Center for Patient-Centered Outcomes Research (CPCOR), Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, 10117, Berlin, Germany.
Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
Qual Life Res. 2024 Nov;33(11):2987-3001. doi: 10.1007/s11136-024-03745-6. Epub 2024 Aug 5.
We applied a previously established common T-score metric for patient-reported and performance-based physical function (PF), offering the unique opportunity to directly compare measurement type-specific patterns of associations with potential laboratory-based, psychosocial, sociodemographic, and health-related determinants in hemodialysis patients.
We analyzed baseline data from the CONVINCE trial (N = 1,360), a multinational randomized controlled trial comparing high-flux hemodialysis with high-dose hemodiafiltration. To explore the associations of potential determinants with performance-based versus patient-reported PF, we conducted multiple linear regression (backward elimination with cross-validation and Lasso regression). We used standardized T-scores as estimated from the PROMIS PF short-form 4a (patient-reported PF) and the Physical Performance Test (performance-based PF) as dependent variables.
Performance-based and patient-reported PF were both significantly associated with a laboratory marker-based indicator of muscle mass (simplified creatinine index), although the effects were relatively small (partial f = 0.04). Age was negatively associated with PF; the effect size was larger for performance-based (partial f = 0.12) than for patient-reported PF (partial f = 0.08). Compared to performance-based PF, patient-reported PF showed a stronger association with self-reported health domains, particularly pain interference and fatigue. When using the individual difference between patient-reported and performance-based T-scores as outcome, we found that younger age and more fatigue were associated with lower patient-reported PF compared to performance-based PF (small effect size).
Patient-reported and performance-based assessments were similarly associated with an objective marker of physical impairment in hemodialysis patients. Age and fatigue may result in discrepancies when comparing performance-based and patient-reported scores on the common PF scale. Trial Registration CONVINCE is registered in the Dutch Trial Register (Register ID: NL64750.041.18). The registration can be accessed at: https://onderzoekmetmensen.nl/en/trial/52958 .
我们应用了一种先前建立的用于患者报告和基于表现的身体功能（PF）的通用 T 评分度量标准，从而有机会直接比较特定于测量类型的关联模式，以及与血液透析患者潜在的实验室、心理社会、社会人口学和健康相关决定因素的关联。
我们分析了 CONVINCE 试验（N=1360）的基线数据，该试验是一项多国随机对照试验，比较了高通量血液透析与高剂量血液透析滤过。为了探索潜在决定因素与基于表现和患者报告的 PF 的关联，我们进行了多元线性回归（带交叉验证的逐步向后消除和套索回归）。我们使用标准化 T 评分作为 PROMIS PF 短式 4a（患者报告 PF）和物理表现测试（基于表现的 PF）的因变量进行估计。
基于表现和患者报告的 PF 均与肌肉量的实验室标志物指标（简化肌酐指数）显著相关，尽管影响相对较小（部分 f=0.04）。年龄与 PF 呈负相关；与基于表现的 PF 相比，该效应大小更大（部分 f=0.12），而患者报告的 PF 则较小（部分 f=0.08）。与基于表现的 PF 相比，患者报告的 PF 与自我报告的健康领域有更强的关联，特别是疼痛干扰和疲劳。当使用患者报告和基于表现的 T 评分之间的个体差异作为结果时，我们发现与基于表现的 PF 相比，年龄较小和疲劳程度较高与患者报告的 PF 较低相关（效应大小较小）。
患者报告和基于表现的评估在血液透析患者中与物理损伤的客观标志物相似相关。在比较基于表现和患者报告的通用 PF 量表评分时，年龄和疲劳可能会导致差异。
CONVINCE 注册于荷兰试验注册中心（注册号：NL64750.041.18）。可在以下网址查询注册信息：https://onderzoekmetmensen.nl/en/trial/52958。
