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The article presents a research on patients reported outcome (PRO) surveys to quantify health related functional status (FS). Its objectives are to compare discriminating ability and minimal clinically important improvement (MCII) calculated FS and on Modified Oswestry low back pain disability questionnaire (ODQ). It discusses several methods, procedures, data analysis and descriptive statistics. It concludes with the analysis performed on patients with Lumbar spine syndrome.

The article examines the association between changes in psychosocial distress (PD), functional status and pain intensity in patients with lumbar impairments referred to physical therapy services. The study categorized the patients according to their levels of risk for persistent disability using the Symptom Checklist Back pain Prediction Model questionnaire. Results showed the proportions of patients classified by patterns of PD change and their level of association with higher pain intensity.

The article presents a study on the effect of adding a single-item variable of fear-avoidance beliefs on physical activities of patients on a model which predicts risk-adjusted functional status (FS) outcomes. Determining this may allow patients with lumbar spine dysfunction to be managed properly. Methods involving models of discharge FS were used to compare fear-avoidance scores. It was shown that elevated fear-avoidance beliefs improve the FS outcomes of predictive model, but additional meaningful interpretation was minimal.

The article discusses highlights of a study that determines the association between directional preference (DP) and centralization in individuals with low back pain. The study methodology is discussed. The study showed that the overall prevalence of DP and centralized (CEN) was 60 percent and 41 percent, respectively. The study concludes with a suggestion that classification by pain patten and DP can improved the ability of a therapist to provide a short-term prognosis for pain and function outcomes.

The article evaluates the efficiency and psychometric adequacy of a computerized adaptive test (CAT) for patients with lumbar spine impairments. The results of the study revealed that patients who were older found to have more chronic symptoms, more surgeries and more comorbidities. It was found out that the CAT functional status (FS) measures were precise, valid, sensitive and responsive which suggests that it supports the lumbar CAT use in clinical and research applications.

The article discusses research on the clinical interpretation of outcome measures in patients exhibiting foot/ankle impairments provided by computerized adaptive testing (CAT). It mentions that more and more clinical studies are using patient-reported outcomes (PRO) yet little evidence exists regarding the positive impact of PRO use on patient health. Results imply that CATs have the potential to hold clinical meaning in medical research once clinical interpretation is added to the CAT estimated functional measures.

Abstract: Objective: Assess practicality of using a computerized adaptive test (CAT) in routine clinical practice, perform a psychometric evaluation of content range coverage and test precision, and assess known group construct validity, sensitivity to change and responsiveness of knee CAT functional status (FS) measures. Study Design and Setting: Secondary analysis of retrospective intake and discharge rehabilitation FS data collected in a prospective cohort study. Data represented a convenience sample of 21,896 patients with knee impairments receiving outpatient physical therapy in 291 clinics in 30 U.S. states (2005–2007). Results: The CAT used an average of seven items to produce precise estimates of FS that adequately covered the content range with negligible floor and ceiling effects. Test information functions and standard errors supported FS measure precision. FS measures discriminated patients by age, symptom acuity, surgical history, condition complexity, and prior exercise history in clinically logical ways. Seventy-two percent of patients obtained discharge FS measures ≥ minimal detectable change (95% confidence interval). Change of 9 FS units (0–100 scale) represented minimal clinically important improvement, which 67% of patients obtained. Conclusion: The knee CAT was efficient and produced precise, valid, and responsive measures of FS for patients receiving therapy for knee impairments and functioned well in routine clinical application. [Copyright &y& Elsevier]

Abstract: Objective: To equate physical functioning (PF) items with Back Pain Functional Scale (BPFS) items, develop a computerized adaptive test (CAT) designed to assess lumbar spine functional status (LFS) in people with lumbar spine impairments, and compare discriminant validity of LFS measures (θIRT) generated using all items analyzed with a rating scale Item Response Theory model (RSM) and measures generated using the simulated CAT (θCAT). Methods: We performed a secondary analysis of retrospective intake rehabilitation data. Results: Unidimensionality and local independence of 25 BPFS and PF items were supported. Differential item functioning was negligible for levels of symptom acuity, gender, age, and surgical history. The RSM fit the data well. A lumbar spine specific CAT was developed that was 72% more efficient than using all 25 items to estimate LFS measures. θIRT and θCAT measures did not discriminate patients by symptom acuity, age, or gender, but discriminated patients by surgical history in similar clinically logical ways. θCAT measures were as precise as θIRT measures. Conclusion: A body part specific simulated CAT developed from an LFS item bank was efficient and produced precise measures of LFS without eroding discriminant validity. [Copyright &y& Elsevier]

Abstract: Background and Objective: To test unidimensionality and local independence of a set of shoulder functional status (SFS) items, develop a computerized adaptive test (CAT) of the items using a rating scale item response theory model (RSM), and compare discriminant validity of measures generated using all items (θIRT) and measures generated using the simulated CAT (θCAT). Study Design and Setting: We performed a secondary analysis of data collected prospectively during rehabilitation of 400 patients with shoulder impairments who completed 60 SFS items. Results: Factor analytic techniques supported that the 42 SFS items formed a unidimensional scale and were locally independent. Except for five items, which were deleted, the RSM fit the data well. The remaining 37 SFS items were used to generate the CAT. On average, 6 items were needed to estimate precise measures of function using the SFS CAT, compared with all 37 SFS items. The θIRT and θCAT measures were highly correlated (r = .96) and resulted in similar classifications of patients. Conclusion: The simulated SFS CAT was efficient and produced precise, clinically relevant measures of functional status with good discriminating ability. [Copyright &y& Elsevier]

Abstract: 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 (θIRT) and measures generated using the simulated CATs (θCAT). 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. θIRT and θCAT measures discriminated patients by symptom acuity, age, and surgical history in similar ways. θCAT measures were as precise as θIRT measures. Conclusion: Body part-specific simulated CATs were efficient and produced precise measures of FS with good discriminant validity. [Copyright &y& Elsevier]

Abstract: Objective: 1) examine association between the Functional Comorbidity Index (FCI) and discharge functional status (FS); 2) examine impact of FCI on FS when added to comprehensive models; and 3) compare additive FCI with weighted FCI and list of condition variables (list). Study Design and Setting: Patients were drawn from Focus On Therapeutic Outcomes, Inc. (FOTO) database (1/1/06–12/31/07). FS collected using computer adaptive tests. Linear regression examined association between FCI and FS. Three methods of including functional comorbidities (FC) were compared. Results: Relationship between FCI and FS varied by group (range, 0.02–0.9). Models with weighted index or list had similar R 2. Weighted FCI or list increased R 2 of crude models by <0.01 for cervical, shoulder, and lumbar; by 0.01 for wrist/hand, knee, and foot/ankle; by 0.02 for hip; by 0.03 for elbow; and by 0.08 for neurological. Addition of FCI to comprehensive models added <0.01 to R 2 (all groups). Weighted FCI increased R 2 by <0.01 for cervical, lumbar, and shoulder; by 0.01 for wrist/hand, hip, knee, and foot/ankle; by 0.02 for elbow; and by 0.04 for neurological; whereas list increased R 2 by <0.01 for cervical, shoulder, and lumbar; by 0.01 for knee and foot/ankle; by 0.02 for elbow, wrist/hand, and hip; and by 0.05 for neurological. Conclusion: List of comorbidities or weighted FCI is preferable to using additive FCI. [Copyright &y& Elsevier]