Floor and ceiling effects in the OHS:an analysis of the NHS PROMs data set

Abstract

ObjectivesThe objective was to examine whether the Oxford Hip Score (OHS) demonstrated a floor or a ceiling effect when used to measure the outcome of hip replacement surgery in a large national cohort.SettingSecondary database analysis of a national audit conducted in England and Wales on patient undergoing hip and knee arthroplasty in a secondary care setting.Participants93 253 primary arthroplasty patients completed preoperative OHS questionnaires and 69 361 completed 6-month postoperative OHS questionnaires. The population had a mean age of 67.78 (range 14–100, SD 11.3) and 59% were female.Primary Secondary Outcome MeasuresPrimary outcome measure was the Oxford Hip Score (OHS). Secondary outcome measures were the OHS-FCS and OHS-PCS. Floor and ceiling effects were considered present if >15% of patients achieved the worst score/floor effect (0/48) or best/ceiling effect (48/48) score.ResultsPreoperatively, 0% of patients achieved the best score (48) and 0.1% achieved the worst score (0). Postoperatively, 0.1% patients achieved the worst score, but the percentage achieving the best score increased to 11.6%. Subgroup analyses demonstrated that patients between 50 and 59 years of age had the highest postoperative best score, at 15.3%. The highest postoperative OHS worst score percentage was in a group of patients who had a preoperative OHS above 41/48 at 28%. Furthermore, 22.6% of patients achieved the best postoperative OHS-PCS and 19.9% best postoperative OHS-FCS.ConclusionsBased on NHS PROMS data the overall OHS does not exhibit a ceiling or floor effect and should continue to be used as a valid measure of patient-reported outcomes for patients undergoing total hip arthroplasty. However, subscale analysis does indicate some limitations in the OHS-PCS and OHS-FCS.Trial registration numberNDORMS. Introducing standardised and evidence-based thresholds for hip and knee replacement surgery. The Arthroplasty Candidacy Help Engine (ACHE tool). HTA Project 11/63/01.

Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults

“…Ceiling or floor effects were considered to be present if more than 15% of respondents achieved the highest or lowest score, respectively [14, 15]. Overall, the global PSQI score did not have floor and ceiling effects; 5.1% of Ethiopian adults reported a minimum score of zero, and none reported a maximum score of 21, respectively.…”

“…All the PSQI components except for sleep latency showed floor effect i.e. more than 15% of respondents achieved the lowest score [14, 15]. Nevertheless, ceiling effect was observed only for components of sleep duration and sleep efficiency i.e.…”

“…Nevertheless, ceiling effect was observed only for components of sleep duration and sleep efficiency i.e. more than 15% of respondents achieved the highest score [14, 15]. …”

“…The individual components of the PSQI had floor and ceiling effects but the global PSQI score did not have either of these effects (Table 2). Therefore, item analysis does support validity of the overall score of the scale [14]. One of the few studies that reported about floor and ceiling effects found that floor effects were observed for all the PSQI components except for sleep disturbances (Table 2) in patients of temporomandibular disorders [17].…”

Exploring the feasibility of delivering standardized genomic care using ophthalmology as an example

“…We looked at the proportion of responses with the lowest and highest possible scores for each measure. We compared these proportions to a commonly used threshold (15% of responses) 35 to confirm or deny the presence of ceiling/floor effects.…”