Prospective Evaluation of the AM-PAC-CAT in Outpatient Rehabilitation Settings

Jette, Alan M.; Haley, Stephen M.; Tao, Wei; Ni, Pengsheng; Moed, Richard; Meyers, Doug; Zurek, Matthew

doi:10.2522/ptj.20060121

Cited by 123 publications

(128 citation statements)

References 34 publications

Supporting

Mentioning

123

Contrasting

Order By: Relevance

“…8,25,30,34,35,50,52 Therefore, multivariable statistical models tend to control the effect of risk adjustment variables in clinically logical ways.…”

Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

show abstract

“…8,25,30,34,35,50,52 Therefore, multivariable statistical models tend to control the effect of risk adjustment variables in clinically logical ways.…”

Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

show abstract

“…The eleven variables included for risk adjustment were intake FS, 10,22,24,33,44,46 intake pain intensity, [66][67][68] 44,47 and number of comorbid conditions. 10,21,45 These eleven variables were specifically selected for inclusion in our linear-regression models, because the previously cited studies demonstrated that each variable influenced FS or pain outcomes in predictive models.…”

Section: Risk Adjustment Factorsmentioning

confidence: 99%

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Werneke

Hart²,

George³

et al. 2011

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

“…30 With good precision, CAT scores are calculated at the item level, using up to 10 questions. 31,32 Item response theory/CAT methods allow the addition of new items into calibrated banks with replenishment calibrations studies. 33 CAT systems currently in use include the Patient Reported Outcomes Measurement Information System 34 and the osteoarthritis (OA) CAT systems ie OA-DISABILITY-CAT, OA-FUNCTION-CAT).…”

Section: Future Directions: Computer-adaptive Testing Systemsmentioning

confidence: 99%

Clinical Outcomes Assessment in Clinical Trials to Assess Treatment of Femoroacetabular Impingement: Use of Patientreported Outcome Measures

Harris‐Hayes

McDonough

Leunig

et al. 2013

Journal of the American Academy of Orthopaedic Surgeons

View full text Add to dashboard Cite

Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels of patients with FAI found no conclusive evidence to support a single diseasespecific questionnaire. Using a systematic review of study methodology, the Copenhagen Hip and Groin Outcome Score and the 33-item International Hip Outcome Tool scored the best. Nevertheless, both of these instruments were developed recently and have not been established in the literature. Although currently used generic and activity-level measures have limitations, as well, they should be considered, depending on the specific goals of the study. Additional research is needed to assess the properties of these measures fully when used to evaluate patients with FAI.Patient-reported outcome measures (PROs) often are the preferred primary outcome metrics to assess symptom modification in clinical trials. They are an important component of outcomes assessment because they represent the patient's health status as assessed by the patient, without interpretation of the healthcare provider. 1 To be useful, PROs must be reliable, valid, responsive, and representative of the patient population of interest.This article provides recommendations for the PROs to be used in clinical trials investigating the efficacy of treatments for femoroacetabular impingement (FAI). It describes and provides quality ratings for disease-specific PROs developed for young-tomiddle-aged adults with hip pain and dysfunction and presents common instruments to assess generic quality of life (QOL) and physical activity levels. Perspectives on future relevant directions and methodologies, such as computer-adaptive testing (CAT), are discussed, as well. (Table 1). In this review, however, we used stringent criteria for instrument selection and therefore only those diseasespecific PROs are included in which content validity was ensured through input from patients of similar age, sex, and activity level who had experienced symptoms and limitations due to FAI. Accordingly, we excluded instruments such as the Hip Outcome Score that although specifically developed and validated for impingement patients undergoing hip arthroscopy did not involve the patient opinion in the developmental process. Therefore, based on previous reviews of the literature 10-13 and the authors' collective knowledge, focus was placed on three disease-specific PROs that explicitly included young to middle-aged adults in the development of the measures.Each PRO described below is patient administered, with a user-friendly format that requires ≤10 minutes to complete. All of them are self-explanatory and can be administered in the waiting room or mailed so that the patient can complete it at home. The quality of each PRO was assessed using the COnsensus-based Standards for the selection of health Measurement I...

show abstract

Prospective Evaluation of the AM-PAC-CAT in Outpatient Rehabilitation Settings

Cited by 123 publications

References 34 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Clinical Outcomes Assessment in Clinical Trials to Assess Treatment of Femoroacetabular Impingement: Use of Patientreported Outcome Measures

Contact Info

Product

Resources

About