Comprehensive ICF Core Set for Obstructive Pulmonary Diseases: validation of the Activities and Participation component through the patient’s perspective

Effects of adherence to the Mediterranean diet on fatigue and activities of daily living in geriatric individuals with COPD

BACKGROUND & AIMS

Fatigue is a commonly diagnosed symptom in cancers and many other chronic debilitating diseases. The second most important complaint after dyspnea in patients with Chronic Obstructive Pulmonary Disease (COPD) is the feeling of fatigue. Fatigue can have significant consequences on health status as it can limit patients' activities of daily living, lead to worsening prognosis, and is an indicator of mortality. It remains unclear how fatigue affects the daily life of COPD patients and what physical, social, and emotional challenges it brings. Some studies are showing that adhering to the Mediterranean diet significantly improves fatigue. In this study, the relationship between fatigue and adherence to a Mediterranean diet in COPD patients was investigated.

METHODS

The present study is a descriptive, cross-sectional, and correlational study. The study population included ≥65-year-old patients with a diagnosis of COPD who were hospitalized in Chest Diseases Clinics of İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital and Chest Diseases Clinic of Sivas Cumhuriyet University Hospital. The Personal Information Form, Mediterranean Diet Adherence Screener (MEDAS), COPD and Asthma Fatigue Scale (CAFS), and KATZ Activities of Daily Living Scale (Katz ADL) were used as data collection tools.

RESULTS

Of the total 526 participants, 58.7% were men, 52.1% were overweight, 54.3% were ex-smokers, and 65.8% were non-drinkers. In the variables related to the disease, the mean duration of having COPD was 16.41 (SD 5.26) years. According to the GOLD classification of the participants, the severity of the disease was determined as Stage III in 57.4% of them, and the severity of dyspnea was determined as "3" (moderate severity) in 54.5% of them according to the mMRC scale. According to the results of the analysis, the mean MEDAS score was 7.84 (SD: 2.76). According to the participants' levels of adherence to the MD, of them, 43.8% had high adherence to MD and 29% had low adherence to MD. The mean CAFS score indicating the level of disease-related fatigue was 69.17 (SD: 15.73), and the lowest and highest scores were 25 and 100 respectively. According to the independence in activities of daily living of the participants, 77.3% were semi-dependent and 6.4% were independent. The comparison of the level of the participant's adherence to the MD according to their mean CAFS scores demonstrated that those who had high adherence to the MD obtained significantly lower scores than the participants in the other groups (p < 0.05). The comparison of the participants' mean MEDAS scores according to their KATZ ADL independence status demonstrated that there was a significant difference (p < 0.001).

CONCLUSIONS

Adherence to the MD was associated with fatigue and independence in older COPD patients. It was found that high adherence to MD is associated with decreased fatigue and increased independence in activities of daily living in older COPD patients.

Validation of the International Classification of Functioning, Disability and Health (ICF) core sets from 2001 to 2019 - a scoping review

Objective: To investigate and summarize the literature on the validation of International Classification of Functioning, Disability and Health (ICF) core sets from 2001 to 2019 and explore what research methods have been used when validating ICF core sets.Methods: The current study is a scoping review using a structured literature search.Results: In total, 66 scientific articles were included, of which 23 ICF core sets were validated. Most validation studies were conducted in Europe using a quantitative methodology and were validated from the perspective of patients. Analysis methods differed considerably between the studies, and most ICF core sets were validated only once for a single target population or from a single perspective. The comprehensive core sets were validated more often than the brief core sets, and core sets for stroke and low back pain were validated most often.Conclusion: The results of the current study show that only 66% of the existing ICF core sets are validated. Many of the validation studies are conducted in a European context and from a single perspective. More validation studies of ICF core sets from the perspective of both patients and professionals are needed.Implications for rehabilitationICF core sets aim to facilitate assessments in clinical settings and research.Validation studies indicate in general that the ICF core sets are valid and relevant for patients and professionals in the specific areas explored and thus can be used in rehabilitation settings.To improve the quality of ICF core sets, more validation studies are needed for ICF core sets not yet tested and for ICF core sets that have been validated only in one study or for one specific population or target group.

The Upper Extremity Functional Index: Reliability and Validity in Patients with Chronic Obstructive Pulmonary Disease

The aim of the current study was to examine the psychometric properties of the upper extremity functional index (UEFI) in patients with chronic obstructive pulmonary disease (COPD). Seventy patients with stable COPD completed the UEFI and St. George Respiratory Questionnaire (SGRQ) and performed lung function tests in the first testing session. They completed the UEFI and the Global Rating of Change Scale in the second session, which was within ten days of the first session. The UEFI floor and ceiling effects, internal consistency, test–retest reliability, measurement error, and construct validity were examined. The UEFI was found to have no floor and ceiling effects. The UEFI was also found to have an excellent internal consistency (Cronbach’s alpha = 0.955) and an excellent test–retest reliability (ICC_2,1 = 0.91). Totals of 4.85 points and 11.32 points represent the scale’s standard error of measurement, and a minimal detectable change at 90% confidence was used. The UEFI scores showed a significant correlation with the SGRQ activity domain (r = −0.66, p < 0.001) and differed significantly between participants with severe disease and those with mild disease (p = 0.03). The UEFI had no floor or ceiling issues, an excellent internal consistency, a good test–retest reliability, and an acceptable measurement error. The UEFI also demonstrated evidence supporting its construct validity as a measure of upper extremity-related activity limitations in patients with COPD.

Community Participation by People with Chronic Obstructive Pulmonary Disease

Little is known regarding community participation in individuals with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore community participation in individuals with COPD and to determine whether there is an association between community participation and activity-related outcome variables commonly collected during pulmonary rehabilitation assessment. We also sought to investigate which of these variables might influence community participation in people with COPD. Ninety-nine individuals with COPD were enrolled (67 ± 9 years, FEV₁: 55 ± 22% predicted). We assessed community participation (Community Participation Indicator (CPI) and European Social Survey (ESS) for formal and informal community participation), daily physical activity levels (activity monitor), exercise capacity (6-minute walk test), breathlessness (Modified Medical Research Council, MMRC scale), self-efficacy (Pulmonary Rehabilitation Adapted Index of Self-Efficacy) and anxiety and depression (Hospital Anxiety and Depression Scale). Higher levels of community participation on the CPI were associated with older age and greater levels of physical activity (total, light and moderate-to-vigorous) (all r_s = 0.30, p < 0.05). Older age and more moderate-to-vigorous physical activity independently predicted greater community participation measured by CPI. Higher levels of depression symptoms were associated with less formal and informal community participation on ESS (r_s = -0.25). More formal community participation on ESS was weakly (r_s = 0.2-0.3) associated with older age, better lung function, exercise capacity and self-efficacy, and less breathlessness. Self-efficacy, exercise capacity, and age independently predicted formal community participation in individuals with COPD. Strategies to optimize self-efficacy and improve exercise capacity may be useful to enhance community participation in people with COPD.

The Reliability and Validity of the Brief ICF Core Set in Patients with Chronic Obstructive Pulmonary Disease

Purpose

To analyze the reliability and validity of the Brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD).

Patients and Methods

A cross-sectional study was conducted in four tertiary hospitals in Tianjin, China. A total of 100 patients with COPD were selected to evaluate functioning and disability involving body functions, body structures, activities and participation as well as environmental factors of the Brief ICF core set for COPD. Internal consistency was calculated by Cronbach's α. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). In addition, construct validity and convergent validity were also examined.

Results

The Brief ICF core set for COPD had a high internal consistency, 0.873 for the total scale, with values of 0.750, 0.640, and 0.843 for body functions, body structures, and activity and participation, respectively. The content validity was calculated by the CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.80-1, 0.929, and 0.986, respectively. Meanwhile, the ICF core set for COPD had good convergent validity, correlating with the mMRC dyspnea score (r=0.690, P<0.01), and there were significant correlations between the ICF core set for COPD and COPD clinical severity grade (r=0.363, P<0.01). A four-factor model of functions and disability in the Brief ICF core set for COPD had the best fit according to confirmatory factor analysis (CFA).

Conclusion

The Brief ICF core set for COPD is a reliable and valid convenient instrument for assessing comprehensive problems in the functioning of patients with COPD, which can be used to design and to evaluate rehabilitation strategies.

Content validity of the Brief and Comprehensive ICF Core Sets for common disabling conditions in a developing country

The International Classification of Functioning, Disability and Health (ICF) features associated tools, the Brief and Comprehensive ICF Core Sets. These are designed to be universally applicable, but have limited evidence of content validity (i.e. comprehensiveness and relevance) in low income, non-Western countries. In this cross-sectional study, we aimed to assess the content validity of the ICF Core Sets in Nepal. We interviewed 161 participants with stroke, spinal cord injury (SCI), chronic obstructive pulmonary disease (COPD), and musculoskeletal conditions and asked them to identify activities they had difficulty performing due to their health condition. We mapped 544 participant responses to the ICF and assessed if these ICF categories were represented in the respective ICF core sets. The Comprehensive Core Sets for stroke, COPD, SCI, and musculoskeletal conditions contained more items identified by participants than the respective Brief Core Sets (e.g., 89% vs. 26% in stroke). Among ICF categories that represented at least 5% of participants' responses, the Brief Core Sets covered 40%-71% of participants' responses whereas the Comprehensive Core Sets covered 67%-100% of responses. This is the first study to evaluate the content validity of the ICF Brief and Comprehensive core sets in Nepali individuals with stroke, SCI, MSK conditions, and COPD. The Comprehensive Core Sets for stroke, COPD, and SCI have adequate content validity for use in clinical practice and research in Nepal; the Brief Core Sets may not adequately meet local and individual needs unless supplemented with additional ICF categories.

A Tool to Assess Participation in People With COPD: Validation of the Late Life Disability Instrument

BACKGROUND

Participation in life roles is a critical patient-centered health outcome associated with morbidity and mortality in older adults, but it is not measured routinely in people with COPD. We aimed to validate a participation measure, the Late Life Disability Instrument (LLDI), in people with COPD.

RESEARCH QUESTION

To what extent does the LLDI demonstrate test-retest measurement error and reliability, internal consistency, construct and face validity, and floor or ceiling effects when applied to people with COPD?

STUDY DESIGN AND METHODS

In this cross-sectional study, LLDI scores were compared with scores on measures of theoretically related constructs and between groups based on symptom severity, prognosis, and frailty. A subsample (n = 36) completed the LLDI a second time over the phone within one week. Participants and health-care professionals were asked about the relevance, comprehensiveness, and comprehensibility of the LLDI. Floor and ceiling effects were explored, and the internal consistency (Cronbach's α) of the LLDI was calculated.

RESULTS

Ninety-six older adults with COPD participated. The frequency and limitation domains of the LLDI showed excellent test-retest reliability (two-way random effect intraclass correlation coefficient, 0.90 [standard error of measurement, 1.74 points] and 0.90 [standard error of measurement, 3.16 points], respectively). Both domains showed fair correlations with physical function, depression, and quality of life (r = 0.38-0.59). The relationship with anxiety was poor for the LLDI frequency domain (r = -0.21) and fair for LLDI limitation domain (r = -0.45). Both domains discriminated between people with different symptom severity, prognosis, and frailty (P ≤ .026). Neither domain showed floor or ceiling effects, and Cronbach's α was 0.69 and 0.91 for the LLDI frequency and limitation domains, respectively. All healthcare professionals and most participants agreed that the LLDI measures participation (79%) and that the items were relevant (81%).

INTERPRETATION

The LLDI shows test-retest reliability, internal consistency, and construct and face validity in people with COPD. The LLDI can be used to assess participation in this population.

Functional Independence in the Community Dwelling Older People: a Scoping Review

Ageing potentially poses a threat to independent functioning of older adults. Although clinicians commonly focus on physical factors limiting Functional Independence (FI), it is likely that personal and environmental interactions also seem important to maintain FI. Herewith, FI exceeds several professional borders and calls for a uniform, multidisciplinary interdisciplinary supported definition of FI. This study aims to provide such a definition of FI in community dwelling older people. A scoping review was performed. Pubmed/Medline, Psychinfo and CINAHL were searched for studies describing aspects of FI. A literature-based definition of FI was discussed by experts (n = 7), resulting in a formulated final definition of FI and insight into contributing factors to FI. A multidisciplinairy focusgroup a stakeholder consultation (n = 15) ensured clinical relevance for daily practice. Data from the focusgroup stakeholder consultation were analyzed by using Atlas.ti (version 8). Based on the literature search, 25 studies were included. FI was finally defined as “Functioning physically safely and independent from another person, within one’s own context”. The contributing factors of FI comprised physical capacity combined with coping, empowerment and health literacy. Moreover, the level of FI is influenced by someone’s own context. This study confirms the relevance of the physical aspect of FI, but additionally stresses the importance of psychological factors. In addition, this study shows that one’s context may affect the level of FI as well. This underlines the importance of a holistic view and calls for multidisciplinary interdisciplinary collaboration in community-dwelling older people.

Description of Participation in Daily and Social Activities for Individuals with COPD

This study described the participation in daily and social activities and the perceived barriers and facilitators to participation of individuals with chronic obstructive pulmonary disease (COPD). Individuals, recruited from outpatient clinics, responded to a survey on their participation in, and barriers and facilitators towards, 26 daily and social activities, divided into 3 categories: (1) physical activity and movement (PAM); (2) self-care; and (3) social engagement. For each activity, chi-square analyses were used to examine participation differences by individuals': quartiles of airflow obstruction [percent predicted forced expiratory volume in 1 second (FEV1%predicted)] and breathlessness burden and exacerbation risk. Of the 200 participants (47% women; mean ± standard deviation age = 68 ± 9 years), most wanted to increase their participation in PAM activities (range 21-75%) and significant differences were found in 5/10 PAM activities for individuals' breathlessness burden and exacerbation risk (e.g., more individuals than expected in group A (modified Medical Research Council breathlessness score <2 and 0-1 exacerbations in past 12 months) participated in regular exercise as much as they wanted (χ₍₉₎²=20.43, Cramer's V=.23)). Regardless of the degree of airflow obstruction or breathlessness burden and exacerbation risk, the most common barrier to participation was breathlessness (p<.001, η²_p=.86) and the most common facilitator was engaging as part of their routine (p<.001, η²_p=.75). Individuals with COPD want to increase their participation in daily and social activities but are limited by breathlessness. Strategies to alleviate breathlessness should be identified/prioritized and incorporated into individuals' daily routines to meet their self-reported participation objectives in daily and social activities.

Validation of the brief international classification of functioning, disability, and health core set for obstructive pulmonary disease in the Chinese context

In order to determine the validity of the International Classification of Functioning, Disability, and Health brief Core Set for Obstructive Pulmonary Disease (ICF-OPD) for the assessment of functioning and environmental factors in Chinese chronic OPD (COPD) patients, we conducted a cross-sectional study with a convenience sample of 100 COPD patients. Data were collected using common questionnaires for COPD patients (Modified British Medical Research Council Questionnaire, COPD Assessment Test, St George’s Respiratory Questionnaire (SGRQ)), the Brief ICF Core Set for OPD, and the comprehensive ICF checklist. All except one category of the Brief ICF-OPD Core Set were confirmed in our evaluation of its content validity, but there is a high prevalence of problems in 8 categories that were not considered in the Brief ICF-OPD Core Set. The functioning-related components of the Brief ICF-OPD Core Set largely performed similarly to SGRQ in terms of differentiating between patients with different disease severity. Moreover, high correlations between the Brief ICF-OPD Core Set overall score and component scores with the respective SGRQ scales and moderate correlations between ICF-OPD Core Set overall score and component scores and lung function parameters. This study largely confirmed content, known group, and convergent validity of the ICF-OPD.

Linking quality of life questionnaires for asthma to the International Classification of Functioning

OBJECTIVE

To link the content of the most common quality of life instruments for children with asthma to the International Classification of Functioning, Disability and Health (ICF).

METHODS

The study was conducted in two stages. The first involved a review of the literature to select quality of life questionnaires and in the second, two independent reviewers identified questionnaire items, and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient.

RESULTS

Two questionnaires were selected: the Pediatric Asthma Quality of Life (PAQLQ) and Pediatric Quality of Life Asthma Module (PedsQL-Asthma), self and proxy versions. The degree of agreement was strong for all the instruments: PAQLQ (k = 0.624), PedsQL- Asthma self (k = 0.610), and PedsQL-Asthma proxy (k = 0.673). A total of 114 concepts were identified in the 77 items. Thirty-five different ICF categories were linked, 16 (45.7%) related "body function," 13 (37.1%) "activity and participation," and 6 (17.1%) "environmental factors." Two items (1.7%) could not be linked because they represent personal factors or are not covered by the ICF.

CONCLUSION

The categories linked to the PAQLQ contained primarily "body function" and "activity and participation," but not "environmental factors." Those linked to the PedsQL-Asthma versions encompass three of the four ICF components, where the highest content frequency was associated with "body function," followed by "environmental factors" and "activities and participation."

The Reliability and Validity of the "Activity and Participation" Component in the Brief ICF Core Set for Chronic Obstructive Pulmonary Diseases Based on Rasch Analysis

Purpose

To analyze the reliability and validity of the “activity and participation” component of the brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD) using a Multi-faceted Rasch model.

Patients and Methods

A total of 103 patients with COPD were selected by two raters to evaluate their ability levels in the four categories of the “activity and participation” component of brief ICF core set for COPD. The Multi-faceted Rasch model was used for data analysis. The analysis software used FACETS (Minifac) 3.67.0.

Results

The “activity and participation” of brief ICF core set for COPD had a high internal consistency (separation index of 5.08, reliability of 0.96, P <0.05) and good inter-rater reliability (mean-square fit statistic range was 0.97–1.04, the separation index was 0.00, the reliability was 0.00, P >0.05), the construct validity was good (mean-square fit statistic range was 0.79–1.36), and the consistency of each category measurement was high (the separation index was 1.70, the reliability was 0.74).

Conclusion

The “activity and participation” of brief ICF core set for COPD has good reliability and validity, which can be used to test the daily activities of patients with COPD.

Implementation of a real-world based ICF set for the rehabilitation of respiratory diseases: a pilot study

BACKGROUND

International Classification Functioning (ICF) Core Sets represent a holistic approach to functioning within rehabilitation field. Information-reporting efficacy of a rehabilitation-based Respiratory ICF set applied on a large scale throughout the ICS Maugeri network was tested.

METHODS

A prospective multi-center study (May-November 2018) was conducted for all respiratory inpatients consecutively admitted for rehabilitation. Doctors, physiotherapists, psychologists, nurses used an electronic Respiratory ICF set (33 items among the ICF body functions, activity and participations components) at admission and at discharge to assess the disability changes. The ICF report qualifiers, from 0 (no impairment) to 4 (maximum impairment), guided clinical, diagnostic and rehabilitation prescriptions.

RESULTS

1886 patients (69.6±10.8 years; M=1045) were admitted (589 chronic obstructive pulmonary disease, 494 chronic respiratory failure [CRF], 21 prolonged mechanical ventilation [PMV], 496 with other respiratory diseases), of whom 15 died, and 117 were transferred to acute care. The mean length of stay was 23.1±11.8 days (range 1-122). The mean time to fill in the ICF set was 23.16±0.70 min. The rate of filled charts improved from 16% in May to 100% in November. The baseline distribution of the more severe qualifiers (>2) progressively increased from the whole sample to the PMV subgroup. After rehabilitation, in the whole sample and in the CRF and PMV subgroups, the severity qualifiers significantly decreased (P<0.0001), showing a positive effect of the intervention on patients' disability.

CONCLUSIONS

Routine use of a Respiratory ICF set for chronic respiratory diseases helps to prepare a personalized rehabilitation program discriminating disability level in different respiratory diseases and assessing disability outcomes pre-post rehabilitation.

A Pervasive Healthcare System for COPD Patients

Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems worldwide. Pervasive computing technology creates a new opportunity to redesign the traditional pattern of medical system. While many pervasive healthcare systems are currently found in the literature, there is little published research on the effectiveness of these paradigms in the medical context. This paper designs and validates a rule-based ontology framework for COPD patients. Unlike conventional systems, this work presents a new vision of telemedicine and remote care solutions that will promote individual self-management and autonomy for COPD patients through an advanced decision-making technique. Rules accuracy estimates were 89% for monitoring vital signs, and environmental factors, and 87% for nutrition facts, and physical activities.

The Kinematic Chain of Arm Elevation Is Impaired in Patients with Chronic Obstructive Pulmonary Disease

Patients with chronic obstructive pulmonary disease (COPD) often complain about difficulties in performing activities with their arms above shoulders height. These difficulties have been associated with increased cardiorespiratory demand and altered lung mechanics; however, musculoskeletal-related mechanisms may also contribute to constrain the mechanics of the upper body quadrant, increasing the effort to perform the activities. This exploratory research aimed to assess potential changes in the kinematic chain of arm elevation in patients with COPD. A secondary analysis from a cross-sectional exploratory case-control and prediction study was conducted in 15 patients with COPD (2 females) and 15 controls (8 females) matched for age and body mass index. The sagittal alignment and active range of motion (ROM) of the head, thoracic spine and shoulder complex were measured, using a computer software, in digital lateral photographs obtained in three different testing positions: arms at rest, arms at 90° of shoulder flexion and full arm elevation. From rest to full arm elevation, both groups moved from a more flexed to a less flexed or more upright thoracic spine position (∼7°, p < 0.001, 0.419 < ηp2 <0.767). However, the COPD group showed significantly less shoulder flexion (∼12°, p = 0.007, d = 1.05) and thoracic spine extension (∼6°, p = 0.015, ηp2 = 0.139) ROM than the control group in the full arm elevation position. These findings suggest that this population may show changes in the kinematic chain of arm elevation that possibly contribute to arm movement-related complains and limited performance in their daily living.

Validation of the International Classification of Functioning, Disability and Health Core Set for obstructive pulmonary diseases in the perspective of adults with asthma

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma.Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis.Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification.Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates.Implications for rehabilitationThe use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring.The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma.The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma.

The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations

OBJECTIVES

To conduct a longitudinal evaluation of Patient-Reported Outcomes Measurement Information System (PROMIS) social function measures (satisfaction with participation in social roles and satisfaction with participation in discretionary social activities) in English-speaking people with chronic health conditions.

STUDY DESIGN AND SETTING

Adults receiving treatment for chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), chronic back pain, or depression completed PROMIS computer-based measures of social health at two time points approximately 3 months apart and global ratings of change. Linear mixed effects models and standardized response means were estimated for the two social function measures.

RESULTS

A total of 599 people participated: 79 with stable COPD, 46 COPD exacerbation, 60 with CHF, 196 with depression, and 218 with back pain. Four groups experienced improvement over time, one (COPD stable) changed very little. Those who reported better global ratings of change in overall health experienced larger changes in social function than those who reported the same or worse global health.

CONCLUSION

This study provided support for responsiveness to change for two PROMIS social function measures. These results provide further evidence of the PROMIS goal to enable comparable measurement of universally relevant symptoms and experiences that apply to people with a variety of diseases.