Abstract
Hart DL, Wright BD. Development of an index of physical functional health status in
rehabilitation. Arch Phys Med Rehabil 2002;83:655-65. Objective: To describe (1) the development of an index of physical functional health status
(FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item
calibrations, and practical application. Design: Rasch analysis of existing data sets. Setting: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities
in 41 states participating with Focus On Therapeutic Outcomes, Inc. Patients: A convenience sample of 92,343 patients (40% male; mean age ± standard deviation
[SD], 48±17y; range, 14-99y) seeking rehabilitation between 1993 and 1999. Interventions: Not applicable. Main Outcome Measures: Patients completed self-report health status surveys at admission and discharge.
The Medical Outcomes Study 36-Item Short-Form Health Survey's physical functioning
scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability
Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent
to patients with upper-extremity impairments, and items pertinent to patients with
more involved neuromusculoskeletal impairments were cocalibrated into the PF-10. Results: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square
measurement error, 5.9; mean square ± SD infit, 0.9±0.5; outfit, 0.9±0.9). Analyses
supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations,
and content and construct validity of the FHS-36. Conclusions: Results support the reliability and validity of FHS-36 measures in the present sample.
Analyses show the potential for a dynamic, computer-controlled, adaptive survey for
FHS assessment applicable for group analysis and clinical decision making for individual
patients. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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References
- Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale.J Clin Epidemiol. 1994; 47: 671-684
- Assessment of unidimensionality of physical functioning in patients receiving therapy in acute, orthopedic outpatient centers.J Outcome Meas. 2000; 4: 413-430
- Evaluation of the MOS SF-36 physical functioning scale (PF-10): II. Comparison of relative precision using Likert and Rasch scoring methods.J Clin Epidemiol. 1997; 50: 451-461
- Comparison of Rasch and summated rating scales constructed from SF-36 physical functioning items in seven countries: results from the IQOLA project.J Clin Epidemiol. 1998; 51: 1203-1214
- Rasch analysis of a brief physical ability scale for long-term outcomes of stroke.Phys Med Rehabil State Art Rev. 1997; 11: 385-396
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.Med Care. 1993; 31: 247-263
- The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.Med Care. 1994; 32: 40-66
- SF-36 Health Survey manual and interpretation guide.: The Health Institute, N Engl Med Center, Boston1993
- The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application.Phys Ther. 1999; 79: 371-383
- Orthotics and Prosthetics National Office Outcomes Tool (OPOT): initial reliability and validity assessment for lower extremity prosthetics.J Prosthet Orthot. 1999; 11: 101-111
- Comparison of the musculoskeletal function assessment questionnaire with the Short Form-36, the Western Ontario and McMaster University's Osteoarthritis Index, and the Sickness Impact Profile health-status measures.J Bone Joint Surg Am. 1997; 79: 1323-1335
- Comparison of a generic (SF-36) and a disease-specific (WOMAC) instrument in the measurement of outcomes after knee replacement surgery.J Rheumatol. 1995; 22: 1193-1196
- Physical therapy and health outcomes in patients with knee impairments.Phys Ther. 1996; 76: 1178-1187
- Physical therapy and health outcomes in patients with spinal impairments.Phys Ther. 1996; 76: 930-945
- Physical therapy treatment choices for musculoskeletal impairments.Phys Ther. 1997; 77: 145-154
- Health status of individuals entering a cardiac rehabilitation program as measured by the medical outcomes study 36-item short-form survey (SF-36).Phys Ther. 1994; 74: 521-527
- Sensitivity to change of the Roland-back pain questionnaire: Part 1.Phys Ther. 1998; 78: 1186-1196
- Defining the minimum level of detectable change for the Roland-Morris Questionnaire.Phys Ther. 1996; 76 (discussion 366-8): 359-365
- Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance.J Chronic Dis. 1986; 39: 897-906
- A methodological framework for assessing health indices.J Chronic Dis. 1985; 38: 27-36
- The power of outcomes: FOTO Industrial Outcomes Tool—initial assessment.Work. 2001; 16: 39-51
- Impact of exercise history on health status outcomes in patients with musculoskeletal impairments.Orthop Phys Ther Clin North Am. 2000; 9: 1-16
- Influence of orthopaedic clinical specialist certification on clinical outcomes.J Orthop Sports Phys Ther. 2000; 30: 183-193
- Assessing health-related quality of life in patients with sciatica.Spine. 1995; 20: 1899-1909
- Changes in health status for persons with wrist or hand impairments receiving occupational or physical therapy.Am J Occup Ther. 2001; 55: 68-74
- Physical therapy for patients with TMD: a descriptive study of treatment, disability, and health status.J Orofacial Pain. 1998; 12: 124-135
- Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses.J Orthop Sports Phys Ther. 1998; 27: 219-230
- Predictors of functional outcomes after arthroscopic partial meniscectomy.J Rheumatol. 1992; 19: 1938-1942
- A comparison of different indices of responsiveness.J Clin Epidemiol. 1997; 50: 239-246
- The MACTAR Patient Preference Disability Questionnaire—an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis.J Rheumatol. 1987; 14: 446-451
- Generic and disease-specific measures in assessing health status and quality of life.Med Care. 1989; 27: S217-S232
- Medical Outcomes Trust conference presents dramatic advances in patient-based outcomes assessment and potential applications in accreditation.Jt Comm J Qual Improv. 1999; 25: 207-218
- Probabilistic models for some intelligence and attainment tests.: MESA Pr, Chicago1980
- Rating scale analysis.: MESA Pr, Chicago1982
- Best test design.: MESA Pr, Chicago1979
- Coma to community: continuity in measurement.in: Physical medicine and rehabilitation: state of the art reviews. : Hanley & Belfus, Philadelphia1997: 375-384
- A technique for the measurement of attitudes.Arch Psychol. 1932; 140: 5-55
- Interpretation of change scores in ordinal clinical scales and health status measures: the whole may not equal the sum of the parts.J Clin Epidemiol. 1996; 49: 711-717
- Ordinal scales and foundations of misinference.Arch Phys Med Rehabil. 1989; 70: 308-312
- Fundamental measurement for outcome evaluation.Phys Med Rehabil State Art Rev. 1997; 11: 261-287
- Observations are always ordinal; measurements, however, must be interval.Arch Phys Med Rehabil. 1989; 70: 857-860
- Discharge outcome after stroke rehabilitation.Stroke. 1992; 23: 978-982
- Professional uncertainty and treatment choices by physical therapists.Arch Phys Med Rehabil. 1997; 78: 1346-1351
- Use of generic versus region-specific functional status measures on patients with cervical spine disorders.Phys Ther. 1998; 78: 951-963
- The Oswestry low back pain disability questionnaire.Physiotherapy. 1980; 66: 271-273
- The Neck Disability Index: a study of reliability and validity.J Manipulative Physiol Ther. 1991; 14: 409-415
- Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med. 1982; 10: 150-154
- Rating systems in the evaluation of knee ligament injuries.Clin Orthop. 1985; 190: 43-49
- Comparison of responses to SF-36 Health Survey questions with one-week and four-week recall periods.Health Serv Res. 1997; 32: 367-384
- A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- A user's guide to WINSTEPS.: MESA Pr, Chicago2000
- Applying psychometric criteria to functional assessment in medical rehabilitation: II. Defining interval measures.Arch Phys Med Rehabil. 1992; 73: 507-518
- The Patient-Specific Functional Scale: validation of its use in persons with neck dysfunction.J Orthop Sports Phys Ther. 1998; 27: 331-338
Article info
Publication history
Accepted:
April 3,
2001
Received in revised form:
April 3,
2001
Footnotes
☆A commercial party with a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or one or more of the authors.
☆☆Reprint requests to Dennis L. Hart, PhD, PT, Focus On Therapeutic Outcomes, Inc, 551 Yopps Cove Rd, White Stone, VA 22578-2403, e-mail: [email protected]
★Supplier
★★a. MESA Press, 5835 S Kimbark Ave, Chicago, IL 60637-1609.
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Copyright
© 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
