Why the study?
Is there a discrepancy between patient self-assessment using validated scoring tools and clinician assessment of functional capacity during preoperative evaluation?
Is there a discrepancy between patient self-assessment using validated scoring tools and clinician assessment of functional capacity during preoperative evaluation?
There is a significant discrepancy between clinician assessment and patient self-assessment of functional capacity in the preoperative setting, with clinicians more frequently estimating capacity at <4 METs.
Clinician assessments may overestimate low functional capacity versus DASI; leaves open which method better predicts perioperative outcomes.
BACKGROUND: Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity. METHODS: Patients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)-Short Form 12a-Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of <4 metabolic equivalents of task (METs) or ≥4 METs. Patients also evaluated the usability of the questionnaires. RESULTS: After IRB approval, 204 patients were enrolled and completed both DASI and PROMIS questionnaires. Clinicians assessed functional capacity at <4 METs for 109 patients (53.4 %) compared to 18 (8.8 %) patient self-assessments <4 METs as estimated by DASI. These results represent a significant discrepancy between assessments (Fisher's exact, two-tailed P value <0.0001). The standard T-score of PROMIS estimates of functional capacity correlated with DASI estimates (R (2) 0.76). The mean and standard deviation for PROMIS T-scores were 43.3 and 9.86, respectively (mean 50.0; SD 10.0 for the general population). Of the 203 patients who completed the entire study survey, 192 (94.6 %) stated that they did not require assistance from another person, and 187 (94 %) responded either "agree" or "strongly agree" to the DASI questionnaire being "easy to understand" and "easy to complete;" 186 (93 %) and 188 (94 %), respectively, responded similarly to the PROMIS questionnaire. CONCLUSIONS: While both electronic questionnaires were easy to understand and complete for most study participants, there was a significant discrepancy between clinician assessments and patient self-assessments of functional capacity. Further study is needed to determine if either patient self-triage by means of activity questionnaires or clinician evaluation is valid and reliable in the preoperative setting.
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Stokes et al. (2016) studied this question.
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