scholarly journals Performance of PROMIS Computer Adaptive Testing As Compared With Established Instruments for Multiple-Ligament Knee Injuries

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986741 ◽  
Author(s):  
Nicholas A. Trasolini ◽  
Shane Korber ◽  
Aaron Gipsman ◽  
Austin E. San ◽  
Alexander E. Weber ◽  
...  
Keyword(s):  
Physical Function ◽  
Knee Injury ◽  
Knee Injuries ◽  
Patient Reported Outcome ◽  
Activity Limitations ◽  
Acl Injuries ◽  
Multiligament Knee Injury ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Multiligament Knee Injuries

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) is a patient-reported outcome metric that has been validated for anterior cruciate ligament (ACL) injuries, ACL reconstructions, and meniscal injuries. Thus far, the system has not been validated for multiligament knee injuries. The Multiligament Quality of Life (MLQOL) questionnaire is a validated, disease-specific patient-reported outcome instrument for this population that can serve as a gold standard for validation of the newer PROMIS. Purpose/Hypothesis: The purpose of this study was to further validate the PROMIS CAT for multiligament knee reconstruction. We hypothesized that the PROMIS CAT modules would correlate with the Lysholm knee score (Lysholm), Tegner activity scale (Tegner), and MLQOL for postoperative multiligamentous knee injury patients and that the PROMIS CAT would use fewer question items than the Lysholm, Tegner, and MLQOL while still avoiding floor and ceiling effects. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 30 patients meeting the inclusion criteria were retrospectively identified and agreed to participate (87% male; mean ± SD age, 36.3 ± 13.5 years). Consenting patients were administered the Lysholm, Tegner, MLQOL, and PROMIS CAT for Physical Function, Mobility, and Pain Interference. Spearman correlations were used to test agreement across survey instruments. Floor and ceiling effects were assessed for all instruments. Results: PROMIS Pain Interference had excellent correlation with MLQOL Activity Limitations ( r = 0.71, P < .0001). Excellent-good correlations were detected between PROMIS Physical Function and MLQOL Activity Limitations ( r = –0.63, P = .0002) and PROMIS Mobility and MLQOL Activity Limitations ( r = –0.62, P < .0002). Good correlations were found between the Lysholm and the PROMIS Physical Function and PROMIS Mobility (for each, r = 0.50, P = .005). Additional correlations were present with other subsections. There were no floor or ceiling effects for the PROMIS CAT instrument in any category. Conclusion: The PROMIS CAT correlates well with existing outcome measures for multiligament knee injury patients without floor or ceiling effects. The PROMIS CAT is a concise adjunct to the validated injury-specific outcome tool for multiligament knee injury. Surgeons should consider implementing the PROMIS CAT because of its broad validity, including ACL injuries, meniscal tears, and now multiligament knee injuries.

scholarly journals Lower limb fractures associated with multiligament knee injury

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0002
Author(s):  
Joaquin Stagnaro ◽  
Carlos Yacuzzi ◽  
Jorge Barla ◽  
Juan Pablo Zicaro ◽  
Matias Costa-Paz
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
Knee Injury ◽  
Knee Injuries ◽  
Ligament Injuries ◽  
Initial Management ◽  
Lower Limb Fractures ◽  
Multiligament Knee Injury ◽  
Limb Fractures ◽  
Multiligament Knee Injuries

Objectives: Knee ligament injuries related to lower limb fractures are common and frequently unnoticed. Management of acute polytrauma is usually focused in the bone lesion and a complete physical examination might be really difficult. The purpose of this study was to analyze a series of patients who suffered multiligament knee injuries associated to a lower limb fracture. Hypothesis: The use of magnetic resonance imaging (MRI) during the initial management can lead to an early diagnosis of ligament injuries. Methods: A retrospective search was conducted from our hospital´s electronic database. We evaluated the initial diagnosis and acute surgical treatment, and management and functional outcomes after the ligament lesion was diagnosed. Results: Seven patients who presented a knee multiligament injury associated with a lower limb fracture were evaluated. The average age was 29 years. Primary diagnoses were: four tibial plateau fractures; one open fracture-dislocation of the knee; one open leg fracture and ipsilateral hip dislocation; and one bifocal femur fracture. Only three patients had an MRI during the initial management of trauma. Six out of seven patients had to be operated on for the multiligament knee injury. The period between the resolution of the fracture and the ligamentous repair was from 3 to 24 months. Conclusion: Poor functional outcomes are reported in patients with multiligament knee injuries associated with high-energy lower limb fractures. We consider an MRI during the initial management can lead to better outcomes. A trauma surgeon working alongside an arthroscopic surgeon might optimize the results for these lesions.

Performance of PROMIS Instruments in Patients With Shoulder Instability

2016 ◽  
Vol 45 (2) ◽  
pp. 449-453 ◽  
Author(s):  
Chris A. Anthony ◽  
Natalie A. Glass ◽  
Kyle Hancock ◽  
Matt Bollier ◽  
Brian R. Wolf ◽  
...  
Keyword(s):  
Physical Function ◽  
Upper Extremity ◽  
Shoulder Instability ◽  
Short Form ◽  
Patient Reported Outcome ◽  
Excellent Correlation ◽  
Sf 36 ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Pro Instruments

Background: Shoulder instability is a relatively common condition occurring in 2% of the population. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains. Purpose: To compare PROMIS instruments to current PRO instruments in patients who would be undergoing operative intervention for recurrent shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 74 patients with a primary diagnosis of shoulder instability who would be undergoing surgery were asked to fill out the American Shoulder and Elbow Surgeons shoulder assessment form (ASES), Marx shoulder activity scale (Marx), Short Form–36 Health Survey Physical Function subscale (SF-36 PF), Western Ontario Shoulder Instability Index (WOSI), PROMIS physical function computer adaptive test (PF CAT), and PROMIS upper extremity item bank (UE). Correlation between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3). Results: Utilization of the PROMIS UE demonstrated excellent correlation with the SF-36 PF ( r = 0.78, P < .01) and ASES ( r = 0.71, P < .01); there was excellent-good correlation with the EQ-5D ( r = 0.66, P < .01), WOSI ( r = 0.63, P < .01), and PROMIS PF CAT ( r = 0.63, P < .01). Utilization of the PROMIS PF CAT demonstrated excellent correlation with the SF-36 PF ( r = 0.72, P < .01); there was excellent-good correlation with the ASES ( r = 0.67, P < .01) and PROMIS UE ( r = 0.63, P < .01). When utilizing the PROMIS UE, ceiling effects were present in 28.6% of patients aged 18 to 21 years. Patients, on average, answered 4.6 ± 1.8 questions utilizing the PROMIS PF CAT. Conclusion: The PROMIS UE and PROMIS PF CAT demonstrated good to excellent correlation with common shoulder and upper extremity PRO instruments as well as the SF-36 PF in patients with shoulder instability. In patients aged ≤21 years, there were significant ceiling effects utilizing the PROMIS UE. While the PROMIS PF CAT appears appropriate for use in adults of any age, our findings demonstrate that the PROMIS UE has significant ceiling effects in patients with shoulder instability who are ≤21 years old, and we do not recommend use of the PROMIS UE in this population.

scholarly journals The Correlation of Communication Effectiveness and Patient Satisfaction

2021 ◽  
Vol 8 ◽  
pp. 237437352199883
Author(s):  
Yvonne Versluijs ◽  
Maartje Lemmers ◽  
Laura E. Brown ◽  
Amanda I. Gonzalez ◽  
Joost T. P. Kortlever ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Patient Reported Outcome Measures ◽  
Cross Sectional Study ◽  
Patient Reported Outcome ◽  
Communication Effectiveness ◽  
Cross Sectional ◽  
Patient Reported ◽  
Ceiling Effects ◽  
As Relationship ◽  
Current Experience

This study assessed the correlation of 9 questions addressing communication effectiveness (the Communication Effectiveness Questionnaire [CEQ]) with other patient-reported experience measures (PREMs; satisfaction, perceived empathy) as well as patient-reported outcome measures (PROMs; pain intensity, activity tolerance) in patients with musculoskeletal illness or injury. In a cross-sectional study, 210 patients visiting an orthopedic surgeon completed the CEQ and measures of satisfaction with the visit, perceived empathy, pain intensity, and activity tolerance. We evaluated correlations between CEQ and other PREMs and CEQ and PROMs. We measured ceiling effects of the PREMs. Communication effectiveness correlated moderately with other PREMs such as satisfaction (ρ = 0.54; P < .001) and perceived empathy (ρ = 0.54; P < .001). Communication effectiveness did not correlate with PROMs: pain intensity (ρ = −0.01; P = .93) and activity tolerance (ρ = −0.05; P = .44). All of the experience measures have high ceiling effects: perceived empathy 37%, satisfaction 80%, and CEQ 46%. The observation of notable correlations of various PREMs, combined with their high ceiling effects, direct us to identify a likely common statistical construct (which we hypothesize as “relationship”) accounting for variation in PREMs, and then develop a PREM which measures that construct in a manner that results in a Gaussian distribution of scores. At least within the limitations of current experience measures, there seems to be no association between illness (PROMs) and experience (PREMs).

Relationship Between PROMIS Computer Adaptive Tests and Legacy Hip Measures Among Patients Presenting to a Tertiary Care Hip Preservation Center

2019 ◽  
Vol 47 (4) ◽  
pp. 876-884 ◽  
Author(s):  
Robert C. Kollmorgen ◽  
Carolyn A. Hutyra ◽  
Cindy Green ◽  
Brian Lewis ◽  
Steven A. Olson ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Strong Correlation ◽  
Social Roles ◽  
Tertiary Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Adaptive Tests ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Computer Adaptive Tests

Background: Legacy hip outcome measures may be burdensome to patients and sometimes yield floor or ceiling effects. Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) allow for low-burden data capture and limited ceiling and floor effects. Purpose/Hypothesis: The purpose of this study was to determine whether the PROMIS CAT domains demonstrate correlation against commonly used legacy patient-reported outcome measures in a population of patients presenting to a tertiary care hip preservation center. The authors hypothesized the following: (1) PROMIS CAT scores based on physical function (PF), pain interference (PIF), pain behavior, and pain intensity would show strong correlation with the following legacy scores: modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), Hip Outcome Score (HOS) Sports and Activities of Daily Living subscales, and Veterans RAND–6D (VR-6D) utility measure. (2) The mental and physical health portions of the VR-6D legacy measure would show weak correlation with mental- and psychosocial-specific PROMIS elements—depression, anxiety, fatigue, sleep, and ability to participate in social roles and activities. (3) All PROMIS measures would exhibit fewer floor and ceiling effects than legacy scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Prospective data were collected on 125 patients in the hip preservation clinics. Enrollees completed legacy scores (visual analog scale for pain, mHHS, iHOT-12, HOS, and VR-6D) and PROMIS CAT questionnaires (PF, PIF, pain behavior, anxiety, depression, sleep, social roles and activities, pain intensity, fatigue). Spearman rank correlations were calculated, with rs values of 0 to 0.3 indicating negligible correlation; 0.3 to 0.5, weak correlation; 0.5 to 0.7, moderately strong correlation; and >0.7, strong correlation. Floor and ceiling effects were evaluated. Results: As anticipated, the PF-CAT yielded strong correlations with the iHOT-12, mHHS, HOS–Sports, HOS–Activities of Daily Living, and VR-6D, with rs values of 0.76, 0.71, 0.81, 0.87, and 0.71, respectively. The PIF-CAT was the only pain score to show moderately strong to strong correlation with all 14 patient-reported outcome measures. A strong correlation was observed between the VR-6D and the social roles and activities CAT ( rs = 0.73). The depression CAT had a significant floor effect at 19%. No additional floor or ceiling effect was present for any other legacy or PROMIS measure. Conclusion: The PF-CAT shows strong correlation with legacy patient-reported outcome scores among patients presenting to a tertiary care hip preservation center. The PIF-CAT also correlates strongly with legacy and PROMIS measures evaluating physical and mental well-being. PROMIS measures are less burdensome and demonstrate no floor or ceiling effects, making them a potential alternative to legacy patient-reported outcome measures for the hip.

scholarly journals Analysis of change in patient-reported outcome measures with floor and ceiling effects using the multilevel Tobit model: a simulation study and an example from a National Joint Register using body mass index and the Oxford Hip Score

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e033646
Author(s):  
Adrian Sayers ◽  
Michael R Whitehouse ◽  
Andrew Judge ◽  
Alex J MacGregor ◽  
Ashley W Blom ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Simulation Study ◽  
Hip Replacement ◽  
Primary Outcome ◽  
Patient Reported Outcome ◽  
Tobit Models ◽  
Post Surgery ◽  
Score Analysis ◽  
Patient Reported ◽  
Ceiling Effects

ObjectivesThis study has three objectives. (1) Investigate the association between body mass index (BMI) and the efficacy of primary hip replacement using a patient-reported outcome measure (PROMs) with a measurement floor and ceiling, (2) Explore the performance of different estimation methods to estimate change in PROMs score following surgery using a simulation study and real word data where data has measurement floors and ceilings and (3) Lastly, develop guidance for practising researchers on the analysis of PROMs in the presence of floor and ceiling effects.DesignSimulation study and prospective national medical device register.SettingNational Register of Joint Replacement and Medical Devices.MethodsUsing a Monte Carlo simulation study and data from a national joint replacement register (162 513 patients with pre- and post-surgery PROMs), we investigate simple approaches for the analysis of outcomes with floor and ceiling effects that are measured at two occasions: linear and Tobit regression (baseline adjusted analysis of covariance, change-score analysis, post-score analysis) in addition to linear and multilevel Tobit models.Primary outcomeThe primary outcome of interest is change in PROMs from pre-surgery to 6 months post-surgery.ResultsAnalysis of data with floor and ceiling effects with models that fail to account for these features induce substantial bias. Single-level Tobit models only correct for floor or ceiling effects when the exposure of interest is not associated with the baseline score. In observational data scenarios, only multilevel Tobit models are capable of providing unbiased inferences.ConclusionsInferences from pre- post-studies that fail to account for floor and ceiling effects may induce spurious associations with substantial risk of bias. Multilevel Tobit models indicate the efficacy of total hip replacement is independent of BMI. Restricting access to total hip replacement based on a patients BMI can not be supported by the data.

Evaluation of the PROMIS Physical Function Computer Adaptive Test in Patients Undergoing Knee Surgery

2019 ◽  
Vol 33 (08) ◽  
pp. 810-817
Author(s):  
Megan Miles ◽  
Vidushan Nadarajah ◽  
Julio J. Jauregui ◽  
Andrew G. Dubina ◽  
Michael P. Smuda ◽  
...  
Keyword(s):  
Physical Function ◽  
Knee Surgery ◽  
Charlson Comorbidity Index Score ◽  
Measurement Information ◽  
Opioid Use ◽  
Cross Sectional ◽  
Computer Adaptive Test ◽  
Adaptive Test ◽  
Patient Reported ◽  
Ceiling Effects

AbstractA cross-sectional analysis of data derived from patients undergoing knee surgery at a single institution was conducted. The objectives of the study were to (1) compare how the Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) computer adaptive test performs against the International Knee Documentation Committee (IKDC) Subjective Knee Form in evaluating functional status, and (2) to determine demographic, clinical, and psychosocial correlates of each outcome measure in an urban population undergoing a variety of knee surgeries. We hypothesized that there would be a strong correlation between PROMIS PF and IKDC, with minimal floor and ceiling effects, and similar clinical correlates. The sample consisted of 412 patients undergoing knee surgery. Bivariate and multivariable statistical analyses were performed to identify significant independent predictors. The PROMIS PF and IKDC scores were strongly correlated (r s = 0.71, p < 0.001), and neither exhibited floor nor ceiling effects. Lower body mass index, no preoperative opioid use, lower Charlson comorbidity index score, employment, and lower income were found to be significant independent predictors for better scores on both PROMIS PF and IKDC. Patients undergoing total knee arthroplasty had significantly lower PROMIS PF and IKDC scores (p < 0.05). Potential explanations for these findings are presented, and clinical implications are discussed.

scholarly journals Performance of the Patient-Reported Outcome Measurement Information System in Patients With Patellofemoral Instability

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091554 ◽  
Author(s):  
Christina J. Hajewski ◽  
Jacqueline E. Baron ◽  
Natalie A. Glass ◽  
Kyle R. Duchman ◽  
Matthew Bollier ◽  
...  
Keyword(s):  
Information System ◽  
Outcome Measurement ◽  
Patellofemoral Instability ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Sf 36 ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Health Domains ◽  
Measurement Information System

Background: The Patient-Reported Outcome Measurement Information System (PROMIS) was developed to improve patient-reported outcome measures (PROMs) and administration through a computer adaptive test (CAT). The PROMIS physical function-CAT (PF-CAT) has not been investigated in patients with patellofemoral instability (PFI). Purpose/Hypothesis: The purpose of this study was to evaluate the construct validity of the PROMIS PF-CAT with previously validated tools for measuring PROMs in patients with a diagnosis of PFI. We hypothesized that the PF-CAT will have the strongest correlations with other PROMs that evaluated PF as well as moderate correlations with PROMs that measured other health domains. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients enrolled in this study who underwent operative intervention for PFI completed the following evaluations preoperatively: PROMIS PF-CAT, 36-Item Short Form Health Survey (SF-36), Knee injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5 dimensions (EQ-5D), and Kujala Anterior Knee Pain Scale (AKPS). Correlation coefficients and the percentage of patients achieving the highest and lowest possible outcome score of each instrument were calculated to assess floor and ceiling effects. Statistical significance was defined as P < .05. Results: In total, 91 participants (63.7% females; mean age, 20.1 ± 7.2 years) completed the questionnaires. PF-CAT had the lowest number of questions (4.3 ± 1.1). The strongest correlations were between the PF-CAT and SF-36 PF subscale ( r = 0.78; P < .01), AKPS ( r = 0.68; P < .01), and KOOS Activities of Daily Living subscale ( r = 0.68; P < .01). Correlation was moderate between the PF-CAT and the KOOS subscales of Sports/Recreation ( r = 0.58; P < .01), Quality of Life ( r = 0.53; P < .01), and Symptoms ( r = 0.47; P < .01). The PROMIS PF-CAT demonstrated no floor or ceiling effects. Conclusion: In patients with PFI, construct validity of the PROMIS PF-CAT was supported by strong correlations demonstrated between the PF-CAT and PROMs evaluating PF and moderate correlations with those assessing other health domains. Our results demonstrated a low respondent burden and no floor or ceiling effects associated with the PROMIS PF-CAT. The PROMIS PF-CAT may be considered a beneficial alternative to previously established PF PROMs for preoperative evaluation of patients with PFI.

Does physical function impact the acceptability of routine patient-reported outcome surveys in cancer patients?

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 67-67
Author(s):  
Lauren Wong ◽  
Catherine Brown ◽  
Andrea Perez-Cosio ◽  
Yvonne Leung ◽  
Mindy Liang ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinic Visit ◽  
Routine Screening ◽  
Limiting Factors ◽  
Related Symptom ◽  
Patient Reported ◽  
Routine Basis ◽  
Caucasian Patients

67 Background: Patient-reported outcome measures (PROMs) are used to collect cancer-related symptom and symptomatic toxicity data. Understanding factors that affect the acceptability of PROMs is useful for improving the participation of such routine screening practices. We investigated the association between patient’s functional status on their acceptance and perception of usefulness of tablet technology to routine collection of PROM data in the clinical setting. Methods: 279 adult cancer outpatients at Toronto’s Princess Margaret Cancer Centre completed two physical function surveys, the HAQ-DI and WHODAS, using touchscreen tablet technology. Patient socio-demographics and their willingness of completing PROMs on a routine basis were also collected. Results: The median age was 62 (range: 20–94); 50% male, and 68% Caucasian. Patients were recruited from breast (10.4%), gastrointestinal (10.4%), genitourinary (14%), gynecology (14.3%), head & neck (17.9%), hematology (17.6%), and thoracic (15.4%) cancer clinics. 87% were willing to complete the survey on a touchscreen tablet, 74% did not find it time-consuming, and 4% found completion of the survey made their clinic visit more difficult. Only 1% found the questions upsetting or distressful; however, less than 60% were willing to complete similar surveys at every visit. Being Caucasian (p = 0.015) and Canadian-born (p = 0.021) were significantly associated with acceptability of the survey on a regular basis. However, HAQ-DI and WHODAS are not significantly associated with willingness to complete PROMs regularly (p = 0.30 & p = 0.16 respectively). Conclusions: Physical function status is not associated with acceptability; however, ethnicity does play a role where Canadian-born and Caucasian patients are more likely to complete PROMs regularly. Despite this, over 40% of patients were not willing to fill in the PROMs at each visit. Socio-cultural factors may impact on patients’ perceptions of the value of routine screening; however, assessment burden may also limit willingness to complete surveys on an ongoing basis. Further research is underway to gain more insight into the limiting factors of patients to complete the survey routinely.

Performance of the patient reported CAPLET2.0 physical functioning assessment tool.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 194-194
Author(s):  
Alexandra McCartney ◽  
Julia Singer ◽  
Reenika Aggarwal ◽  
Katrina Hueniken ◽  
Raiza Commiting ◽  
...  
Keyword(s):  
Physical Function ◽  
Cancer Patients ◽  
Physical Functioning ◽  
Assessment Tool ◽  
Performance Status ◽  
Patient Reported Outcome ◽  
Cancer Center ◽  
Patient Reported ◽  
Hematological Cancers ◽  
Screening Questions

194 Background: CAPLET is a published patient reported outcome measure which assesses domains of physical function efficiently in cancer patients through a branching logic algorithm using a patient-reported outcome version of ECOG performance status and EQ5D-3L health utility score (PMID: 29982902; a total of 6 screening questions). We assessed the sensitivity and specificity of this tool after updating it with screening questions from the EQ5D-5L (CAPLET2.0) as opposed to the previously published EQ5D-3L screener (CAPLET). Methods: Eligible cancer patients across all outpatient clinics and disease sites (solid and liquid cancers) at the Princess Margaret Cancer Center completed a questionnaire on touch-screen technology containing the EQ5D-5L, patient-reported outcome (PRO)-ECOG performance scale, the gold standard WHODAS 2.0 (12 items) and HAQ-DI (20 items) physical functioning questionnaires, and a clinico-demographic survey. Results: Of 261 patients, 53% were female, 61% were Caucasian, and 71% had English as a first language. Disease sites included: 12% breast, 10% gastrointestinal, 12% genitourinary, 19% gynecological, 13% head and neck, 13% lung and 13% hematological cancers. The optimal branching logic cut-points were identified when PRO-ECOG, scored as 0-1 and individual EQ5D items scored with the best functioning category allowed specific WHODAS/HAQ-DI questions to be skipped. Against individual WHODAS-HAQ-DI items, CAPLET2.0 had sensitivities ranging from 83-100% (median 93%), and specificities of 50-82% (median 58%). Using CAPLET 2.0, 45% of patients could have skipped all but five questions measuring mental health and cognition which are always asked. Sensitivities, specificities and the proportion of questions that could have been skipped were all similar to the original CAPLET tool. Conclusions: CAPLET2.0, which uses the updated EQ5D-5L and PRO-ECOG as screening questions to assess physical function in cancer patients has comparable performance to the original CAPLET tool. CAPLET2.0 is therefore a viable alternative physical functioning screening tool for both routine and research use.

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