Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation

Abstract

BackgroundPreoperative 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.MethodsPatients 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.ResultsAfter 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 (R2 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.ConclusionsWhile 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0041-4) contains supplementary material, which is available to authorized users.

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

“…22 The DASI questionnaire is a more objective measure of functional capacity and an easier and cheaper method of estimating functional capacity as compared to CPET testing. [8][9][10][11][12]16,[23][24][25] In the METS study, the DASI was significantly associated with myocardial injury and death after adjustment for other variables. 17 Another test to determine functional capacity more objectively is the six-minute walk test (6MWT).…”

Comparison of Duke Activity Status Index with cardiopulmonary exercise testing in cancer patients

“…The Duke Activity Status Index (DASI: range between 0 and 58), a static questionnaire that has been developed almost 3 decades ago as a simple, quick, and cost-free surrogate measure of pVO 2, is, therefore, appealing to identify at-risk patients for triage to a CPET laboratory. Based on simple yes or no answers to 12 questions related to the patient's activities of daily living (Appendix 1 in supplementary material), pVO 2 can be estimated using the following equation: pVO 2 = DASI score × 0.43 + 9.6 [14,15]. Although it was originally developed to monitor clinical progress of cardiovascular patients, the DASI has also been shown to have a modest correlation with pVO 2 measured by CPET in patients undergoing general intraabdominal surgery [16].…”

Risk Assessment

“…The importance of functional status as a predictor of survival after surgery has been apparent for many years [ 17 ]. However, the patient and clinician’s subjective impressions of functional status or metabolic equivalents (METs) are often inaccurate [ 18 •, 19 ]. Even with semi-objective measures such as stair climbing, direct observation of physical activity is important and can provide a stronger basis for discussion with the patient as part of shared decision-making before surgery.…”