Member's paper - Kidney Health Education and Research Group

Abstract

Validation of PROMIS physical function item bank (CAT) in patients on kidney replacement therapies

Ghazi, W., Tang, E., Mauti, E., Sun, Y., Gyatso, K., Siddiqui, R., El-Dassouki, N., Hajjar, W., Chen, A., Afzal, A., Ahmadzadeh, G., Mucsi, I

2021

PROMIS Health Organization (PHO)

Full Abstract
Objective: Poor physical function (PF) is an independent risk factor for mortality among patients with chronic kidney disease. Here we validate the Patient Reported Outcome Measurement Information System (PROMIS) PF item bank administered using computer adaptive test (CAT) among patients treated with kidney replacement therapies (dialysis or kidney transplant). Methods: A cross-sectional sample of adults treated with kidney transplant or dialysis completed PROMIS PF CAT using tablet-based electronic data capture. Participants also completed a sociodemographic questionnaire and legacy questionnaires (12-item Medical Outcomes Study Short Form [SF-12] and the EQ-5D-5L). Clinical data was extracted from medical records. We assessed reliability on the participant level by standard errors of measurement (SEM) over the range of T-scores. SEMs were converted to reliability coefficients (1–SEM2). Average reliability was calculated as 1-Σ(standard error)2. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) in a subgroup of participants who repeated PROMIS PF CAT within 3 to 14 days. Convergent validity was assessed using correlation between PROMIS PF CAT and SF-12 physical component summary (PCS). Discrimination was assessed using receiver operating characteristic (ROC) curves with the EQ-5D mobility item as a reference for “impaired mobility”, categorized as ‘no problems’ versus ‘any mobility problems’. Results: Of the 371 participants, mean (SD) age was 56(16) years, 64% male and 46% White; 64% had received a kidney transplant whilst 36% were on dialysis. Mean (SD) hemoglobin level was 123(19) g/L. The mean (SD) PROMIS PF T-score was 44(11). The average reliability was high (0.94) with 98% of individual reliability coefficients > 0.90 over the T-score range of 15-66. Test-retest reliability was good (ICC=0.91, n=75). A strong correlation (Rho=0.77) was observed between PROMIS PF T-score and SF-12-PCS. ROC analysis confirmed that PROMIS PF CAT had very good discrimination for “impaired mobility” (area under the ROC=0.83). Overall similar results were seen in the dialysis and kidney transplant sub-cohorts. Conclusion: Our results support the validity and reliability of PROMIS PF CAT among patients treated with kidney replacement therapies. PROMIS PF CAT may be useful to monitor physical function in clinical and research settings.

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