Eden, Melissa M.

ABSTRACT Objectives The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis. Methods One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII). Results DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics. Conclusions Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended. Impact This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians.

Abstract Background Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data Sources PubMed and CINAHL were searched up to September 2018. Study Selection Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data Extraction Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data Synthesis Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.

Purpose: The purpose of this study was to establish the test-retest reliability and concurrent validity of the Modified Brief Fatigue Inventory (MBFI) and the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) scale in a population of patients treated for cancers of the head and neck. Methods: The MBFI and the FACIT-Fatigue were administered to 65 participants in a tertiary medical center with a diagnosis of head and neck cancer (HNC), skin cancer, and thyroid cancer who had undergone surgery within the past 3 months and/or were currently receiving radiation and/or chemotherapy treatments. Test-retest reliability, internal consistency, and concurrent validity are reported. Results: For the HNC group, the MBFI had an intraclass correlation coefficient (ICC) of 0.825 (0.68-0.91) and an internal consistency of 0.828. The FACIT-Fatigue ICC was 0.866 (0.75-0.93) and internal consistency was 0.874. The MBFI ICC for the skin and thyroid cancer groups was 0.932 (0.76-0.98) and 0.880 (0.60-0.97), and internal consistency of 0.929 and 0.880, respectively. The FACIT-Fatigue ICC for the skin and thyroid cancer groups was 0.945 (0.81-0.99) and 0.941 (0.81-0.98), and the internal consistency was 0.945 and 0.941, respectively. The Spearman ρ correlation coefficient for concurrent validity of the MBFI and FACIT-Fatigue was −0.871 for HNC, −0.838 for skin cancer, and −0.903 for thyroid cancer. Conclusions: The MBFI and the FACIT-Fatigue demonstrate good test-retest reliability, internal consistency, and concurrent validity for all subgroups. The FACIT-Fatigue demonstrates a slight advantage over the MBFI with respect to test-retest reliability and internal consistency.