Does a Concise Patient-reported Outcome Measure Provide a Valid Measure of Physical Function for Cancer Patients...

Area of Science:

• Orthopaedic Oncology
• Functional Assessment Tools
• Patient-Reported Outcomes

Background:

• Existing functional assessment tools in orthopaedic oncology are lengthy, leading to patient survey fatigue.
• Current tools often fail to differentiate functional capabilities in patients who are mobile but have activity limitations.
• A need exists for a shorter, more responsive tool to assess function in orthopaedic oncology patients.

Purpose of the Study:

• To develop and validate a concise, 14-item functional assessment tool derived from the Toronto Extremity Salvage Score for the lower extremity (TESS LE) and the Lower Extremity Functional Scale (LEFS).
• To evaluate the responsiveness (sensitivity and specificity) of the new tool compared to the TESS LE and LEFS.
• To assess the precision and accuracy of the concise tool against established measures.

Main Methods:

• Functional outcome data from 339 patients undergoing lower extremity procedures were analyzed.
• A 14-item tool was derived using correlation, principal component analysis (PCA), and item response theory (IRT) modeling from the TESS LE and LEFS.
• Responsiveness and concordance were evaluated using receiver operating characteristic (ROC) curves and statistical comparisons against the PROMIS global health tool.

Main Results:

• The 14-item tool demonstrated similar responsiveness (sensitivity and specificity) to the TESS LE and LEFS, with areas under the curve (AUCs) ranging from 0.62 to 0.65.
• The new tool showed high sensitivity (96%) and specificity (90%) when compared to the TESS LE, and high sensitivity (95%) and specificity (86%) when compared to the LEFS.
• Concordance analysis indicated high precision (0.98) and accuracy (0.97 vs. TESS LE; 0.83 vs. LEFS) for the 14-item tool.

Conclusions:

• The developed 14-item Lower Extremity Oncology Functional Assessment Tool (LEO) is a concise and effective measure for assessing lower extremity function in orthopaedic oncology patients.
• LEO exhibits comparable responsiveness and accuracy to the longer TESS LE and LEFS, addressing survey fatigue while maintaining clinical utility.
• This tool aids clinicians and patients in understanding functional status post-orthopaedic surgery for oncologic and non-oncologic conditions.