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Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

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Upper Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic

Daniel Deutscher^1,2, Deanna Hayes¹, Karon F Cook³

¹Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA.

Physical Therapy

|October 12, 2021

Summary

A new patient-reported outcome measure (PROM) effectively assesses upper quadrant edema (UQE) impact on physical function. This reliable and valid tool offers efficient computerized adaptive testing (CAT) and short-form (SF) administration for clinical use.

Keywords:

Computerized Adaptive Testing Edema Item Response Theory Lymphedema Patient-Reported Outcome Measures Physical Function

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Area of Science:

Rehabilitation Medicine
Health Outcomes Measurement
Biostatistics

Background:

Upper quadrant edema (UQE) significantly impacts patients' physical function.
Existing measures may not adequately capture the functional limitations associated with UQE.
Development of a robust patient-reported outcome measure (PROM) is needed for accurate assessment.

Purpose of the Study:

To develop and validate a PROM item bank for UQE's impact on physical function.
To assess the reliability, validity, and efficiency of computerized adaptive testing (CAT) and short-form (SF) administration modes for the UQE PROM.

Main Methods:

Retrospective study of 3486 patients with UQE treated in outpatient rehabilitation.
Item response theory (IRT) was used to calibrate a 25-item UQE PROM from 27 candidate items.
Reliability, validity, and efficiency of UQE-CAT and UQE-SF scores were evaluated.

Main Results:

A 25-item UQE PROM demonstrated unidimensionality and fit to the IRT model with reliability >0.93 for both CAT and SF scores.
No differential item functioning was observed; scores showed clinical validity and responsiveness.
UQE-CAT administration averaged 5.6 items, indicating high efficiency.

Conclusions:

The UQE PROM is a reliable, valid, and efficient tool for assessing physical function in patients with UQE.
The measure is suitable for both research and routine clinical application in outpatient rehabilitation settings.
Modern measurement approaches like IRT enhance PROM accuracy and efficiency.