The Physical Performance Test and the evaluation of functional status in patients with cerebral aneurysms

Joseph T. King Jr. M.D., M.S.C.E. 1 , Joel Tsevat M.D., M.P.H. 1 , and Mark S. Roberts M.D., M.P.P. 1
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  • 1 Section of Neurosurgery, Veterans Affairs Connecticut Healthcare System, West Haven; Department of Neurosurgery, Yale University, New Haven, Connecticut; Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine; Center for Clinical Effectiveness, Institute for Health Policy and Health Services Research, University of Cincinnati Medical Center, Cincinnati; Veterans Affairs Medical Center, Cincinnati, Ohio; and Center for Research on Health Care and Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Object

Cerebral aneurysms can adversely affect the functional status of patients who harbor them through rupture, mass effect, or treatment sequela. The authors compared the Physical Performance Test (PPT)—an observer-administered test requiring the completion of seven tasks—with three functional status measures based on patient self-reports: the Glasgow Outcome Scale (GOS), the modified Rankin Scale (mRS), and the modified Barthel Index (mBI).

Methods

Data were collected from 144 patients with aneurysms who had been recruited from a neurosurgery clinic. The patients completed the PPT and were assigned GOS scores, mRS scores, and mBIs based on their responses during a structured interview. The validity of the PPT was assessed by examining the relationship between the results of the PPT and the values assigned to each patient by using the GOS, mRS, and mBI by applying rank-order methods; the reliability of the PTT was assessed using the Cronbach α coefficient.

The mean age of the patients was 52.8 years; 72% were women and 54% had survived a subarachnoid hemorrhage. The mean ± standard deviation PPT score was 24.0 ± 3.7. The PPT generated a broad distribution of scores, whereas GOS and mRS scores and mBIs displayed significant ceiling effects, that is, 75% of the patients were clustered in the highest categories. The PPT scores were validated by their strong association with GOS scores, mRS scores, and mBIs (for all, p < 0.001), and the reliability of the PPT was demonstrated by a Cronbach α value of 0.77.

Conclusions

The PPT provides an objective measure of functional status in patients with cerebral aneurysms. The results suggest that the PPT may differentiate among patients better than the GOS, mRS, or mBI. The PPT is a valid and reliable instrument for measuring functional status in patients with cerebral aneurysms.

Abbreviations used in this paper: ADL = activities of daily living; BI = Barthel Index; GOS = Glasgow Outcome Scale; mBI = modified BI; MMSE = Mini-Mental State Examination; mRS = modified Rankin Scale; PPT = Physical Performance Test; SAH = subarachnoid hemorrhage; SD = standard deviation.

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Contributor Notes

Address reprint requests to: Joseph T. King Jr., M.D., M.S.C.E., Section of Neurosurgery, Veterans Affairs Connecticut Healthcare System/112, 950 Campbell Avenue, West Haven, Connecticut 06516. email: Joseph.KingJr@med.va.gov.
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