Abstract
Objective
To (1) characterize the agreement between patient and proxy responses on a multidimensional
computerized adaptive testing measure of function, and to (2) determine whether patient,
proxy, or multidimensional computerized adaptive testing score characteristics identify
when a proxy report can be used as a substitute for patient report in clinical decision
making.
Design
A psychometric study of the Functional Assessment in Acute Care Multidimensional Computerized
Adaptive Testing (FAMCAT) and its 3 scales (Applied Cognition, Daily Activity, and
Basic Mobility).
Setting
An upper midwestern quaternary academic medical center
Participants
A total of 300 pairs of patients (average age 60.9 years; range, 19-89) hospitalized
on general medical services or readmitted to surgical services for postoperative complications
and their proxies (average age 60.5 years; range, 20-88).
Intervention
Not applicable.
Main Outcome Measures
There were 3 outcomes: (1) agreement between patient and proxy scores on the FAMCAT
domains, as well as age and sex, analyzed with univariate and multivariate analysis
of variance (MANOVA); (2) associations of patient-proxy relationship and FAMCAT score
characteristics with patient-proxy score agreement; and (3) presence of psychometrically
significant intra-dyad differences in FAMCAT scores.
Results
The results of the MANOVA and follow-up ANOVAs indicated that there were no statistically
significant differences in FAMCAT scale scores between patient and proxy estimates
for either the Daily Activity or Basic Mobility scales. There were significant differences
for the Applied Cognition scale (P<.005) between mean patient and proxy scores, with proxies rating patients as functioning
at a higher level (mean=0.42) than patients did themselves (mean=0.00). However, psychometrically
significant intra-dyadic Applied Cognition score differences occurred in only 14%
of dyads, compared with 25% in the other 2 scales. Sex and age were associated with
patient-proxy agreement, but the patterns were not sufficiently consistent to permit
generalizations regarding the likely validity of a proxy's scores.
Conclusions
Patient and proxy FAMCAT Daily Activity and Basic Mobility scores did not differ significantly,
and proxy reporting offers a creditable surrogate for patient report on these domains.
Low rates of psychometrically significant intra-dyadic score differences suggest that
proxy report may serve as a low-resolution screen for functional deficits in all FAMCAT
domains. Approximately half the proxies provided multi-domain profile ratings on the
3 scales that did not differ significantly from these of the associated patients,
but more research is needed to identify situations in which proxy profiles could be
used in place of those provided by patients.
Keywords
List of abbreviations:
ANOVA (analysis of variance), FAMCAT (Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test), IRT (item response theory), LRT (likelihood ratio test), MANOVA (multivariate analysis of variance), n1, n2, n3 (number of items administered by the FAMCAT for each scale), PROM (patient-reported outcome measure), SEM (standard error of measurement (standard error of the θ estimate for each of the 3 FAMCAT scales)), θ (IRT estimated scale score)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 19, 2021
Accepted:
August 17,
2021
Received in revised form:
August 9,
2021
Received:
January 16,
2021
Footnotes
This research was supported by the Eunice Kennedy Shriver National Institutes of Child Health and Human Development of the National Institutes of Health under Award Number R01HD079439 to the Mayo Clinic in Rochester Minnesota through subcontracts to the University of Minnesota and the University of Washington.
Disclosures: none.
This paper is part of a supplement from the American Congress of Rehabilitation Medicine.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
