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Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
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Lower Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic

Daniel Deutscher1,2, Michael A Kallen3, Deanna Hayes1

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

Physical Therapy
|September 8, 2023
PubMed
Summary

This study developed a reliable and valid patient-reported outcome measure (PROM) for lower quadrant edema (LQE) impact on physical function. The LQE PROM, available in computerized adaptive testing (CAT) and short form (SF) versions, offers efficient assessment for research and clinical care.

Keywords:
Computerized Adaptive TestingItem Response TheoryLower Quadrant EdemaLymphedemaPatient-Reported Outcome MeasuresPhysical Function

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Area of Science:

  • Rehabilitation Medicine
  • Health Outcomes Measurement
  • Psychometrics

Background:

  • Lower quadrant edema (LQE) significantly impacts patients' physical function.
  • Existing measures may not adequately capture the nuanced effects of LQE on daily activities.
  • Development of patient-reported outcome measures (PROMs) is crucial for personalized care and research.

Purpose of the Study:

  • To develop a patient-reported outcome measure (PROM) item bank for LQE using item response theory (IRT).
  • To evaluate the reliability, validity, and efficiency of LQE PROM scores via computerized adaptive testing (CAT) and a 10-item short form (SF).

Main Methods:

  • Retrospective analysis of 4894 patients with LQE from outpatient rehabilitation.
  • Application of item response theory (IRT) to a 30-item candidate bank, assessing unidimensionality, fit, and differential item functioning (DIF).
  • Evaluation of LQE-CAT and LQE-SF scores for reliability, validity, and administration efficiency.

Main Results:

  • A 20-item LQE item bank was established, demonstrating strong psychometric properties (reliability > 0.92 for CAT and SF).
  • No DIF was observed for tested variables; scores effectively discriminated between patient groups.
  • CAT administration averaged 6.1 items, with high correlation (0.98) to full-bank scores; small effect size (0.4) for change noted.

Conclusions:

  • The LQE PROM (CAT and SF) is reliable, valid, and efficient for assessing physical function in LQE patients.
  • These PROMs are suitable for both research and routine clinical practice in rehabilitation settings.
  • The study advocates for modern measurement approaches in PROMs for accuracy and efficiency.