concurrent validity

并发有效性
  • 文章类型: Journal Article
    目的:在167名符合焦虑相关障碍诊断标准的自闭症青年样本中,对DSM-IV-自闭症谱系附录(ADIS-ASA)-父母访谈的焦虑症访谈时间表中特定焦虑症部分的并发有效性进行检查(Mage=9.91;男性78.4%;非西班牙裔82%;白人77.67%)。
    方法:通过与(a)父母报告的青年焦虑症状学维度和(b)青年焦虑相关功能障碍的维度测量的关系,检查了诊断和统计手册(DSM)定义的ADIS-ASA焦虑症诊断的并发有效性。分别,使用逻辑回归模型和点双材料相关性。
    结果:发现分离焦虑症和社交焦虑症(但不是广泛性焦虑症或强迫症)之间存在显着关系,分别,和理论上一致的维度青年焦虑症状学方面。ADIS-ASA诊断性与青年功能障碍相关变量之间的关系表明,只有分离焦虑症表现出收敛有效性的有力证据。
    结论:尽管关于ADIS-ASA焦虑症的诊断结果与焦虑严重程度和焦虑相关损害的维度测量之间的关系有不同的发现,本研究结果为ADIS-ASA作为评估自闭症青年焦虑的金标准提供了进一步的支持.这项工作还强调了继续提高自闭症青年焦虑症状学测量精度的重要性,对临床评估有影响。
    OBJECTIVE: Examine the concurrent validity of specific Anxiety Disorders Section of the Anxiety Disorder Interview Schedule for DSM-IV-Autism Spectrum Addendum (ADIS-ASA)-Parent Interview in a sample of 167 autistic youth who met diagnostic criteria for an anxiety-related disorder (Mage = 9.91; 78.4% male; 82% non-Hispanic; 77.67% White).
    METHODS: Concurrent validity of Diagnostic and Statistical Manual (DSM)-defined ADIS-ASA anxiety disorder diagnostic caseness was examined via relations with (a) parent-reported dimensions of youth anxiety symptomology and (b) dimensional measures of youth anxiety-related functional impairment, respectively, using logistic regression models and point-biserial correlations.
    RESULTS: Significant relations were found between separation anxiety disorder and social anxiety disorder (but not generalized anxiety disorder nor obsessive-compulsive disorder) caseness, respectively, and theoretically consistent facets of dimensional youth anxiety symptomology. Relations between ADIS-ASA diagnostic caseness and youth functional impairment-related variables revealed that only separation anxiety disorder demonstrated robust evidence of convergent validity.
    CONCLUSIONS: Despite mixed findings concerning relations between ADIS-ASA anxiety disorder diagnostic caseness and dimensional measures of anxiety severity and anxiety-related impairment, the present findings provide further support for the status of the ADIS-ASA as a gold standard for assessment of anxiety in autistic youth. This work also highlights the importance of continuing to improve precision in measurement of anxiety symptomology in autistic youth, with implications for clinical assessment.
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  • 文章类型: Journal Article
    为了调查可靠性,并发有效性,以及评估下肢淋巴水肿(LLL)患者和健康对照者体积的测量的临床可行性。
    为了研究评估者内和评估者间的可靠性,两名评估员对47例LLL患者和30例健康对照进行了3次评估。要调查会话之间的可靠性,两周后对50名参与者进行了重新评估。每次评估包括测量中线区域(臀围;耻骨上体积),腿部体积(周长每4厘米;Perometer®),和英尺体积(水置换;八字法)。用相关系数评估并发效度。测量是定时的,并审查了实际局限性。临床试验登记号:NCT:05269264。
    对不同区域的总体积的测量显示出弱至非常高的组内相关系数(ICC)(0.131-998)。绝对和相对体积差异具有较低的ICC值(0.360-0.976)。在同一区域的总体积之间发现了很强的相关性。Perometer®和8字法是腿部和足部体积最快的方法,分别。
    评估的总体积在评估双侧LLL中体积的演变方面可能比计算出的两肢之间的绝对和相对差异更有价值。Perometer®和8字形方法对于腿部和足部体积是最有效的时间,分别。对康复的影响淋巴水肿是一种慢性疾病,对其进行可靠且临床可行的体积评估对于诊断至关重要。治疗决定,和治疗的评估。这项研究表明,腿/脚的总体积比计算出的两肢之间的绝对和相对差异更可靠,因此对评估双侧下肢淋巴水肿更有价值。为了评估腿部体积,Perometer®是最可靠和最快的方法。对于脚部体积的评估,八位数法总体上是最好的方法。
    UNASSIGNED: To investigate reliability, concurrent validity, and clinical feasibility of measurements assessing volume in patients with lower limb lymphedema (LLL) and healthy controls.
    UNASSIGNED: To investigate intra- and interrater reliability, 47 patients with LLL and 30 healthy controls were assessed three times by two assessors. To investigate between session reliability, 50 participants were reassessed two weeks later. Each assessment included measurements of the midline region (hip circumference; suprapubic volume), leg volume (perimeter every 4 cm; Perometer®), and foot volume (water displacement; figure-of-eight method). Concurrent validity was assessed with correlation coefficients. Measurements were timed and practical limitations were reviewed. Clinical trial registration number: NCT: 05269264.
    UNASSIGNED: Measurements of the total volume of different regions showed weak to very high intraclass correlation coefficients (ICCs) (0.131-998). Absolute and relative volume differences had lower ICC values (0.360-0.976). A strong correlation was found between the total volumes of the same region. The Perometer® and figure-of-eight method were the fastest method for leg and foot volume, respectively.
    UNASSIGNED: The assessed total volumes might be more valuable in assessing the evolution of volume in bilateral LLL than the calculated absolute and relative differences between both limbs. The Perometer® and figure-of-eight method were the most time efficient for leg and foot volume, respectively.Implications for rehabilitationLymphedema is a chronic condition for which a reliable and clinically feasible assessment of volume is essential for the diagnosis, treatment decisions, and the evaluation of the treatment.This study shows that the total leg/foot volumes were more reliable than the calculated absolute and relative differences between both limbs and could therefore more valuable to evaluate bilateral lower limb lymphedema.For the assessment of leg volume, the Perometer® was the most reliable and fastest method.For the evaluation of the foot volume, the figure-of-eight method was overall the best method.
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  • 文章类型: Journal Article
    教师分配的成绩与学业成绩的外部评估之间的适度相关性(r=.40-.60)导致许多教育利益相关者认为成绩主观且不可靠。然而,理论和方法上的挑战,例如构造错位,数据不可用和样本不代表性,限制了以前发现的普遍性。我们通过剥削富人来克服这些挑战,来自挪威国家登记处的全人口数据(n=51858),州法规要求在等级和外部考试之间建立紧密的一致性。初中教育最终成绩与外部考试成绩之间的相关性(r=.64-.86)表明,成绩是比以前公认的更好的学业成绩衡量标准。优势分析和多元回归分析表明,外部考试结果是同一科目成绩的最佳预测指标。然而,我们的结果还表明,国家法规和质量保证体系不能完全消除潜在的差异来源。
    Modest correlations between teacher-assigned grades and external assessments of academic achievement (r = .40-.60) have led many educational stakeholders to deem grades subjective and unreliable. However, theoretical and methodological challenges, such as construct misalignment, data unavailability and sample unrepresentativeness, limit the generalisability of previous findings. We overcome these challenges by exploiting rich, population-wide data from the National Registries in Norway (n = 511,858), where state regulations require close construct alignment between grades and external exams. Correlations between lower-secondary education final grades and external exam results (r = .64-.86) suggest that grades are better measures of academic achievement than previously acknowledged. Dominance analyses and multivariate regression analyses indicate that external exam results are the best predictor of grades in the same subject. However, our results also indicate that state regulations and quality assurance systems cannot completely eradicate potential sources of discrepancy.
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  • 文章类型: Journal Article
    最近,国际疾病分类第11版(ICD-11)和《精神疾病诊断和统计手册》(第五版)中包含了两个相似但截然不同的长期悲伤障碍(PGD)版本。文本修订(DSM-5-TR)。这项研究提供了PGD的两个新标准集的标准有效性测试,通过检查ICD-11和DSM-5-TR延长悲伤症状与生活质量(QOL)的并发和纵向关联。
    失去亲人的成年人完成了一项调查,评估了ICD-11和DSM-5-TR延长的悲伤症状,抑郁症状,基线和6个月随访时的失眠症状和生活质量。
    ICD-11和DSM-5-TR延长的悲伤症状与生活质量呈负相关,同时控制失眠和抑郁症状。ICD-11长期悲伤症状,但不是DSM-5-TR长时间的悲伤症状,预测6个月随访时的QOL,同时控制基线生活质量和失眠和抑郁症状。
    结果为ICD-11PGD的标准有效性提供了一致的证据,但DSM-5-TRPGD标准有效性的证据参差不齐。研究结果可以帮助指导优化和协调未来PGD标准的尝试。
    UNASSIGNED: Two similar but distinct versions of prolonged grief disorder (PGD) have recently been included in the International Classification of Diseases eleventh edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders - fifth edition, Text-Revision (DSM-5-TR). This study provides a criterion validity test of both new criteria sets of PGD, by examining concurrent and longitudinal associations of ICD-11 and DSM-5-TR prolonged grief symptoms with quality of life (QOL).
    UNASSIGNED: Bereaved adults completed a survey assessing ICD-11 and DSM-5-TR prolonged grief symptoms, depressive symptoms, insomnia symptoms and QOL at baseline and 6-month follow-up.
    UNASSIGNED: Both ICD-11 and DSM-5-TR prolonged grief symptoms related negatively to QOL concurrently, while controlling for insomnia and depressive symptoms. ICD-11 prolonged grief symptoms, but not DSM-5-TR prolonged grief symptoms, predicted QOL at 6-month follow-up, while controlling for baseline QOL and insomnia and depression symptoms.
    UNASSIGNED: Results provide consistent evidence for the criterion validity of ICD-11 PGD, but mixed evidence for the criterion validity of DSM-5-TR PGD. Study results can help guide attempts to optimize and harmonize future PGD criteria.
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  • 文章类型: Journal Article
    背景:积极健康(PH)的概念作为衡量个人在面对环境挑战时适应能力的一种方式,已引起越来越多的关注。然而,尚未开发出包含上下文因素的PH的合适测量仪器。本文通过开发与能力方法(CA)保持一致的上下文特定的积极健康(CPH)测量仪器来响应这一需求。
    方法:测量仪器是在具有不同社会人口统计学背景的1002名荷兰互联网调查小组成员的代表性样本中开发和测试的。该文书分为两个阶段制定:一个由焦点小组和专家磋商组成的准备阶段,以及荷兰公民代表小组的验证。准备阶段的目标,是对先前提出的“积极健康”问卷进行试点测试,并将其完善为CPHQ的初始版本。验证阶段旨在使用因子分析检查初始CPHQ的因子效度,及其使用多元回归分析的并发有效性。
    结果:开发的问卷显示出足够的因子效度和并发效度。此外,它明确包括对弹性的评估,这是PH的关键组成部分。
    结论:引入的测量工具,CPHQ,包括11个维度,我们标记如下:松弛,自主性,健身,感知到的环境安全,排除,社会支持,财政资源,政治代表,健康素养,弹性,和享受。在这篇文章中,我们提出四大贡献。首先,我们将测量嵌入到理论框架中。其次,我们将问卷集中在积极健康的一个关键概念上——“适应能力”。第三,我们通过考虑环境因素来解决健康不平等问题。最后,我们促进了更易于理解的测量项目的开发。
    BACKGROUND: The concept of Positive Health (PH) has gained increasing attention as a way of measuring individuals\' ability to adapt in the face of contextual challenges. However, a suitable measurement instrument for PH that encompasses contextual factors has not yet been developed. This paper responds to this need by developing a Context-specific Positive Health (CPH) measurement instrument that aligns with the Capability Approach (CA).
    METHODS: The measurement instrument was developed and tested among a representative sample of 1002 Dutch internet survey panel members with diverse sociodemographic backgrounds. The instrument was developed in two stages: a preparation phase consisting of focus groups and expert consultations, and a validation among a representative panel of Dutch citizens. The goal of the preparation phase, was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase aimed to examine the initial CPHQ\'s factorial validity using Factor Analysis, and its concurrent validity using Multivariate Regression Analysis.
    RESULTS: The developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly includes an assessment of resilience, this being a key component of PH.
    CONCLUSIONS: The introduced measurement tool, the CPHQ, comprises 11 dimensions that we have labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. In this article, we present four major contributions. Firstly, we embedded the measurement in a theoretical framework. Secondly, we focused the questionnaire on a key concept of Positive Health - the \"ability to adapt.\" Thirdly, we addressed issues of health inequality by considering contextual factors. Finally, we facilitated the development of more understandable measurement items.
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  • 文章类型: Journal Article
    目的:深入的自杀风险评估对长期预防自杀尤为重要。精神病理学的宽带测量,例如明尼苏达州多相人格量表(MMPI)工具,评估自杀风险因素和各种心理健康合并症。随着MMPI-3的发布,自杀/死亡意念(SUI)量表进行了修订,以提高其结构效度和对自杀危险因素的检测。因此,我们假设MMPI-3SUI量表将证明与自杀经历和行为有中等到大的关联,未来的想法,自杀的人际关系危险因素。
    方法:对124名接受抑郁症状筛查的大学生进行了一项简短的纵向研究。参与者完成了一次基线会议,包括MMPI-3和标准措施,每2周进行三次简短的随访。
    结果:SUI评分与过去自杀意念的风险增加密切相关,规划,和感知到的负担。前瞻性评估的自杀意念也与SUI有意义相关。SUI量表升高表明自杀相关危险因素的风险增加。
    结论:MMPI-3是一个有价值的工具,可以为那些经历抑郁症状的人提供长期自杀预防的信息,因为SUI量表可以评估过去,电流,和未来自杀相关的危险因素,包括自杀意念和行为.
    OBJECTIVE: In-depth suicide risk assessments are particularly important to long-term suicide prevention. Broadband measures of psychopathology, such as the Minnesota Multiphasic Personality Inventory (MMPI) instruments, assess suicide risk factors and various mental health comorbidities. With the recent release of the MMPI-3, the Suicidal/Death Ideation (SUI) scale underwent revisions to improve its construct validity and detection of suicide risk factors. Thus, we hypothesized the MMPI-3 SUI scale would demonstrate medium to large associations with suicidal experience and behaviors, future ideation, and interpersonal risk factors of suicide.
    METHODS: A sample of 124 college students screened for elevated depressive symptoms completed a brief longitudinal study. Participants completed a baseline session including the MMPI-3 and criterion measures and three brief follow-ups every 2 weeks.
    RESULTS: SUI scores were most robustly associated with increased risk for past suicidal ideation, planning, and perceived burdensomeness. Prospectively assessed suicidal ideation was also meaningfully associated with SUI. SUI scale elevations indicate an increased risk of suicide-related risk factors.
    CONCLUSIONS: The MMPI-3 is a valuable tool to inform long-term suicide prevention for those experiencing elevated depressive symptoms as the SUI scale can assess past, current, and future suicide-related risk factors, including suicidal ideation and behaviors.
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  • 文章类型: Journal Article
    在不失去平衡的情况下执行功能活动和其他高级生活任务需要稳定性极限,和稳定性极限的评估在临床实践中是必不可少的。向前,横向,和倾斜方向达到测试是临床平衡测试,评估稳定性的限制,并且这些在各个方向上的到达距离可以是对称的或不对称的。目的是在三个到达测试中建立各种到达距离之间的对称性,并建立倾斜的并发有效性,forward,和横向方向达到测试距离与由TecnoBody公司的IsoFree机器测量的稳定性极限。
    方法:倾斜的测量,forward,在通过便利抽样招募的50名典型的上大学的年轻人中,在TechnoBody的IsoFree机器上的八个方向上进行了横向延伸测试和压力中心稳定性偏移的极限。采用皮尔逊相关检验来寻找远期与远期之间的关系,横向,倾斜方向到达和向前稳定的极限,横向,和倾斜的方向。回归分析用于寻找影响远期的因素,横向,和斜伸测试。
    结果:到达距离是对称的,在三个测试中,横向和倾斜方向的到达测试与横向和倾斜方向的稳定性测试极限呈中度正相关,r值分别为0.569(p<0.001)和0.50(p<0.001)。倾斜方向的显著标准化β值0.49(p<0.05)达到总稳定性极限。
    结论:倾斜和横向触达测试与它们各自的压力偏移中心相关。然而,倾斜方向达到测试与稳定性分数的总极限适度相关。在年轻的沙特成年人中,向前延伸的距离更多,其次是倾斜和横向延伸的距离。
    Limits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company.
    METHODS: The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests.
    RESULTS: The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p < 0.001) and 0.50 (p < 0.001) respectively. A Significant standardized beta value of 0.49 (p < 0.05) for the oblique direction reach test with total stability limits.
    CONCLUSIONS: The oblique and lateral direction reach tests are correlated with their respective center of pressure excursion. However, the oblique direction reach test moderately correlated with the total limits of stability scores. Forward reach distances were more in number followed by oblique and lateral reach distances among young Saudi adults.
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  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fpsyg.203.1132154。].
    [This corrects the article DOI: 10.3389/fpsyg.2023.1132154.].
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  • 文章类型: Journal Article
    10项凯斯勒心理困扰量表(K10)用于在澳大利亚临床实践中筛查青少年的精神障碍;但是,澳大利亚没有青少年规范数据。
    数据来自澳大利亚青少年(11-17岁)的全国代表性样本(N=2964)。这项研究有三个目的:(1)检查K10和优势和困难问卷(SDQ)情绪症状分量表之间的并发有效性,(2)建立规范的澳大利亚青少年K10数据;(3)通过受试者操作员特征曲线分析和特定阶层的似然比,确定筛选重度抑郁症(MDD)的最佳K10截止分数。
    K10和SDQ情绪症状量表呈中度相关(rs=0.63,p<0.001)。与年轻的女性青少年(15-17岁:M=20.2,标准误差[SE]=0.3;11-14岁:M=16.8,SE=0.3)和男性青少年(11-14岁:M=16.6,SE=0.2;15-17岁:M=16.0,SE=0.2)相比,年龄较大的女性青少年报告的K10总分更高。K10评分可最佳区分有和没有MDD的人,因年龄和性别而异,并且特异性较低。特定阶层的似然比表明,K10得分≥30的青少年患MDD的可能性为12.9(95%置信区间=[10.2,16.2])。
    K10可用于评估澳大利亚青少年的医疗保健和流行病学研究中的心理困扰。K10得分在“非常高”范围内的青少年患MDD的风险增加。对这些年轻人进行进一步评估,以确定患有MDD或有发展MDD风险的人。
    UNASSIGNED: The 10-item Kessler Psychological Distress Scale (K10) is used to screen adolescents for mental disorders in Australian clinical practice; however, there are no Australian adolescent normative data.
    UNASSIGNED: Data were drawn from a nationally representative sample (N = 2964) of Australian adolescents (11-17 years). This study had three aims: (1) to examine concurrent validity between the K10 and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms subscale, (2) to establish normative Australian adolescent K10 data and (3) to determine optimal K10 cut-off scores for screening for major depressive disorder (MDD) via receiver operator characteristic curve analysis and stratum-specific likelihood ratios.
    UNASSIGNED: The K10 and SDQ emotional symptoms scales were moderately correlated (rs = 0.63, p < 0.001). Older female adolescents reported higher total K10 scores compared with younger female adolescents (15-17 years: M = 20.2, standard error [SE] = 0.3; 11-14 years: M = 16.8, SE = 0.3) and male adolescents (11-14 years: M = 16.6, SE = 0.2; 15-17 years: M = 16.0, SE=0.2). K10 scores to optimally discriminate those with and without MDD varied by age and sex and had low specificities. Stratum-specific likelihood ratios indicated adolescents with a K10 score of ≥30 will have a 12.9 (95% confidence interval = [10.2, 16.2]) increased likelihood of MDD.
    UNASSIGNED: The K10 has utility for assessing psychological distress in health care and epidemiological research in Australian adolescents. Adolescents with K10 scores in the \'very high\' range are at increased risk of MDD. Further assessment of these young people is indicated to identify those with or at risk of developing MDD.
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  • 文章类型: Journal Article
    背景:关节成形术外科医生使用各种患者报告的结果指标(PROM)来评估功能健康状况,包括膝关节损伤和骨关节炎结果评分(KOOS)身体功能简表(KOOS-PS),患者报告结果测量信息系统(PROMIS)身体功能简表10a(PROMISPFSF10a),和PROMISGlobal-10体质健康分量表。然而,评估其并发有效性和性能的文献很少。
    方法:在2016年6月至2020年12月之间,确定了因膝关节问题在关节成形术诊所就诊的患者。完成KOOS-PS的患者,PROMISPFSF10a,和PROMISGlobal-10,包括其身心健康分量表,在同一次访问中被确认。计算了Spearmanρ(ρ)相关性,并确定了天花板和地板效应。总的来说,包括5,303名患者的遭遇。
    结果:在物理功能域中,KOOS-PS与PROMISPFSF10a之间存在很强的相关性(ρ=0.76,P<.001),KOOS-PS和PROMIS全球身体健康(ρ=0.71,P<.001),和PROMISPFSF10a和PROMIS全球身体健康(ρ=0.78,P<.001)。没有以物理功能为重点的PROM具有明显的地板效应(即,或超过1%)。KOOS-PS具有小但可测量的上限效应(n=105[2.0%])。
    结论:所有检查的PROM均可用于测量膝关节病理患者的功能状态,PROMISGlobal-10也能够捕获心理健康的元素。PROMISGlobal-10可能是评估的PROM中最具价值的,美国医疗保险和医疗补助服务中心已经将精神健康部分纳入新的替代支付模式。
    BACKGROUND: Arthroplasty surgeons use a variety of patient-reported outcome measures (PROMs) to assess functional well-being, including the Knee Injury and Osteoarthritis Outcome Score (KOOS) Physical Function short form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PROMIS PF SF 10a), and PROMIS Global-10 Physical Health subscale. However, there is a paucity of literature assessing their concurrent validity and performance.
    METHODS: Between June 2016 and December 2020, patient visits at an arthroplasty clinic for knee concerns were identified. Patients who completed KOOS-PS, PROMIS PF SF 10a, and PROMIS Global-10, including its physical and mental health subscales, at the same visit were identified. Spearman rho (ρ) correlations were calculated and ceiling and floor effects identified. Overall, 5,303 patient encounters were included.
    RESULTS: Among physical function domains, strong correlation existed between the KOOS-PS and PROMIS PF SF 10a (ρ = 0.76, P < .001), KOOS-PS and PROMIS Global Physical Health (ρ = 0.71, P < .001), and PROMIS PF SF 10a and PROMIS Global Physical Health (ρ = 0.78, P < .001). No physical function-focused PROM had an appreciable floor effect (ie, at or more than 1%). The KOOS-PS had a small but measurable ceiling effect (n = 105 [2.0%]).
    CONCLUSIONS: All of the examined PROMs are acceptable to measure the functional status of patients with knee pathology, with the PROMIS Global-10 also being able to capture elements of mental health too. The PROMIS Global-10 may be of most value of the PROMs assessed, as the United States Centers for Medicare and Medicaid Services already incorporate the mental health component into new alternative payment models.
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