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Hung M, Lauren E, Hon ES, Birmingham WC, Xu J, Su S, Hon SD, Park J, Dang P, Lipsky MS. Social Network Analysis of COVID-19 Sentiments: Application of Artificial Intelligence. J Med Internet Res 2020; 22:e22590. [PMID: 32750001 PMCID: PMC7438102 DOI: 10.2196/22590] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic led to substantial public discussion. Understanding these discussions can help institutions, governments, and individuals navigate the pandemic. Objective The aim of this study is to analyze discussions on Twitter related to COVID-19 and to investigate the sentiments toward COVID-19. Methods This study applied machine learning methods in the field of artificial intelligence to analyze data collected from Twitter. Using tweets originating exclusively in the United States and written in English during the 1-month period from March 20 to April 19, 2020, the study examined COVID-19–related discussions. Social network and sentiment analyses were also conducted to determine the social network of dominant topics and whether the tweets expressed positive, neutral, or negative sentiments. Geographic analysis of the tweets was also conducted. Results There were a total of 14,180,603 likes, 863,411 replies, 3,087,812 retweets, and 641,381 mentions in tweets during the study timeframe. Out of 902,138 tweets analyzed, sentiment analysis classified 434,254 (48.2%) tweets as having a positive sentiment, 187,042 (20.7%) as neutral, and 280,842 (31.1%) as negative. The study identified 5 dominant themes among COVID-19–related tweets: health care environment, emotional support, business economy, social change, and psychological stress. Alaska, Wyoming, New Mexico, Pennsylvania, and Florida were the states expressing the most negative sentiment while Vermont, North Dakota, Utah, Colorado, Tennessee, and North Carolina conveyed the most positive sentiment. Conclusions This study identified 5 prevalent themes of COVID-19 discussion with sentiments ranging from positive to negative. These themes and sentiments can clarify the public’s response to COVID-19 and help officials navigate the pandemic.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States.,George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States.,Department of Occupational Therapy & Occupational Science, Towson University, Towson, MD, United States.,David Eccles School of Business, University of Utah, Salt Lake City, UT, United States.,Department of Educational Psychology, University of Utah, Salt Lake City, UT, United States.,Division of Public Health, University of Utah, Salt Lake City, UT, United States
| | - Evelyn Lauren
- Department of Biostatistics, Boston University, Boston, MA, United States
| | - Eric S Hon
- Department of Economics, University of Chicago, Chicago, IL, United States
| | - Wendy C Birmingham
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Julie Xu
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Sharon Su
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States
| | - Shirley D Hon
- Department of Electrical & Computer Engineering, University of Utah, Salt Lake City, UT, United States.,School of Computing, University of Utah, Salt Lake City, UT, United States.,International Business Machines Corporation, Poughkeepsie, NY, United States
| | - Jungweon Park
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States
| | - Peter Dang
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States
| | - Martin S Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States
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Hansen C, Cushman D, Anderson N, Chen W, Cheng C, Hon SD, Hung M. A Normative Dataset of the Balance Error Scoring System in Children Aged Between 5 and 14. Clin J Sport Med 2016; 26:497-501. [PMID: 27783573 DOI: 10.1097/jsm.0000000000000285] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pediatric head injuries occur commonly and are being reported in increasing numbers. Balance testing is a key component in the evaluation of suspected concussion, and the balance error scoring system (BESS) is likely the most well-known and widely used measure. To date, normative BESS scores for adults have been reported but not for children. DESIGN Normative data for BESS scores and modified BESS scores were created in a cohort of healthy children. Potential variables were analyzed as predictors of BESS performance. SETTING Local elementary and junior high schools. PARTICIPANTS A total of 373 healthy children between the ages of 5 and 14. INTERVENTIONS The BESS was performed on all children. ASSESSMENT OF RISK FACTORS Gender, body mass index percentile, previous concussions, athletic participation, age, and the parental opinion of child's balance ability were examined as factors associated with the BESS score. MAIN OUTCOME MEASURES BESS scores. RESULTS Normative data are reported, stratified by age groups of 5 to 7 years, 8 to 10 years, and 11 to 14 years of age, for both BESS and modified BESS. Median BESS scores are 23 for children aged 5 to 7, 18 for children aged 8 to 10, and 16 for children aged 11 to 14. Median modified BESS scores are 8 for children age 5 to 7, 5 for children age 8 to 10, and 4 for children age 11 to 14. Increasing age and positive parental opinion regarding their child's balance ability were independently correlated with decreasing BESS scores (P < 0.01). CONCLUSIONS The normative data on BESS scores for healthy children reported here provide age-stratified reference values for suspected balance alterations.
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Affiliation(s)
- Colby Hansen
- *Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah;†Division of Epidemiology, University of Utah, Salt Lake City, Utah;‡College of Pharmacy, Roseman University, South Jordan, Utah;Departments of §Electrical & Computer Engineering; and¶Orthopaedics, University of Utah, Salt Lake City, Utah
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Hung M, Cheng C, Hon SD, Franklin JD, Lawrence BD, Neese A, Grover CB, Brodke DS. Challenging the norm: further psychometric investigation of the neck disability index. Spine J 2015; 15:2440-5. [PMID: 24662211 DOI: 10.1016/j.spinee.2014.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 02/12/2014] [Accepted: 03/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The neck disability index (NDI) was the first patient-reported outcome (PRO) instrument specific to patients with neck pain, and it remains one of the most widely used PROs for the neck population. The NDI is an appealing measure as it is a short and well-known PRO measure. Currently, there are conflicting data on the performance and applicability of the NDI in patients undergoing either operative or nonoperative treatment for neck-related conditions. PURPOSE This study investigates the psychometric properties, performance, and applicability of the NDI in the spine patient population. STUDY DESIGN A total of 865 patients visiting a university-based spine clinic with neck complaints, with or without radiating upper extremity pain, numbness, or weakness were enrolled in the study. Visit types included new and follow-up visits to both operative and nonoperative treatments. Questionnaires were administered electronically on a tablet computer, and all patients answered all 10 questions of the NDI. METHODS Standard descriptive statistics were performed to describe the demographic characteristics of the patients. Rasch modeling was applied to examine the psychometric properties of the NDI. RESULTS The NDI demonstrated insufficient unidimensionality (ie, unexplained variance after accounting for the first dimension=9.4%). Person reliability was 0.85 and item reliability was 1.00 for the NDI. The overall item fit for the NDI was good with an outfit mean square of 1.03. The NDI had a floor effect of 35.5% and ceiling effect of 4.6%. The raw score to measure correlation of the NDI was 0.019. CONCLUSIONS Although the NDI had good person and item reliability, it did not demonstrate strong evidence of unidimensionality. The NDI exhibited a very large floor effect. Because of the poor raw score to measure correlation, the sum score should not be used in interpretation of findings. Despite great investment by physicians and other stakeholders in the NDI, this evaluation and previous research have demonstrated that the NDI needs further investigation and refinement.
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Affiliation(s)
- Man Hung
- University of Utah School of Medicine, Department of Orthopaedics, Department of Public Health, Division of Epidemiology, Huntsman Cancer Institute, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Christine Cheng
- University of Utah School of Medicine, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Shirley D Hon
- University of Utah College of Engineering, Department of Electrical and Computer Engineering, 50 S. Central Campus Dr., Rm. 3280 MEB, Salt Lake City, 84112, UT, USA
| | | | - Brandon D Lawrence
- University of Utah School of Medicine, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Ashley Neese
- University of Utah School of Medicine, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Chase B Grover
- University of Utah School of Medicine, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Darrel S Brodke
- University of Utah School of Medicine, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Hung M, Zhang W, Chen W, Bounsanga J, Cheng C, Franklin JD, Crum AB, Voss MW, Hon SD. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study. JMIR Public Health Surveill 2015; 1:e13. [PMID: 27227131 PMCID: PMC4869209 DOI: 10.2196/publichealth.4360] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/12/2015] [Accepted: 08/17/2015] [Indexed: 11/13/2022] Open
Abstract
Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.
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Affiliation(s)
- Man Hung
- Department of OrthopaedicsUniversity of UtahSalt Lake City, UTUnited States; Division of Public HealthUniversity of UtahSalt Lake City, UTUnited States; School of BusinessUniversity of UtahSalt Lake City, UTUnited States; School of MedicineUniversity of UtahSalt Lake City, UTUnited States; Division of EpidemiologyUniversity of UtahSalt Lake City, UTUnited States; College of EducationUniversity of UtahSalt Lake City, UTUnited States
| | - Weiping Zhang
- School of Medicine University of Utah Salt Lake City, UT United States
| | - Wei Chen
- Division of Epidemiology University of Utah Salt Lake City, UT United States
| | - Jerry Bounsanga
- Department of Orthopaedics University of Utah Salt Lake City, UT United States
| | - Christine Cheng
- Department of Orthopaedics University of Utah Salt Lake City, UT United States
| | - Jeremy D Franklin
- College of Education University of Utah Salt Lake City, UT United States
| | - Anthony B Crum
- Department of Orthopaedics University of Utah Salt Lake City, UT United States
| | - Maren W Voss
- Department of Orthopaedics University of Utah Salt Lake City, UT United States
| | - Shirley D Hon
- Department of Orthopaedics University of Utah Salt Lake City, UT United States
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Birmingham WC, Hung M, Boonyasiriwat W, Kohlmann W, Walters ST, Burt RW, Stroup AM, Edwards SL, Schwartz MD, Lowery JT, Hill DA, Wiggins CL, Higginbotham JC, Tang P, Hon SD, Franklin JD, Vernon S, Kinney AY. Effectiveness of the extended parallel process model in promoting colorectal cancer screening. Psychooncology 2015; 24:1265-1278. [PMID: 26194469 DOI: 10.1002/pon.3899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 04/27/2015] [Accepted: 06/10/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely. METHODS We collected intention-to-screen and medical record-verified colonoscopy information on 218 individuals who received the personalized intervention. RESULTS Structural equation modeling showed poor main model fit (root mean square error of approximation (RMSEA) = 0.109; standardized root mean residual (SRMR) = 0.134; comparative fit index (CFI) = 0.797; Akaike information criterion (AIC) = 11,601; Bayesian information criterion (BIC) = 11,884). However, the alternative model (RMSEA = 0.070; SRMR = 0.105; CFI = 0.918; AIC = 11,186; BIC = 11,498) showed good fit. Cancer susceptibility (B = 0.319, p < 0.001) and colonoscopy self-efficacy (B = 0.364, p < 0.001) perceptions predicted intention to screen, which was significantly associated with colonoscopy uptake (B = 0.539, p < 0.001). CONCLUSIONS Our findings provide support of the utility of Extended Parallel Process Model for designing effective interventions to motivate CRC screening in persons at increased risk when individual elements of the model are considered. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | - Scott T Walters
- Department of Behavioral and Community Health, University of North Texas, Houston, TX, USA
| | | | - Antoinette M Stroup
- New Jersey State Cancer Registry, Rutgers University, New Brunswick, NJ, USA
| | | | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jan T Lowery
- University of Colorado Cancer Center, Denver, CO, USA
| | - Deirdre A Hill
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA
| | | | - Philip Tang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Shirley D Hon
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy D Franklin
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Sally Vernon
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Anita Y Kinney
- University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM, USA
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Boonyasiriwat W, Hung M, Hon SD, Tang P, Pappas LM, Burt RW, Schwartz MD, Stroup AM, Kinney AY. Intention to undergo colonoscopy screening among relatives of colorectal cancer cases: a theory-based model. Ann Behav Med 2015; 47:280-91. [PMID: 24307472 DOI: 10.1007/s12160-013-9562-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is recommended that persons having familial risk of colorectal cancer begin regular colonoscopy screening at an earlier age than those in the general population. However, many individuals at increased risk do not adhere to these screening recommendations. PURPOSE The goal of this study was to examine cognitive, affective, social, and behavioral motivators of colonoscopy intention among individuals at increased risk of familial colorectal cancer. METHODS Relatives of colorectal cancer cases (N = 481) eligible for colonoscopy screening completed a survey assessing constructs from several theoretical frameworks including fear appeal theories. RESULTS Structural equation modeling indicated that perceived colorectal cancer risk, past colonoscopy, fear of colorectal cancer, support from family and friends, and health-care provider recommendation were determinants of colonoscopy intention. CONCLUSIONS Future interventions to promote colonoscopy in this increased risk population should target the factors we identified as motivators. (ClinicalTrials.gov number NCT01274143).
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Hung M, Hon SD, Cheng C, Franklin JD, Aoki SK, Anderson MB, Kapron AL, Peters CL, Pelt CE. Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score. Orthop J Sports Med 2014; 2:2325967114562191. [PMID: 26535291 PMCID: PMC4555528 DOI: 10.1177/2325967114562191] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. Purpose: To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. Results: All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. Conclusion: The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior in all psychometric aspects examined in this study. Future research should investigate the LE CAT for wider use in different populations.
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Affiliation(s)
- Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Division of Public Health, University of Utah, Salt Lake City, Utah, USA. ; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA. ; Huntsman Cancer Institute, University Medical Center, Salt Lake City, Utah, USA
| | - Shirley D Hon
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Department of Computer & Electrical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Christine Cheng
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; College of Pharmacy, Roseman University of Health Sciences, South Jordan, Utah, USA
| | - Jeremy D Franklin
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA. ; Department of Education, Culture & Society, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Mike B Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Ashley L Kapron
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Christopher E Pelt
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Tyser AR, Beckmann J, Franklin JD, Cheng C, Hon SD, Wang A, Hung M. Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 2014; 39:2047-2051.e4. [PMID: 25135249 DOI: 10.1016/j.jhsa.2014.06.130] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare psychometric and responder burden characteristics between the Patient-Reported Outcomes Measurement Information System Physical Function Computer Adaptive Test (PF CAT) and the Disabilities of Arm, Shoulder, and Hand (DASH) instruments in a tertiary hand and upper extremity practice. METHODS Adult patients who presented to the clinic of 2 hand and upper extremity surgeons in a university-based tertiary care center were enrolled in this study. Participants received the DASH and PF CAT administered via tablet computer. Time to completion was recorded for both the DASH and PF CAT. We conducted statistical analyses to calculate Pearson correlation coefficients between the 2 instruments and performed a Rasch item response theory analysis to determine dimensionality, reliability, ceiling and floor effects, and item bias for each instrument. RESULTS A total of 134 patients were included. Time to completion for the DASH was 262 seconds, and for the PF CAT 57 seconds. The instruments had strong correlation (r = 0.726). The item and Pearson reliability were 0.97 and 0.94, respectively, for the DASH and 0.99 and 0.96 for the PF CAT. The DASH and PF CAT had 5% and 5% of unexplained variance, respectively. The DASH exhibited 5% of ceiling effect and 1% floor effect whereas the PF CAT had no ceiling or floor effects. CONCLUSIONS The psychometric characteristics of the Patient-Reported Outcomes Measurement Information System PF CAT instrument compared favorably with the DASH in a tertiary upper extremity practice. Patient time burden was significantly reduced with the PF CAT compared with the DASH. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Andrew R Tyser
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT.
| | - James Beckmann
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy D Franklin
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
| | - Christine Cheng
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
| | - Shirley D Hon
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
| | - Angela Wang
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
| | - Man Hung
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT
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Hung M, Baumhauer JF, Brodsky JW, Cheng C, Ellis SJ, Franklin JD, Hon SD, Ishikawa SN, Latt LD, Phisitkul P, Saltzman CL, SooHoo NF, Hunt KJ. Psychometric Comparison of the PROMIS Physical Function CAT With the FAAM and FFI for Measuring Patient-Reported Outcomes. Foot Ankle Int 2014; 35:592-599. [PMID: 24677217 DOI: 10.1177/1071100714528492] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Selecting optimal patient-reported outcome (PRO) instruments is critical to improving the quality of health care. The purpose of this study was to compare the reliability, responsiveness, and efficiency of three PRO measures: the Foot and Ankle Ability Measure-Activity of Daily Living subscale (FAAM_ADL), the Foot Function Index 5-point verbal rating scale (FFI-5pt), and the PROMIS Physical Function computerized adaptive test (PF CAT). METHODS Data were aggregated from 10 clinical sites in the AOFAS's National Orthopaedic Foot and Ankle Research (OFAR) Network from 311 patients who underwent elective surgery for a disorder of the foot or ankle. Patients were administered the FAAM_ADL, FFI-5pt, and PF CAT at their preoperative visit and at 6 months after surgery. Reliabilities were evaluated using a Rasch model. Responsiveness was calculated using paired samples t test and efficiency was recorded as number of seconds to complete the instrument. RESULTS Similar reliabilities were found for the three instruments. Item reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were all .99. Pearson reliabilities for FAAM_ADL, FFI-5pt, and PF CAT were .95, .93, and .96, respectively. On average, patients completed the FAAM_ADL in 179 seconds, the FFI-5pt in 194 seconds, and the PF CAT in 44 seconds, ( P < .001). The PF CAT and FAAM_ADL showed significant improvement ( P = .01 and P = .001, respectively) in patients' physical function after treatment; the FFI-5pt did not show improvement. CONCLUSIONS Overall, the PF CAT performed best in terms of reliability, responsiveness, and efficiency in this broad sample of foot and ankle patients. It can be a potential replacement for the conventional PRO measures, but further validation is needed in conjunction with the PROMIS Pain instruments. LEVEL OF EVIDENCE Level I, prospective comparative outcome study.
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Affiliation(s)
- Man Hung
- 1 University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | | | | | | | - Nelson F SooHoo
- 8 University of California, Los Angeles, Los Angeles, CA, USA
| | - Kenneth J Hunt
- 9 Stanford University, Stanford, CA, USA
- 10 National Orthopaedic Foot & Ankle Outcomes Research Network, American Orthopaedic Foot & Ankle Society
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Hung M, Franklin JD, Hon SD, Cheng C, Conrad J, Saltzman CL. Time for a paradigm shift with computerized adaptive testing of general physical function outcomes measurements. Foot Ankle Int 2014; 35:1-7. [PMID: 24101733 DOI: 10.1177/1071100713507905] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-reported outcomes (PRO) are critical to understanding the value of orthopedic treatments. We hypothesized that use of the computerized adaptive testing from a well-characterized physical function item bank would show superiority in assessing all levels of physical function compared to current standard generic physical function outcomes instruments for foot and ankle patients. METHODS In a population of 126 foot and ankle patients we compared the psychometric properties for three PROs: the Physical Function subscale of the Medical Outcomes General Health Survey (SF-36 PF) version 2, the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computerized Adaptive Test (CAT), and the Lower Extremity (LE) CAT. A Rasch item response theory (IRT) model was applied to assess and compare the fit, dimensionality, reliability, validity, and coverage. RESULTS The unexplained variance for the PF CAT was 3.9% and the LE CAT was 2.1%, suggesting each instrument explained a single concept. The SF-36 PF had more concerning unexplained variance of 7.6%. We found no floor or ceiling effects for the PF CAT, a minimal floor effect (1.6%) but no ceiling effect for the LE CAT, and an 11.1% floor effect and 9.5% ceiling effect for the SF-36 PF. CONCLUSION Foot and ankle clinicians and researchers interested in measuring patient perceived functional outcomes with a generic instrument should consider using either the PF CAT or the LE CAT rather than the SF-36 PF. Further studies comparing these CATs to anatomic specific instruments are needed. LEVEL OF EVIDENCE Level I, diagnostic study.
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Affiliation(s)
- Man Hung
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Hung M, Conrad J, Hon SD, Cheng C, Franklin JD, Tang P. Uncovering patterns of technology use in consumer health informatics. Wiley Interdiscip Rev Comput Stat 2013; 5:432-447. [PMID: 24904713 PMCID: PMC4041299 DOI: 10.1002/wics.1276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Internet usage and accessibility has grown at a staggering rate, influencing technology use for healthcare purposes. The amount of health information technology (Health IT) available through the Internet is immeasurable and growing daily. Health IT is now seen as a fundamental aspect of patient care as it stimulates patient engagement and encourages personal health management. It is increasingly important to understand consumer health IT patterns including who is using specific technologies, how technologies are accessed, factors associated with use, and perceived benefits. To fully uncover consumer patterns it is imperative to recognize common barriers and which groups they disproportionately affect. Finally, exploring future demand and predictions will expose significant opportunities for health IT. The most frequently used health information technologies by consumers are gathering information online, mobile health (mHealth) technologies, and personal health records (PHRs). Gathering health information online is the favored pathway for healthcare consumers as it is used by more consumers and more frequently than any other technology. In regard to mHealth technologies, minority Americans, compared with White Americans utilize social media, mobile Internet, and mobile applications more frequently. Consumers believe PHRs are the most beneficial health IT. PHR usage is increasing rapidly due to PHR integration with provider health systems and health insurance plans. Key issues that have to be explicitly addressed in health IT are privacy and security concerns, health literacy, unawareness, and usability. Privacy and security concerns are rated the number one reason for the slow rate of health IT adoption.
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Affiliation(s)
- Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Jillian Conrad
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Shirley D. Hon
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Christine Cheng
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Philip Tang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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