title: Symptom burden and comorbidities impact the consistency of responses on patient-reported functional outcomes.
abstract: OBJECTIVE
  To assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs).
  
  
  METHODS
  Two data sources were used. The first, a cross-sectional database of patients with breast cancer who completed functional PROs and were administered the FIM, was used to examine whether average pain intensity (as measured with an 11-point numeric rating scale [NRS]) and Rand Mental Health inventory scores differed among those rating their functional independence as different than clinicians. The second, a longitudinal database of 311 adults with late-stage lung cancer who completed the Activity Measure for Post Acute Care Computer Adaptive Test (AM PAC CAT) with differences between their expected and actual responses as reflected in their AM PAC CAT SEs.
  
  
  METHODS
  Two tertiary medical centers.
  
  
  METHODS
  Data source #1, 163 women with stage IV breast cancer; data source #2, 311 adults with late-stage lung cancer.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Data source #1, FIM, pain NRS, Older Americans Resource Study activities of daily living subscale, Physical Function-10, Mental Health Inventory-17. Data source #2, AM PAC CAT and NRS symptom ratings.
  
  
  RESULTS
  Pain intensity was significantly higher when clinicians and patients disagreed regarding a patient's independence in the ability to transfer (NRS pain severity, 3.78 vs 2.40; P=.014), groom (3.71 vs 2.36, P=.009), bathe (3.76 vs 2.40, P=.016), and dress (3.09 vs 2.44, P=.034). The magnitude of AM PAC CAT SEs was significantly associated with the severity of participants' pain, dyspnea, and fatigue, as well as the presence of musculoskeletal disorders and coronary artery disease. Neither mood nor emotional distress was associated with clinician-patient agreement or AM PAC CAT SE.
  
  
  CONCLUSIONS
  Pain intensity is associated with disagreement between patients and clinicians about the patient's level of functioning. Moreover, physical symptoms (pain, dyspnea, fatigue) as well as specific medical comorbidities (musculoskeletal disorders, coronary artery disease), but not mood, are associated with inconsistency in patients' assessment of their functional abilities.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: cheville.andrea@mayo.edu.
authors.forename: Andrea Lynne
authors.initials: AL
authors.lastname: Cheville
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
authors.forename: Jeffrey Rogers
authors.initials: JR
authors.lastname: Basford
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
authors.forename: Katiuska
authors.initials: K
authors.lastname: Dos Santos
authors.affiliation: Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Health Services and Outcomes, Indianapolis, IN.
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000523:psychology*; D026741:Physical Therapy Modalities; D011369:Professional-Patient Relations; D062606:Tertiary Care Centers
keywords: AM PAC CAT; Activity Measure Post Acute Care Computer Adaptive Test; CAD; CAT; COPD; CRO; Cancer; Function; GEE; IRT; Item response theory; MHI-17; Measurement; Mental Health Inventory-17; NRS; OARS; Older Americans Resource Study; PF-10; PRO; Patient reported outcomes; Physical Function-10; Rehabilitation; chronic obstructive pulmonary disease; clinician-rated outcome; computer adaptive test; coronary artery disease; general estimating equations; item response theory; numeric rating scale; patient-reported outcome