title: A comparison of questionnaires for assessing physical function in patients with lower extremity bone metastases.
abstract: OBJECTIVE
  To assess, (i) the degree to which the: PROMIS Physical Function Cancer, PROMIS Neuro-QoL Mobility, Toronto Extremity Salvage Score (TESS), Lower Extremity Function Score (LEFS), and Musculoskeletal Tumor Society score (MSTS), measure physical function; (ii) differences in coverage and reliability; and (iii) difference in completion time.
  
  
  METHODS
  One hundred of 115 (87%) patients with lower extremity metastases participated in this prospective study. We used exploratory factor analysis-correlating questionnaires with an underlying trait-to assess if questionnaires measure the same. Coverage was assessed by floor and ceiling effect and reliability by the standard error of measurement (SEM). Completion time was compared using the Friedman test.
  
  
  RESULTS
  All questionnaires measured the same concept; demonstrated by high correlations (>0.7). Floor effect was absent, while ceiling effect was present in all, but highest for the PROMIS Neuro-QoL Mobility (7%). The SEM was below the threshold-indicating reliability-over a wide range of ability levels for the PROMIS-Physical Function, TESS, and LEFS. Completion time differed between questionnaires (P < 0.001) and was shortest for the PROMIS questionnaires.
  
  
  CONCLUSIONS
  The PROMIS Physical Function is the most useful questionnaire. This is due to its reliability over a wide range of ability levels, validity, brevity, and good coverage. J. Surg. Oncol. 2016;114:691-696. © 2016 Wiley Periodicals, Inc.
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. steinjanssen@gmail.com.
authors: Stein J
authors: SJ
authors: Janssen
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Nuno Rui
authors: NR
authors: Paulino Pereira
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Kevin A
authors: KA
authors: Raskin
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's HospitalHarvard Medical School, Boston, Massachusetts.
authors: Marco L
authors: ML
authors: Ferrone
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Francis J
authors: FJ
authors: Hornicek
authors: Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: C Niek
authors: CN
authors: van Dijk
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Santiago A
authors: SA
authors: Lozano-Calderón
authors: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Joseph H
authors: JH
authors: Schwab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000503:physiopathology* / Q000556:secondary*; D005163:Factor Analysis, Statistical; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007867:Leg Bones; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
keywords: bone; function; metastasis