PMID:36906218

Abstract

RATIONALE & OBJECTIVE: Fatigue is a debilitating symptom for many patients receiving kidney replacement therapy (KRT). Patient-reported outcome measures can help clinicians identify and manage fatigue efficiently. We assessed the measurement characteristics of the Patient Reported Outcome Measurement Information System (PROMIS)-Fatigue Computer Adaptive Test (PROMIS-F CAT) in patients receiving KRT using the previously validated Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire.

STUDY DESIGN

Cross-sectional study.

SETTING & PARTICIPANTS: 198 adults treated with dialysis or recipients of a kidney transplant in Toronto, Canada.

PREDICTORS

Demographic data, FACIT-F scores, KRT type.

OUTCOME

Measurement properties of PROMIS-F CAT T scores.

ANALYTICAL APPROACH

Reliability and test-retest reliability were assessed using standard errors of measurement and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed using correlation and comparisons across predefined groups expected to have different levels of fatigue. Receiver operating characteristic (ROC) curves were used to assess the discrimination of PROMIS-F CAT, with clinically relevant fatigue defined by a FACIT-F score of≤30.

RESULTS

Of the 198 participants, 57% were male, the mean±SD age was 57±14 years; 65% had received a kidney transplant. Based on the FACIT-F score, 47 patients (24%) had clinically relevant fatigue. PROMIS-F CAT and FACIT-F were strongly correlated (ρ =-0.80, P<0.001). PROMIS-F CAT had excellent reliability (>0.90 for 98% of sample), and good test-retest reliability (ICC=0.85). The ROC analysis demonstrated outstanding discrimination (area under ROC=0.93 [95%, CI 0.89-0.97]). A PROMIS-F CAT cutoff score of≥59 accurately identified most patients with clinically relevant fatigue (sensitivity=0.83; specificity=0.91).

LIMITATIONS

A convenience sample of clinically stable patients. FACIT-F items are a part of the PROMIS-F item bank, although there was minimal overlap with only 4 FACIT-F items completed in PROMIS-F CAT.

CONCLUSIONS

PROMIS-F CAT has robust measurement properties with low question burden to assess fatigue among patients with KRT.

摘要

背景与目的

疲劳是接受肾脏替代治疗（KRT）的许多患者的一种虚弱症状。患者报告的结局测量可以帮助临床医生有效地识别和管理疲劳。我们使用先前经过验证的慢性疾病治疗功能评估-疲劳（FACIT-F）问卷评估了接受 KRT 的患者使用患者报告的结果测量信息系统（PROMIS）-疲劳计算机自适应测试（PROMIS-F CAT）的测量特性。

研究设计

横断面研究。

地点和参与者

加拿大多伦多的 198 名接受透析或肾移植的成年人。

预测因素

人口统计学数据、FACIT-F 评分、KRT 类型。

结局

PROMIS-F CAT T 分数的测量特性。

分析方法

使用测量标准误差和组内相关系数（ICC）分别评估可靠性和重测信度。使用相关性和与预期具有不同疲劳水平的预定义组进行比较来评估结构有效性。使用接收器工作特征（ROC）曲线评估 PROMIS-F CAT 的区分能力，以 FACIT-F 评分≤30 定义为具有临床相关疲劳。

结果

在 198 名参与者中，57%为男性，平均年龄±标准差为 57±14 岁；65%接受过肾移植。根据 FACIT-F 评分，47 名患者（24%）存在临床相关疲劳。PROMIS-F CAT 和 FACIT-F 相关性很强（ρ=-0.80，P<0.001）。PROMIS-F CAT 具有极好的可靠性（98%的样本可靠性>0.90），并且具有良好的重测信度（ICC=0.85）。ROC 分析表明，区分能力非常出色（ROC 曲线下面积=0.93[95%置信区间，0.89-0.97]）。PROMIS-F CAT 截距分数≥59 可以准确识别大多数具有临床相关疲劳的患者（敏感性=0.83；特异性=0.91）。