Development and assessment of floor and ceiling items for the PROMIS physical function item bank

Arthritis Research & Therapy, Oct 2013

Introduction Disability and Physical Function (PF) outcome assessment has had limited ability to measure functional status at the floor (very poor functional abilities) or the ceiling (very high functional abilities). We sought to identify, develop and evaluate new floor and ceiling items to enable broader and more precise assessment of PF outcomes for the NIH Patient-Reported-Outcomes Measurement Information System (PROMIS). Methods We conducted two cross-sectional studies using NIH PROMIS item improvement protocols with expert review, participant survey and focus group methods. In Study 1, respondents with low PF abilities evaluated new floor items, and those with high PF abilities evaluated new ceiling items for clarity, importance and relevance. In Study 2, we compared difficulty ratings of new floor items by low functioning respondents and ceiling items by high functioning respondents to reference PROMIS PF-10 items. We used frequencies, percentages, means and standard deviations to analyze the data. Results In Study 1, low (n = 84) and high (n = 90) functioning respondents were mostly White, women, 70 years old, with some college, and disability scores of 0.62 and 0.30. More than 90% of the 31 new floor and 31 new ceiling items were rated as clear, important and relevant, leaving 26 ceiling and 30 floor items for Study 2. Low (n = 246) and high (n = 637) functioning Study 2 respondents were mostly White, women, 70 years old, with some college, and Health Assessment Questionnaire (HAQ) scores of 1.62 and 0.003. Compared to difficulty ratings of reference items, ceiling items were rated to be 10% more to greater than 40% more difficult to do, and floor items were rated to be about 12% to nearly 90% less difficult to do. Conclusions These new floor and ceiling items considerably extend the measurable range of physical function at either extreme. They will help improve instrument performance in populations with broad functional ranges and those concentrated at one or the other extreme ends of functioning. Optimal use of these new items will be assisted by computerized adaptive testing (CAT), reducing questionnaire burden and insuring item administration to appropriate individuals.

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Development and assessment of floor and ceiling items for the PROMIS physical function item bank

Bonnie Bruce 0 2 James Fries 0 2 Bharathi Lingala 0 2 Yusra Nazar Hussain 1 2 Eswar Krishnan 0 2 0 Stanford University Department of Medicine, Division of Rheumatology & Immunology , 1000 Welch Rd., Suite 203, Palo Alto, CA 94304 , USA 1 Stanford University Department of Medicine, Division of General Internal Medicine , 211 Quarry Road, Suite 302, MC 5988, Palo Alto, CA 94304-1426 , USA 2 University of Washington , Seattle, PIs: Dagmar Amtmann, PhD and Karon Cook, PhD , 1U01AR052171; University of North Carolina , Chapel Hill, PI: Darren A. DeWalt, MD, MPH , 2U01AR052181; Children's Hospital of Philadelphia , PI: Christopher B. Forrest, MD , PhD, 1U01AR057956; Stanford University , PI: James F. Fries, MD , 2U01AR052158; Boston University , PIs: Stephen M. Haley, PhD and David Scott Tulsky , PhD (University of Michigan, Ann Arbor), 1U01AR057929; University of California , Los Angeles, PIs: Dinesh Khanna, MD and Brennan Spiegel, MD, MSHS , 1U01AR057936; University of Pittsburgh, PI: Paul A. Pilkonis, PhD, 2U01AR052155; Georgetown University , PIs: Carol. M. Moinpour , PhD (Fred Hutchinson Cancer Research Center, Seattle) and Arnold L. Potosky, PhD, U01AR057971; Children's Hospital Medical Center , Cincinnati, PI: Esi M. Morgan DeWitt, MD, MSCE , 1U01AR057940; University of Maryland , Baltimore, PI: Lisa M. Shulman, MD , 1U01AR057967; and Duke University , PI: Kevin P. Weinfurt, PhD , 2U01AR052186). NIH Science Officers on this project have included Deborah Ader , PhD, Vanessa Ameen, MD, Susan Czajkowski, PhD, Basil Eldadah, MD, PhD, Lawrence Fine, MD, DrPH, Lawrence Fox, MD, PhD, Lynne Haverkos, MD, MPH, Thomas Hilton, PhD, Laura Lee Johnson, PhD, Michael Kozak, PhD, Peter Lyster, PhD, Donald Mattison, MD, Claudia Moy, PhD, Louis Quatrano, PhD, Bryce Reeve, PhD, William Riley, PhD, Ashley Wilder Smith, PhD, MPH, Susana Serrate-Sztein, MD, Ellen Werner, PhD and James Witter, MD , PhD. This manuscript was reviewed by PROMIS reviewers before submission for external peer review. See the Web site at http://www.nihpromis.org for additional information on the PROMIS initiative Introduction: Disability and Physical Function (PF) outcome assessment has had limited ability to measure functional status at the floor (very poor functional abilities) or the ceiling (very high functional abilities). We sought to identify, develop and evaluate new floor and ceiling items to enable broader and more precise assessment of PF outcomes for the NIH Patient-Reported-Outcomes Measurement Information System (PROMIS). Methods: We conducted two cross-sectional studies using NIH PROMIS item improvement protocols with expert review, participant survey and focus group methods. In Study 1, respondents with low PF abilities evaluated new floor items, and those with high PF abilities evaluated new ceiling items for clarity, importance and relevance. In Study 2, we compared difficulty ratings of new floor items by low functioning respondents and ceiling items by high functioning respondents to reference PROMIS PF-10 items. We used frequencies, percentages, means and standard deviations to analyze the data. Results: In Study 1, low (n = 84) and high (n = 90) functioning respondents were mostly White, women, 70 years old, with some college, and disability scores of 0.62 and 0.30. More than 90% of the 31 new floor and 31 new ceiling items were rated as clear, important and relevant, leaving 26 ceiling and 30 floor items for Study 2. Low (n = 246) and high (n = 637) functioning Study 2 respondents were mostly White, women, 70 years old, with some college, and Health Assessment Questionnaire (HAQ) scores of 1.62 and 0.003. Compared to difficulty ratings of reference items, ceiling items were rated to be 10% more to greater than 40% more difficult to do, and floor items were rated to be about 12% to nearly 90% less difficult to do. Conclusions: These new floor and ceiling items considerably extend the measurable range of physical function at either extreme. They will help improve instrument performance in populations with broad functional ranges and those concentrated at one or the other extreme ends of functioning. Optimal use of these new items will be assisted by computerized adaptive testing (CAT), reducing questionnaire burden and insuring item administration to appropriate individuals. - Introduction Physical Function (PF) is frequently measured using patient reported outcomes (PRO). The original 20-item ("Legacy) Health Assessment Questionnaire Disability Index (HAQ) [1,2] and the original 10-item ("Legacy) SF-36 Physical Function form (PF-10) [3] are widely used traditional PRO instruments. Both have demonstrated good reliability across diverse conditions and in different administration modes. However, they do not reliably measure physical function ability in the very able or the very disabled. They need new items at the extremes of function and populations at the extremes to validate the new items. The Patient-Reported-Outcomes Measur (...truncated)


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Bonnie Bruce, James Fries, Bharathi Lingala, Yusra Nazar Hussain, Eswar Krishnan. Development and assessment of floor and ceiling items for the PROMIS physical function item bank, Arthritis Research & Therapy, 2013, pp. R144, 15, DOI: 10.1186/ar4327