Psychometric comparison of the PROMIS physical function CAT with the FAAM and FFI for measuring patient-reported outcomes

Man Hung, Judith F. Baumhauer, James W. Brodsky, Christine Cheng, Scott J. Ellis, Jeremy D. Franklin, Shirley D. Hon, Susan N. Ishikawa, L. Daniel Latt, Phinit Phisitkul, Charles L. Saltzman, Nelson F. SooHoo, Kenneth J. Hunt

Research output: Contribution to journalArticlepeer-review

107 Scopus citations


Background: Selecting optimal patient-reported outcome (PRO) instruments is critical to improving the quality of health care. The purpose of this study was to compare the reliability, responsiveness, and efficiency of three PRO measures: the Foot and Ankle Ability Measure-Activity of Daily Living subscale (FAAM-ADL), the Foot Function Index 5-point verbal rating scale (FFI-5pt), and the PROMIS Physical Function computerized adaptive test (PF CAT). Methods: Data were aggregated from 10 clinical sites in the AOFAS's National Orthopaedic Foot and Ankle Research (OFAR) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle. Patients were administered the FAAM-ADL, FFI-5pt, and PF CAT at their preoperative visit and at 6 months after surgery. Reliabilities were evaluated using a Rasch model. Responsiveness was calculated using paired samples t test and efficiency was recorded as number of seconds to complete the instrument. Results: Similar reliabilities were found for the three instruments. Item reliabilities for FAAM-ADL, FFI-5pt, and PF CAT were all .99. Pearson reliabilities for FAAM-ADL, FFI-5pt, and PF CAT were .95, .93, and .96, respectively. On average, patients completed the FAAM-ADL in 179 seconds, the FFI-5pt in 194 seconds, and the PF CAT in 44 seconds, (P < .001). The PF CAT and FAAM-ADL showed significant improvement (P = .01 and P = .001, respectively) in patients' physical function after treatment; the FFI-5pt did not show improvement. Conclusions: Overall, the PF CAT performed best in terms of reliability, responsiveness, and efficiency in this broad sample of foot and ankle patients. It can be a potential replacement for the conventional PRO measures, but further validation is needed in conjunction with the PROMIS Pain instruments.

Original languageEnglish (US)
Pages (from-to)592-599
Number of pages8
JournalFoot and Ankle International
Issue number6
StatePublished - Jun 2014


  • Computerized adaptive testing
  • FAAM
  • FFI
  • OFAR
  • Patient-reported outcomes
  • Physical function
  • Psychometrics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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