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Responsiveness of the short musculoskeletal function assessment (SMFA) in patients with femoral neck fractures

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Abstract

Purpose

The aim of this study was to evaluate the internal and external responsiveness of the Short Musculoskeletal Function Assessment (SMFA), i.e. the instrument’s ability to capture clinically important changes, in patients with hip fractures within the context of a randomized controlled trial.

Methods

To evaluate the internal responsiveness of the SMFA, the observed change and the standardized response mean (SRM) in relation to the change in the Dysfunction Index and the Bother Index were calculated. In order to calculate external responsiveness, an external criterion (EC) was constructed by using the Harris hip score. Receiver operating characteristic (ROC) curves and logistic regression analysis were used in the evaluation.

Results

Both the Bother and the Dysfunction SMFA indices displayed good internal responsiveness as expressed by significant change scores and by moderate and large SRMs, 0.76 and 0.96, respectively. The ROC curve and logistic regression analyses showed that both indices had acceptable external responsiveness and were able to discriminate between patients with a less good outcome versus a moderately good or good outcome based on the EC while the ability to differ between patients with moderately good versus a good outcome was limited. The percentage of correctly classified cases was 64% (good/moderately good), 80% (good/less good), and 74% (moderately good/less good) for both the Dysfunction and Bother Indices.

Conclusions

The SMFA had good overall responsiveness in patients with hip fractures and, based on our results, we conclude that the SMFA can be recommended for use as one of the measures to evaluate the outcome after a hip fracture.

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Abbreviations

ADL:

Activities of daily living

EC:

External criterion

HA:

Hemiarthroplasty

HHS:

Harris hip score

HRQoL:

Health-related Quality of Life

RCT:

Randomized controlled trial

ROC:

Receiver operating characteristic

SMFA:

Short musculoskeletal function assessment

SPMSQ:

Short portable mental status questionnaire

SRM:

Standardized response mean

THA:

Total hip arthroplasty

95% CI:

95% confidence interval

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Acknowledgments

The study was supported by the Trygg-Hansa Insurance Company and the Stockholm County Council.

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Authors and Affiliations

  1. Department of Clinical Science and Education, Section of Orthopedics, Karolinska Institute, Södersjukhuset, Stockholm, Sweden

    Carl Johan Hedbeck, Jan Tidermark, Sari Ponzer & Richard Blomfeldt

  2. Department of Public Health Sciences, Division of Intervention and Implementation Research, Karolinska Institute, Stockholm, Sweden

    Gunnar Bergström

  3. Capio St. Görans Hospital, Stockholm, Sweden

    Jan Tidermark

  4. Department of Orthopedics, Södersjukhuset, 118 83, Stockholm, Sweden

    Carl Johan Hedbeck

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  1. Carl Johan Hedbeck
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Correspondence to Carl Johan Hedbeck.

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Hedbeck, C.J., Tidermark, J., Ponzer, S. et al. Responsiveness of the short musculoskeletal function assessment (SMFA) in patients with femoral neck fractures. Qual Life Res 20, 513–521 (2011). https://doi.org/10.1007/s11136-010-9784-4

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