title: Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation.
abstract: BACKGROUND
  Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity.
  
  
  METHODS
  Patients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)-Short Form 12a-Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of <4 metabolic equivalents of task (METs) or ≥4 METs. Patients also evaluated the usability of the questionnaires.
  
  
  RESULTS
  After IRB approval, 204 patients were enrolled and completed both DASI and PROMIS questionnaires. Clinicians assessed functional capacity at <4 METs for 109 patients (53.4 %) compared to 18 (8.8 %) patient self-assessments <4 METs as estimated by DASI. These results represent a significant discrepancy between assessments (Fisher's exact, two-tailed P value <0.0001). The standard T-score of PROMIS estimates of functional capacity correlated with DASI estimates (R (2) 0.76). The mean and standard deviation for PROMIS T-scores were 43.3 and 9.86, respectively (mean 50.0; SD 10.0 for the general population). Of the 203 patients who completed the entire study survey, 192 (94.6 %) stated that they did not require assistance from another person, and 187 (94 %) responded either "agree" or "strongly agree" to the DASI questionnaire being "easy to understand" and "easy to complete;" 186 (93 %) and 188 (94 %), respectively, responded similarly to the PROMIS questionnaire.
  
  
  CONCLUSIONS
  While both electronic questionnaires were easy to understand and complete for most study participants, there was a significant discrepancy between clinician assessments and patient self-assessments of functional capacity. Further study is needed to determine if either patient self-triage by means of activity questionnaires or clinician evaluation is valid and reliable in the preoperative setting.
authors.affiliation: Vanderbilt University School of Medicine, 2215 Garland Avenue (Light Hall), Nashville, TN 37232 USA.
authors.forename: John Whittemore
authors.initials: JW
authors.lastname: Stokes
authors.affiliation: Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614 USA.
authors.forename: Jonathan Porter
authors.initials: JP
authors.lastname: Wanderer
authors.affiliation: Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614 USA.
authors.forename: Matthew David
authors.initials: MD
authors.lastname: McEvoy
keywords: Electronic questionnaire; Functional capacity; Perioperative risk; Preoperative assessment; Self-triage