Assessing the inter-rater and intra-rater reliability of the Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS).

BACKGROUND AND PURPOSE: The Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter-rater and intra-rater reliability of the PT-CAAS. METHODS: Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter-rater and intra-rater reliability. Participants were physiotherapists with suctioning experience. RESULTS: Twenty physiotherapists completed initial scoring and re-scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter-rater reliability ranged from 0.569 [lower one-sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one-sided 95% CI: 0.612; SEM: 0.722) for post-suctioning assessment and care. The inter-rater ICC for overall performance was 0.752 (lower one-sided 95% CI: 0.602; SEM: 0.660). ICCs for intra-rater reliability ranged from 0.759 (lower one-sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one-sided 95% CI: 0.544; SEM: 0.550) for post-suctioning assessment and care. The intra-rater ICC for overall performance was 0.867 (lower one-sided 95% CI: 0.559; SEM: 0.483). DISCUSSION: Evidence of moderate to good inter-rater and good intra-rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended.

Development and assessment of a verbal response scale for the Patient-Specific Functional Scale (PSFS) in a low-literacy, non-western population.

PURPOSE: The Patient-Specific Functional Scale (PSFS) is a routinely used measure of physical function with a 0-10 response scale. We aimed to develop verbal response options for the PSFS, pre-test it for use in a multilingual, low-literacy country- Nepal, and compare preference and error rates between numeric and verbal scale. We hypothesized that a verbal scale would be preferred by respondents and yield fewer errors. METHOD: We interviewed 42 individuals with musculoskeletal, neurological, and cardiopulmonary conditions to understand how people describe varying levels of physical ability. Transcripts were thematically analyzed, and through consensus, we developed two sets of verbal responses for the PSFS. Next, we pre-tested the scales on an additional 119 respondents following which participants were asked to specify their preferred scale. Error rates were analyzed retrospectively using pre-specified criteria. RESULTS: Participants described their ability in terms of the quality (95%) and the quantity of task performance (88%). Although the verbal scales were preferred over the numeric scale (50% versus 12%), there was no significant difference in error rates between numeric (34%) and verbal scales (32% and 36%). Higher error rates were associated with greater age, fewer years of education, and inexperience with numeric scales. CONCLUSION: Despite a higher preference for verbal scale, 1 out of 3 patients made errors in using the PSFS, even with an interview format. The error rates were higher among participants with low literacy. The findings raise questions about the utility of PROMs in countries with low literacy rates.

Estimating the Threshold Value for Change for the Six Dimensions of the Impairment Inventory of the Chedoke-McMaster Stroke Assessment.

Purpose: Our purpose was to estimate a threshold value for change for the six dimensions of the Impairment Inventory of the Chedoke-McMaster Stroke Assessment and the confidence in labelling a person as having improved or not. Method: Secondary analysis of two data sets, previously reported by two research teams, consisted of two statistical analyses. The first analysis used a multiple of the standard error of measurement to calculate the threshold value for change for the six dimensions. The second analysis used the diagnostic test method to calculate a threshold improvement value and the confidence a clinician had in labelling a person as having improved or not on the leg, foot, and postural control dimensions. Results: The threshold value for change was determined to be 1 impairment point (i.e., stage) for the arm, hand, leg, foot, and postural control dimensions and 2 impairment points for the shoulder pain dimension. The positive predictive values associated with the leg, foot, and postural control dimensions were 74%, 59%, and 65%, respectively. Conclusions: Clinicians can use a change of 1 impairment point for the arm, hand, leg, foot, and postural control dimensions and a change of 2 impairment points for the shoulder pain dimension to identify true change in a patient's motor recovery.

Objectif : parvenir à une valeur seuil de changement aux six dimensions de l'inventaire des déficiences de l'évaluation Chedoke-McMaster de l'AVC ainsi que de la confiance à déclarer que l'état d'une personne s'est amélioré ou non. Méthodologie : l'analyse secondaire de deux ensembles de données, dont deux équipes de recherche avaient déjà rendu compte, s'est déclinée en deux analyses statistiques. La première faisait appel à un multiple de l'écart-type de mesure pour calculer la valeur seuil de changement aux six dimensions. La seconde puisait dans la méthode de test diagnostique pour calculer une valeur d'amélioration du seuil et la confiance du clinicien à déclarer que l'état d'une personne s'est amélioré ou non dans les dimensions du contrôle de la jambe, du pied et de la posture. Résultats : les chercheurs ont établi que la valeur seuil de changement correspondait à 1 point de déficience (phase) pour les dimensions du contrôle du bras, de la main, de la jambe, du pied et de la posture et de 2 points de déficience pour la dimension de la douleur de l'épaule. Les valeurs prédictives positives associées aux dimensions de contrôle de la jambe, du pied et de la posture s'élevaient à 74 %, 59 % et 65 %, respectivement. Conclusions : les cliniciens peuvent utiliser un changement d'1 point de déficience des dimensions de contrôle du bras, de la main, de la jambe, du pied et de la posture, et un changement de 2 points de déficience pour la dimension de la douleur de l'épaule pour déclarer un véritable changement dans le rétablissement moteur du patient.

Slow Stream Rehabilitation for Older Adults: A Scoping Review.

ABSTRACTCanadian older adults with complex health problems are often considered ineligible for traditional rehabilitation programs but may benefit from slow stream rehabilitation (SSR). This scoping review summarizes the literature related to SSR for older adults, within single-payer health care systems. METHODS: Peer-reviewed and grey-literature documents relevant to older adults in SSR were systematically reviewed. RESULTS: 1,445 documents were screened independently by two reviewers [Cohen Kappa value of 0.78 (CI = 0.73, 0.83)], and included 18 documents. SSR programs were found to be multidisciplinary with a mean duration ranging from 30 to 141.2 days. SSR participants were more likely to be female, with a mean age range of 72-82 years, multiple co-morbidities and mild-to-moderate cognitive impairments. SSR participants demonstrated improvements in physical and functional measures. DISCUSSION: SSR programs have the potential to be an integral part of the continuum of care for older adults with complex medical histories.

Comparison of the sensitivity to change of the Functional Independence Measure with the Assessment of Motor and Process Skills within different rehabilitation populations.

PURPOSE: To determine whether there was a difference in the sensitivity to change of the subscales of the Functional Independence Measure and the Assessment of Motor and Process Skills within three different post-acute inpatient rehabilitation populations. MATERIAL AND METHODS: We conducted retrospective chart review of patients consecutively admitted to inpatient rehabilitation units, with both admission and discharge Functional Independence Measure and Assessment of Motor and Process Skills scores. A total of 276 participants were included and categorized into diagnostic groups (orthopedic, oncology, and geriatric). Within group, sensitivity to change was evaluated for the subscales of each measure by calculating the difference in standardized response means (SRM) and 95% confidence intervals (CI). RESULTS: The Functional Independence Measure motor subscale was more sensitive to change than the Assessment of Motor and Process Skills in the orthopedic and geriatric groups (SRMdifference = 1.53 [95% CI 0.93, 2.3] and 0.65 [95% CI 0.3, 1.02], respectively) but not in the oncology group (SRMdifference = 0.42 [95% CI -0.2, 1.04]). For the cognitive subscales, the Assessment of Motor and Process Skills was more sensitive to change than the Functional Independence Measure in all three groups (SRMdifference = 0.38 [95% CI 004, 0.74], 0.65 [95% CI 0.45, 0.90], and 1.15 [95% CI 0.77, 1.69] for orthopedic, geriatric, and oncology, respectively). CONCLUSIONS: The Functional Independence Measure is a mandated measure for all rehabilitation units in Canada. As the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change than the Functional Independence Measure, we recommend also administering the Assessment of Motor and Process Skills to better detect changes in the cognitive aspect of function. Implications for rehabilitation When deciding between the Functional Independence Measure or the Assessment of Motor and Process Skills, it is important to consider whether patients' functional status is expected to change similarly or differently. The difference in sensitivity to change between the subscales of the two outcome measures varies with the characteristics of change (similar or different) in patients' functional status. We recommend using the Assessment of Motor and Process Skills, along with the Functional Independence Measure, for patients who are expected to make similar amounts of change in functional status, as the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change and can better detect changes in the cognitive aspect of functioning. For patients whose functional status are expected to change differently (diverse diagnoses), the Functional Independence Measure may be more useful as the motor subscale was more sensitive to change when comparing between rehabilitation populations.

Development of a Telephone Interview Version of the Chedoke-McMaster Stroke Assessment Activity Inventory.

Purpose: To develop a telephone version of the Chedoke-McMaster Stroke Assessment Activity Inventory (CMSA-AI) and estimate the test-retest reliability, interrater reliability (between participant and proxy), and construct validity of the scores for individuals with stroke. Methods: Adults with stroke and their caregivers or proxies were included. Participants were assessed with the CMSA-AI at discharge from a stroke rehabilitation unit and interviewed using the telephone version (TCMSA-AI). Two months after discharge, participants were evaluated with the CMSA-AI and interviewed over the phone using the TCMSA-AI on two occasions 2-3 days apart. Proxies were interviewed with the TCMSA-AI within another 2-3 days. Results: The mean age of the 53 participants with stroke was 62 years; 59% were male; 43% had right-side hemiparesis; 42 completed follow-up interviews; and 18 had proxies who also participated. Test-retest reliability showed an intra-class correlation coefficient of 0.98 (95% CI: 0.96, 0.99) for the total score, 0.96 (95% CI: 0.91, 0.98) for the Gross Motor Function Index, and 0.96 (95% CI: 0.91, 0.98) for the Walking Index, and an interrater reliability (between participant and proxy) of 0.75 (95% CI: 0.28, 0.90) for total score. Spearman's rho correlation between CMSA-AI and TCMSA-AI total scores was 0.62 (lower-sided 95% CI: 0.42) at discharge and 0.90 (lower-sided 95% CI: 0.82) at 2 months after discharge. Correlations between the change scores of the CMSA-AI and TCMSA-AI were 0.50 or lower. Conclusion: There is potential for remote evaluation of the functional mobility of individuals with stroke in research and clinical settings.

Objectif : élaborer une version téléphonique de l'inventaire des activités post-AVC Chedoke-McMaster (CMSA­AI) et estimer la fiabilité de test-retest, la fiabilité interévaluateurs (entre le participant et le mandataire), ainsi que la validité de construit de l'évaluation. Méthode : des adultes victimes d'un AVC ont été évalués à l'aide du CMSA­AI lors de leur congé d'une unité de réadaptation post-AVC et interviewés par téléphone au moyen de la version téléphonique (TCMSA­AI). Deux mois après leur congé, les participants ont été évalués à l'aide du CMSA­AI et interviewés au téléphone à l'aide du TCMSA­AI à deux ou trois jours d'intervalle. Les mandataires ont été interviewés à l'aide du TCMSA­AI dans les deux à trois jours suivants. Résultats : parmi les 53 participants victimes d'un AVC, l'âge moyen était de 62 ans; 59% étaient des hommes; 43% souffraient d'une hémiparésie du côté droit; 42 ont répondu aux entrevues de suivi; et 18 avaient des mandataires qui ont également participé. En ce qui concerne la fiabilité de test-retest, un coefficient de corrélation intraclasse (intervalle de confiance de 95%) de 0,98 (0,96­0,99) a été calculé pour la note totale, de 0,96 (0,91­0,98) pour l'index de motricité globale et de 0,96 (0,91­0,98) pour l'index de marche. Quant à la fiabilité interévaluateurs (entre le participant et le mandataire), le coefficient mesuré était de 0,75 (0,28­0,90) pour la note totale. La corrélation (rho) de Spearman des notes totales CMSA­AI et TCMSA­AI s'élevait à 0,62 (limite de confiance unilatérale inférieure de 95%=0,42) au congé et de 0,90 (0,82) deux mois après le congé. Les corrélations des variations CMSA­AI et TCMSA­AI étaient de 0,50 ou moins. Conclusion : l'évaluation à distance de la mobilité fonctionnelle des victimes d'un AVC présente un potentiel en contextes clinique et de recherche.

Cross-cultural validation and psychometric evaluation of the Participation and Environment Measure for Children and Youth in Korea.

PURPOSE: To develop the Korean version of the Participation and Environment Measure for Children and Youth (KPEM-CY) and examine its psychometric properties. METHOD: The PEM-CY was cross-culturally translated into Korean using a specific guideline: pre-review of participation items, forward/backward translation, expert committee review, pre-test of the KPEM-CY and final review. To establish internal consistency, test-retest reliability and construct validity of the KPEM-CY, 80 parents of children with disabilities aged 5-13 years were recruited in South Korea. RESULTS: Across the home, school and community settings, 76% of participation items and 29% of environment items were revised to improve their fit with Korean culture. Internal consistency was moderate to excellent (0.67-0.92) for different summary scores. Test-retest reliability was excellent (>0.75) in the summary scores of participation frequency and extent of involvement across the three settings and moderate to excellent (0.53-0.95) in all summary scores at home. Child's age, type of school and annual income were the factors that significantly influenced specific dimensions of participation and environment across all settings. CONCLUSIONS: Results indicated that the KPEM-CY is equivalent to the original PEM-CY and has initial evidence of reliability and validity for use with Korean children with disabilities. Implications for rehabilitation Because 'participation' is a key outcome of the rehabilitation, measuring comprehensive participation of children with disabilities is necessary. The PEM-CY is a parent-report survey measure to assess comprehensive participation of children and youth and environment, which affect their participation, at home, school and in the community. A cross-cultural adaptation process is mandatory to adapt the measurement tool to a new culture or country. The Korean PEM-CY has both reliability and validity and can therefore generate useful clinical data for Korean children with disabilities.

Psychometric properties of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) in patients with musculoskeletal disorders: a replication study with additional findings.

BACKGROUND: The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a recently developed self-report outcome instrument designed to measure the extent of activity limitation as defined by the World Health Organization. OBJECTIVE: The purposes of the study were to replicate some aspects of the original study of the OPTIMAL Difficulty and Confidence scales and to conduct additional psychometric tests. DESIGN: A cross-sectional design was used in the study. METHODS: Of a total of 1,150 patients who received treatment at 4 outpatient centers over the study period, 1,030 patients were recruited for this study and completed the OPTIMAL instrument and previously validated region-specific functional status measures. A variety of analytic methods were used to examine the extent of redundancy between the OPTIMAL Difficulty and Confidence scales, as well as the internal consistency reliability, standard error of measurement, known-groups validity, and convergent validity of OPTIMAL Difficulty Scale scores. RESULTS: The OPTIMAL Difficulty and Confidence scale scores were found in a factor analysis to be load-based on anatomical region rather than on difficulty and confidence concepts. Internal consistency reliability for the subscales of the Confidence Scale varied and was .80 or higher for the lower-extremity subscale but .50 or less for the trunk and upper-extremity subscales. LIMITATIONS: Only cross-sectional relationships were examined, and another pure measure of activity limitation was not used for comparison. CONCLUSIONS: The findings generally did not support the psychometric properties of the OPTIMAL instrument. Although not conclusive, the data suggested that the OPTIMAL Difficulty and Confidence scales demonstrate substantial overlap. Reliability was generally low, with the exception of the lower-extremity subscale. Scores for the subscales of the Difficulty Scale differentiated among patients with lower-extremity versus trunk or upper-extremity diagnoses, but associations with previously validated region-specific measures were generally weak or absent. Clinicians treating outpatients with musculoskeletal disorders should consider alternative measures when attempting to quantify the extent of activity limitations.

Estimating the Accuracy of the Chedoke-McMaster Stroke Assessment Predictive Equations for Stroke Rehabilitation.

PURPOSE: To estimate the predictive accuracy and clinical usefulness of the Chedoke-McMaster Stroke Assessment (CMSA) predictive equations. METHOD: A longitudinal prognostic study using historical data obtained from 104 patients admitted post cerebrovascular accident was undertaken. Data were abstracted for all patients undergoing rehabilitation post stroke who also had documented admission and discharge CMSA scores. Published predictive equations were used to determine predicted outcomes. To determine the accuracy and clinical usefulness of the predictive model, shrinkage coefficients and predictions with 95% confidence bands were calculated. RESULTS: Complete data were available for 74 patients with a mean age of 65.3±12.4 years. The shrinkage values for the six Impairment Inventory (II) dimensions varied from -0.05 to 0.09; the shrinkage value for the Activity Inventory (AI) was 0.21. The error associated with predictive values was greater than ±1.5 stages for the II dimensions and greater than ±24 points for the AI. CONCLUSIONS: This study shows that the large error associated with the predictions (as defined by the confidence band) for the CMSA II and AI limits their clinical usefulness as a predictive measure. Further research to establish predictive models using alternative statistical procedures is warranted.

Inter-rater agreement and reliability of the COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist.

BACKGROUND: The COSMIN checklist is a tool for evaluating the methodological quality of studies on measurement properties of health-related patient-reported outcomes. The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist (n = 114). METHODS: 75 articles evaluating measurement properties were randomly selected from the bibliographic database compiled by the Patient-Reported Outcome Measurement Group, Oxford, UK. Raters were asked to assess the methodological quality of three articles, using the COSMIN checklist. In a one-way design, percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item. RESULTS: 88 raters participated. Of the 75 selected articles, 26 articles were rated by four to six participants, and 49 by two or three participants. Overall, percentage agreement was appropriate (68% was above 80% agreement), and the kappa coefficients for the COSMIN items were low (61% was below 0.40, 6% was above 0.75). Reasons for low inter-rater agreement were need for subjective judgement, and accustom to different standards, terminology and definitions. CONCLUSIONS: Results indicated that raters often choose the same response option, but that it is difficult on item level to distinguish between articles. When using the COSMIN checklist in a systematic review, we recommend getting some training and experience, completing it by two independent raters, and reaching consensus on one final rating. Instructions for using the checklist are improved.

The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content.

BACKGROUND: The COSMIN checklist (COnsensus-based Standards for the selection of health status Measurement INstruments) was developed in an international Delphi study to evaluate the methodological quality of studies on measurement properties of health-related patient reported outcomes (HR-PROs). In this paper, we explain our choices for the design requirements and preferred statistical methods for which no evidence is available in the literature or on which the Delphi panel members had substantial discussion. METHODS: The issues described in this paper are a reflection of the Delphi process in which 43 panel members participated. RESULTS: The topics discussed are internal consistency (relevance for reflective and formative models, and distinction with unidimensionality), content validity (judging relevance and comprehensiveness), hypotheses testing as an aspect of construct validity (specificity of hypotheses), criterion validity (relevance for PROs), and responsiveness (concept and relation to validity, and (in) appropriate measures). CONCLUSIONS: We expect that this paper will contribute to a better understanding of the rationale behind the items, thereby enhancing the acceptance and use of the COSMIN checklist.

The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.

BACKGROUND: Aim of the COSMIN study (COnsensus-based Standards for the selection of health status Measurement INstruments) was to develop a consensus-based checklist to evaluate the methodological quality of studies on measurement properties. We present the COSMIN checklist and the agreement of the panel on the items of the checklist. METHODS: A four-round Delphi study was performed with international experts (psychologists, epidemiologists, statisticians and clinicians). Of the 91 invited experts, 57 agreed to participate (63%). Panel members were asked to rate their (dis)agreement with each proposal on a five-point scale. Consensus was considered to be reached when at least 67% of the panel members indicated 'agree' or 'strongly agree'. RESULTS: Consensus was reached on the inclusion of the following measurement properties: internal consistency, reliability, measurement error, content validity (including face validity), construct validity (including structural validity, hypotheses testing and cross-cultural validity), criterion validity, responsiveness, and interpretability. The latter was not considered a measurement property. The panel also reached consensus on how these properties should be assessed. CONCLUSIONS: The resulting COSMIN checklist could be useful when selecting a measurement instrument, peer-reviewing a manuscript, designing or reporting a study on measurement properties, or for educational purposes.

Patients can provide a valid assessment of quality of life, functional status, and general health on the day they undergo knee surgery.

BACKGROUND: In the interest of efficiency, investigators often offer participants in surgical trials the option of completing baseline assessments on the day of surgery. The emotional affects of this day may, however, increase bias or random error. We studied the validity and reliability of collecting subjective ratings of health on the day of surgery. METHODS: One hundred and seventy-seven patients undergoing anterior cruciate ligament reconstruction and/or knee arthroscopy completed quality-of-life, functional status, and general health instruments at four weeks preoperatively, on the day of surgery, and one year postoperatively. We evaluated results with use of three conceptual frameworks: (1) that ratings provided four weeks preoperatively provide a gold standard for preoperative ratings, (2) that there is no gold standard for preoperative ratings and that, if valid, ratings on the day of surgery should be highly correlated with ratings at four weeks preoperatively and moderately and similarly correlated with ratings at one year postoperatively, and (3) that ratings provided four weeks preoperatively and on the day of surgery are measuring identical constructs and should therefore show high reliability. RESULTS: Most patients (97%) had a chronic injury as the interval between the injury and surgery was more than ninety days. Data collected on the day of surgery demonstrated high predictive validity with data collected within one month before surgery. There was no significant heterogeneity between variances for data collected four weeks preoperatively and on the day of surgery. The correlation between data collected on the day of surgery and four weeks preoperatively was moderate to high (range, 0.64 to 0.93), and the correlation between preoperative ratings and the one-year postoperative ratings was moderate (range, 0.40 to 0.59) across all instruments. Agreement between the ratings provided four weeks preoperatively and on the day of surgery was excellent (intraclass correlation coefficient, 0.64 to 0.91), and the standard error of measurement was small across instruments. CONCLUSIONS: In the treatment of chronic knee injuries, patients can accurately rate their quality of life, general health, and functional status on the day on which they undergo surgery.

Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments.

BACKGROUND AND OBJECTIVE: To develop computerized adaptive tests (CATs) designed to assess lower extremity functional status (FS) in people with lower extremity impairments using items from the Lower Extremity Functional Scale and compare discriminant validity of FS measures generated using all items analyzed with a rating scale Item Response Theory model (theta(IRT)) and measures generated using the simulated CATs (theta(CAT)). METHODS: Secondary analysis of retrospective intake rehabilitation data. RESULTS: Unidimensionality of items was strong, and local independence of items was adequate. Differential item functioning (DIF) affected item calibration related to body part, that is, hip, knee, or foot/ankle, but DIF did not affect item calibration for symptom acuity, gender, age, or surgical history. Therefore, patients were separated into three body part specific groups. The rating scale model fit all three data sets well. Three body part specific CATs were developed: each was 70% more efficient than using all LEFS items to estimate FS measures. theta(IRT) and theta(CAT) measures discriminated patients by symptom acuity, age, and surgical history in similar ways. theta(CAT) measures were as precise as theta(IRT) measures. CONCLUSION: Body part-specific simulated CATs were efficient and produced precise measures of FS with good discriminant validity.

Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change.

OBJECTIVE: We determined whether the sensitivity to change of the Western Ontario McMaster Osteoarthritis Index (WOMAC) physical function (PF) subscale, a condition-specific measure for persons with osteoarthritis of the hip or knee, was superior to a lower extremity region-specific measure, the Lower Extremity Functional Scale (LEFS), in persons with osteoarthritis of the hip or knee undergoing total joint arthroplasty. METHODS: The WOMAC and LEFS were administered to 102 patients with osteoarthritis preoperatively, within 16 days of surgery, and >20 days after the first postoperative assessment. These time points enabled the assessment of deterioration and improvement. Two timed performance measures (40 m walk test and the timed-up-and-go test) were also assessed. Change was quantified by the standardized response mean (SRM). RESULTS: WOMAC PF SRMs were not greater than the LEFS SRMs. Performance measures' times increased significantly over the deterioration interval and decreased over the improvement interval. The WOMAC PF and LEFS demonstrated significant improvement over the second assessment interval; only the LEFS showed significant deterioration over the first assessment interval. WOMAC PF scores seem to be strongly influenced by pain. CONCLUSION: The findings do not support the hypothesis that the WOMAC PF subscale is superior to the LEFS in detecting change.

The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales.

STUDY DESIGN: Prospective observation study. OBJECTIVES: To compare the test-retest reliability and longitudinal validity (sensitivity to change) of 2 single-item numeric pain rating scales (NPRSs) with a 4-item pain intensity measure (P4). BACKGROUND: Pain is a frequent outcome measure for patients seen in physical therapy; however, the error associated with efficient pain measures, such as the single-item NPRS, is greater than for self-report measures of functional status. Initial evaluation of the P4 suggests that it is more reliable and sensitive to change than the NPRS. METHODS AND MEASURES: Two single-item NPRSs and the P4 were administered on 3 occasions--initial visit (n = 220), within 72 hours of baseline (n = 213), and 12 days following baseline assessment (n = 183)--to patients with musculoskeletal problems receiving physical therapy. Reliability was assessed using a type 2,1 intraclass correlation coefficient. Longitudinal validity was assessed by correlating the measures' change scores with a retrospective rating of change that included patients' and clinicians' perspectives. RESULTS: The test-retest reliability and longitudinal validity of the P4 were significantly greater (P1<.05) than both single-item NPRSs. Minimal detectable change of the P4 at the 90% confidence level was estimated to be a change of 22% of the scale range (9 points) compared to 27.3% (3 points) and 31.8% (3.5 points) for the 2-day NPRS and 24-hour NPRS, respectively. CONCLUSIONS: The findings of this study suggest the P4 is more adept at assessing change in pain intensity than popular versions of single-item NPRSs.