2010 review - Patient-Reported Outcomes Measurement - University ...

Responsiveness of the DASI was illustrated in the study by King (2000), with significant
improvement in functional status for both genders. Significant score changes were reported
for the CABG group in a study comparing outcomes among three groups of patients with
advanced CAD (Kandzari et al., 2001; MOSS study). Significant improvement in DASI
scores post-revascularisation was reported for the Canadian (but not the US) group in the
GUSTO-IIb QoL substudy (Kaul et al., 2004). The DASI also demonstrated responsiveness
in the survival study by Koch et al. (2007); however, distribution of scores was skewed, with
a clustering of scores at the higher end of the range, suggesting the measure lacks precision
for patients with better functional capacity.
Interpretability of the DASI was supported in the 1997 study by Hlatky and colleagues where
a small change in score (2.7 units) was found to be clinically meaningful.
Ease of application, or feasibility, of the DASI is noted (Nelson et al., 1991).
d. Heart Surgery Symptom Inventory, HSSI (LaPier & Jung, 2002)
The HSSI was developed to provide a measure of functional status and QoL for patients in
the subacute stage of recovery from CABG (from two to six months post-surgery). It covers a
broader range of symptoms than most cardiac-specific measures, which focus principally on
angina and dyspnoea. In its current form it is not appropriate for pre-operative assessments
owing to the large number of surgery-specific items (LaPier & Jung, 2002). The developers
suggest it could be readily adapted for use in the immediate post-operative period (up to two
months) and/or during long-term recovery, i.e. beyond six months (LaPier & Jung, 2002);
however, it has not yet been evaluated for this purpose (LaPier, 2006; LaPier & Wilson,
2006).
Three studies (the most recent being from 2007) and a review article were identified which
evaluated the HSSI in US patients having undergone CABG.
Content was derived from previously published qualitative studies, clinicians, and patients
recovering from CABG; a preliminary list of items was revised and added to by a panel of
specialist physical therapists (LaPier & Jung, 2002). The final version of the instrument
comprises 76 items in five symptom categories - namely, cardiac; general (includes sleep,
fatigue, sexual functioning, cognitive functioning); trunk (includes incision/drain site pain,
wound healing); lower extremity (for those receiving grafts harvested from the saphenous
vein); upper extremity (for recipients of radial artery grafts). Respondents are asked to assess
symptoms over the previous week, selecting from five Likert-type response options. Domain
scores are summed to produce a total, with lower scores indicating greater severity of
symptoms.
Internal consistency was supported by significant correlations between domain and total
scores, and most inter-domain scores, in a study with a small sample of patients who had
undergone CABG six months previously (LaPier, 2006). However, individual item-domain
and item-total correlations ranged 0.01-0.85, with several values falling well below the norm
of 0.20 (LaPier, 2006). Test-retest reliability was supported by significant correlations
between HSSI scores on two administrations; however, these were conducted on the same
day, and results could therefore be subject to recall bias (LaPier, 2006).
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