Distance to first symptoms measured by the 6-min walking test differentiates between treatment success and failure in patients with degenerative lumbar disorders

Abstract Purpose The smartphone-based 6-min walking test (6WT) is an established digital outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). In addition to the 6WTs primary outcome measure, the 6-min walking distance (6WD), the patient’s distance to first symptoms (DTFS) and time to first symptoms (TTFS) can be recorded. This is the first study to analyse the psychometric properties of the DTFS and TTFS. Methods Forty-nine consecutive patients (55 ± 15.8 years) completed the 6WT pre- and 6 weeks (W6) postoperative. DTFS and TTFS were assessed for reliability and content validity using disease-specific patient-reported outcome measures. The Zurich Claudication Questionnaire patient satisfaction subscale was used as external criterion for treatment success. Internal and external responsiveness for both measures at W6 was evaluated. Results There was a significant improvement in DTFS and TTFS from baseline to W6 (p < 0.001). Both measures demonstrated a good test–retest reliability (β = 0.86, 95% CI 0.81–0.90 and β = 0.83, 95% CI 0.76–0.87, both p < 0.001). The DTFS exceeded the 6WD capability to differentiate between satisfied (82%) and unsatisfied patients (18%) with an AUC of 0.75 (95% CI 0.53–0.98) vs. 0.70 (95% CI 0.52–0.90). The TTFS did not demonstrate meaningful discriminative abilities. Conclusion Change in DTFS can differentiate between satisfied and unsatisfied patients after spine surgery. Digital outcome measures on the 6WT metric provide spine surgeons and researchers with a mean to assess their patient’s functional disability and response to surgical treatment in DLD.

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Normative data of a smartphone app–based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine2084 ◽

2020 ◽

Vol 33 (4) ◽

pp. 480-489 ◽

Cited By ~ 1

Author(s):

Lazar Tosic ◽

Elior Goldberger ◽

Nicolai Maldaner ◽

Marketa Sosnova ◽

Anna M. Zeitlberger ◽

...

Keyword(s):

Outcome Measures ◽

Content Validity ◽

Normative Data ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Walking Distance ◽

Walking Test ◽

Retest Reliability ◽

Patient Reported ◽

Test Retest Reliability

OBJECTIVEThe 6-minute walking test (6WT) is used to determine restrictions in a subject’s 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements.METHODSThe maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16–91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3–40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs.RESULTSThe ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87–0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7–597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001).CONCLUSIONSThis study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.

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Development of a patient-reported outcome measure for neck pain in military aircrew: qualitative interviews to inform design and content

BMJ Open ◽

10.1136/bmjopen-2020-039488 ◽

2021 ◽

Vol 11 (2) ◽

pp. e039488

Author(s):

Anna Dowling ◽

Ellen Slungaard ◽

Nicola R Heneghan

Keyword(s):

Neck Pain ◽

Outcome Measure ◽

Physical Symptoms ◽

Patient Reported Outcome ◽

Direct Access ◽

Specific Patient ◽

Concept Elicitation ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

The Impact

IntroductionThe prevalence of flight-related neck pain is 70% in UK fast jet pilots; much higher than the general population. The Aircrew Conditioning Programme and direct access physiotherapy exist to minimise the impact on military capability, but a population specific patient-reported outcome measure (PROM) is required to investigate the effectiveness of these. We aimed to explore the experiences of flight-related neck pain to inform the content validity and development of a population specific PROM.MethodsQualitative semistructured interviews combining phenomenological and grounded theory methods, reported using Consolidated criteria for Reporting Qualitative research guidelines. A purposive sample of 10 fast jet pilots with neck pain was recruited. Concept elicitation interviews were audio recorded, transcribed verbatim along with field notes. Data analysis involved subject and methodological expertise used a concept elicitation approach.ResultsParticipants included 10 male fast jet pilots, age 34.7 years. Identified themes included: (1) physical symptoms associated with flying activities; (2) occupational effects revealed modifications of flying, or ‘suboptimal’ performance owing to neck pain; (3) psychological effects revealed feelings or worry and (4) social and activity effects showed impact on out of work time.ConclusionPopulation-specific occupational, psychological and social factors should be considered alongside physical symptoms when managing neck pain in military aircrew. Findings support the development of a PROM specifically designed for military aircrew with neck pain.

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Health-related quality of life in ANCA-associated vasculitis and item generation for a disease-specific patient-reported outcome measure

Patient Related Outcome Measures ◽

10.2147/prom.s144992 ◽

2018 ◽

Vol Volume 9 ◽

pp. 17-34 ◽

Cited By ~ 8

Author(s):

Joanna C Robson ◽

Jill Dawson ◽

Peter F Cronholm ◽

Nataliya Milman ◽

Katherine Kellom ◽

...

Keyword(s):

Outcome Measure ◽

Patient Reported Outcome ◽

Health Related Quality ◽

Specific Patient ◽

Patient Reported Outcome Measure ◽

Anca Associated Vasculitis ◽

Patient Reported ◽

Related Quality ◽

Health Related

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PO-1148: Implementation of a cervix cancer specific patient reported outcome measure in clinical practice

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)01166-x ◽

2020 ◽

Vol 152 ◽

pp. S604

Author(s):

S. Atallah ◽

L. Barbera ◽

M. Folwell ◽

D. Howell ◽

A. Liu ◽

...

Keyword(s):

Clinical Practice ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Cervix Cancer ◽

Specific Patient ◽

Patient Reported Outcome Measure ◽

Patient Reported

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A method to create a standardized generic and condition-specific patient-reported outcome measure for patient care and healthcare improvement

Quality of Life Research ◽

10.1007/s11136-017-1675-5 ◽

2017 ◽

Vol 27 (2) ◽

pp. 367-378 ◽

Cited By ~ 6

Author(s):

Karen E. Schifferdecker ◽

Susan E. Yount ◽

Karen Kaiser ◽

Anna Adachi-Mejia ◽

David Cella ◽

...

Keyword(s):

Patient Care ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Specific Patient ◽

Patient Reported Outcome Measure ◽

Healthcare Improvement ◽

Patient Reported

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THU0037 Validation of A Disease-Specific Patient-Reported Outcome Measure for Arabic Patients with Systemic Lupus Erythematosus

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.3758 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 189.2-189

Author(s):

Y. El Miedany ◽

M. El Gaafary ◽

S. Sayed ◽

I. Ahmed

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Systemic Lupus ◽

Specific Patient ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

Disease Specific

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Development of a crosswalk for the bidirectional mapping of two commonly used condition-specific patient-reported outcome measures, the oswestry disability index (ODI) and the core outcome measures index (COMI)

Brain and Spine ◽

10.1016/j.bas.2021.100042 ◽

2021 ◽

Vol 1 ◽

pp. 100042

Author(s):

Anne F. Mannion ◽

Achim Elfering ◽

Frank S. Kleinstück ◽

Markus Loibl ◽

Tamás Fekete ◽

...

Keyword(s):

Outcome Measures ◽

Oswestry Disability Index ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Core Outcome ◽

Specific Patient ◽

The Core ◽

Patient Reported ◽

Core Outcome Measures ◽

Bidirectional Mapping

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Development and Validation of a Novel Knee-Specific Patient-Reported Outcomes Measure

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0264 ◽

2020 ◽

pp. 1-11

Author(s):

James L. Farnsworth ◽

Todd Evans ◽

Helen Binkley ◽

Minsoo Kang

Keyword(s):

Outcome Measures ◽

Patient Reported Outcomes ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Properties ◽

Partial Credit Model ◽

Partial Credit ◽

Specific Patient ◽

Patient Reported ◽

Full Study

Context: Previous research suggests that several knee-specific patient-reported outcome measures have poor measurement properties. The patient-reported outcomes knee assessment tool (PROKAT) was created to improve assessment of knee-specific function. Examination of the measurement properties of this new measure is critical to determine its clinical value. Objective: Examine the measurement properties of the PROKAT. Design: Cross-sectional study. Setting: Clinical athletic training setting. Patients or Other Participants: The pilot study included 32 student-athletes (mean age = 20.78 [1.01], males = 56.30%). The full study included 203 student-athletes (mean age = 21.46 [4.64], males = 54.70%) from 3 separate institutions. The participants were recruited for both the pilot and full study using face-to-face and electronic (eg, email and social media sites) communications. Intervention(s): Evaluation of the measurement properties of the PROKAT occurred using the Rasch partial-credit model. Main Outcome Measures: Infit and outfit statistics, item step difficulties, person ability parameters, category function, item and test information functions, and Cronbach alpha. An independent samples t test was used to evaluate the differences in injured and noninjured athletes’ scores. Results: The Rasch partial-credit model analysis of pilot test items and qualitative participant feedback were used to modify the initial PROKAT. Evaluation of the revised PROKAT (32 items) indicated 27 items had acceptable model–data fit. The injured athletes scored significantly worse than the noninjured athletes (t188 = 12.89; P < .01). The ceiling effects for the PROKAT were minimal (3.9%). Conclusions: A major advantage of this study was the use of the Rasch measurement and the targeted population. Compared with alternative knee-specific patient-reported outcome measures (eg, Knee Injury Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Form), the PROKAT has low ceiling effects in athletic populations. In addition, evidence suggests the measure may be capable of distinguishing between injured and noninjured athletes.

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