The Lower Extremity Physical Function Patient-Reported Outcome Measure Was Reliable, Valid, and Efficient for Patients With Musculoskeletal Impairments.
OBJECTIVE
To calibrate the Lower Extremity Functional Scale (LEFS) items into a regional lower extremity physical function (LEPF) item bank and assess reliability, validity, and efficiency of computerized adaptive test (CAT) and short form (SF) administration modes.


DESIGN
Retrospective cohort.


SETTING
Data were collected from patients treated in outpatient rehabilitation clinics for musculoskeletal impairments of the hip, knee, foot, and ankle that responded to all 20 LEFS items at intake.


PARTICIPANTS
Patients aged 14 years or older who started an episode of care during January 2016-October 2019 and identified the lower extremity region as the source of a primary musculoskeletal complaint. Total cohort included 78,186 patients (mean age, 53±19y, range, 14-89y).


INTERVENTIONS
Not applicable.


MAIN OUTCOME MEASURES
Item response theory (IRT) model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were studied. LEPF-CAT- and LEPF-SF-generated scores were evaluated.


RESULTS
An 18-item solution was supported for its unidimensionality and fit to the IRT model, with reliability estimates >0.9 for all administration modes. No DIF impact on LEPF scores was identified. Scores discriminated between multiple patient groups in clinically logical ways and were highly responsive to change, with negligible floor or ceiling effects. CAT scores were generated using an average of 4.9 items (median, 4).


CONCLUSIONS
The LEPF scores were reliable, valid, and efficient for assessing perceived physical function of patients with musculoskeletal impairments of the hip, knee, foot, and ankle; thus, it was found suitable for research and routine clinical administration. These findings are limited to the type of patients included in this study, with further validation needed to assess their generalizability.
['Deutscher|Daniel|D|', 'Kallen|Michael A|MA|', 'Hayes|Deanna|D|', 'Werneke|Mark W|MW|', 'Mioduski|Jerome E|JE|', 'Tucker|Carole A|CA|', 'Cook|Karon F|KF|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D006801:Humans D035002:Lower Extremity D008297:Male D008875:Middle Aged D009140:Musculoskeletal Diseases D000071066:Patient Reported Outcome Measures D000076604:Physical Functional Performance D015203:Reproducibility of Results D012189:Retrospective Studies D055815:Young Adult
Lower extremity Patient-reported outcome measures Rehabilitation Physical functional performance