title: Psychometric Comparison of the PROMIS Physical Function CAT With the FAAM and FFI for Measuring Patient-Reported Outcomes.
abstract: BACKGROUND
  Selecting optimal patient-reported outcome (PRO) instruments is critical to improving the quality of health care. The purpose of this study was to compare the reliability, responsiveness, and efficiency of three PRO measures: the Foot and Ankle Ability Measure-Activity of Daily Living subscale (FAAM_ADL), the Foot Function Index 5-point verbal rating scale (FFI-5pt), and the PROMIS Physical Function computerized adaptive test (PF CAT).
  
  
  METHODS
  Data were aggregated from 10 clinical sites in the AOFAS's National Orthopaedic Foot and Ankle Research (OFAR) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle. Patients were administered the FAAM_ADL, FFI-5pt, and PF CAT at their preoperative visit and at 6 months after surgery. Reliabilities were evaluated using a Rasch model. Responsiveness was calculated using paired samples t test and efficiency was recorded as number of seconds to complete the instrument.
  
  
  RESULTS
  Similar reliabilities were found for the three instruments. Item reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were all .99. Pearson reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were .95, .93, and .96, respectively. On average, patients completed the FAAM_ADL in 179 seconds, the FFI-5pt in 194 seconds, and the PF CAT in 44 seconds, ( P < .001). The PF CAT and FAAM_ADL showed significant improvement ( P = .01 and P = .001, respectively) in patients' physical function after treatment; the FFI-5pt did not show improvement.
  
  
  CONCLUSIONS
  Overall, the PF CAT performed best in terms of reliability, responsiveness, and efficiency in this broad sample of foot and ankle patients. It can be a potential replacement for the conventional PRO measures, but further validation is needed in conjunction with the PROMIS Pain instruments.
  
  
  METHODS
  Level I, prospective comparative outcome study.
authors.affiliation: 1 University of Utah, Salt Lake City, UT, USA.
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.affiliation: 2 University of Rochester, Rochester, NY, USA.
authors.forename: Judith F
authors.initials: JF
authors.lastname: Baumhauer
authors.affiliation: 3 Orthopedic Associates of Dallas, Dallas, TX, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Brodsky
authors.affiliation: 1 University of Utah, Salt Lake City, UT, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Cheng
authors.affiliation: 4 Hospital for Special Surgery, New York, NY, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
authors.affiliation: 1 University of Utah, Salt Lake City, UT, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Franklin
authors.affiliation: 1 University of Utah, Salt Lake City, UT, USA.
authors.forename: Shirley D
authors.initials: SD
authors.lastname: Hon
authors.affiliation: 5 Campbell Clinic, Cordova, TN, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Ishikawa
authors.affiliation: 6 University of Arizona, Tucson, AZ, USA.
authors.forename: L Daniel
authors.initials: LD
authors.lastname: Latt
authors.affiliation: 7 University of Iowa, Iowa City, IA, USA.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: 1 University of Utah, Salt Lake City, UT, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Saltzman
authors.affiliation: 8 University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Nelson F
authors.initials: NF
authors.lastname: SooHoo
authors.affiliation: 9 Stanford University, Stanford, CA, USA.|10 National Orthopaedic Foot & Ankle Outcomes Research Network, American Orthopaedic Foot & Ankle Society.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Hunt
keywords: FAAM; PROMIS; FFI; OFAR; computerized adaptive testing; patient-reported outcomes; physical function; psychometrics