Development of an index of physical functional health status in rehabilitation.
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.


METHODS
Rasch analysis of existing data sets.


METHODS
A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc.


METHODS
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.


METHODS
Not applicable.


METHODS
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.
Hart
Dennis L
DL
Focus On Therapeutic Outcomes, Inc, White Stone, VA 22578-2403, USA. dsailhart@rivnet.net
Wright
Benjamin D
BD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D010809:Physical Fitness / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D012047:Rehabilitation Centers; D015203:Reproducibility of Results; D012189:Retrospective Studies