title: New paradigm for patient-reported outcomes assessment in foot & ankle research: computerized adaptive testing.
abstract: BACKGROUND
  Accurately measuring, reporting and comparing outcomes is essential for improving health care delivery. Current challenges with available health status scales include patient fatigue, floor/ceiling effects and validity/reliability.
  
  
  METHODS
  This study compared Patient Reported Outcomes Measurement Information System (PROMIS)-based Lower Extremity Physical Function Computerized Adaptive Test (LE CAT) and two legacy scales -the Foot and Function Index (FFI) and the sport module from the Foot and Ankle Ability Measure (spFAAM) -for 287 patients scheduled for elective foot and ankle surgery. We documented the time required by patients to complete the instrument, instrument precision, and the extent to which each instrument covered the full range of physical functioning across the patient sample.
  
  
  RESULTS
  Average time of test administration: 66 seconds for LE CAT, 130 seconds for spFAAM and 239 seconds for FFI. All three instruments were fairly precise at intermediate physical functioning levels (i.e., Standard Error of Measurement < 0.35), were relatively less precise at the higher trait levels and the LE CAT maintained precision in the lower range while the spFAAM and FFI's had decreased precision. The LE CAT had less floor/ceiling effects than the FFI and the spFAAM.
  
  
  CONCLUSIONS
  The LE CAT showed considerable advantage compared to legacy scales for measuring patient-reported outcomes in orthopaedic patients with foot and ankle problems.
  
  
  CONCLUSIONS
  A paradigm shift to broader use of PROMIS-based CATs should be considered to improve precision and reduce patient burden with patient-reported outcome measuremen foot and ankle patients.
authors.affiliation: University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA. Man.Hung@hsc.utah.edu
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.forename: Florian
authors.initials: F
authors.lastname: Nickisch
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Beals
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Clegg
authors.forename: Charles L
authors.initials: CL
authors.lastname: Saltzman
mesh_terms: D000704:Analysis of Variance; D000842:Ankle / Q000503:physiopathology* / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D005528:Foot / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D011594:Psychometrics