Reliability and Usability of a Weighted Version of the Functional Comorbidity Index

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2019 Feb 27

PMID 30804668

Citations 8

Authors

Anouk D Kabboord

Monica van Eijk

Lisette van Dingenen

Monique Wouters

Marieke Koet

Romke van Balen

Wilco P Achterberg

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the reliability of a weighted version of the Functional Comorbidity Index (w-FCI) compared with that of the original Functional Comorbidity Index (FCI) and to test its usability.

Patients And Methods: Sixteen physicians collected data from 102 residents who lived in 16 different nursing homes in the Netherlands. A multicenter, prospective observational study was carried out in combination with a qualitative part using the three-step test interview, in which participants completed the w-FCI while thinking aloud and being observed, and were then interviewed afterward. To analyze inter-rater reliability, a subset of 41 residents participated. The qualitative part of the study was completed by eleven elderly care physicians and one advanced nurse practitioner.

Measurements: The w-FCI was composed of the original FCI supplemented with a severity rating per comorbidity, ranging from 0 (disease absent) to 3 (severe impact on daily function). The w-FCI was filled out at baseline by 16 physicians and again 2 months later to establish intra-rater reliability (intraclass correlations; ICCs). For inter-rater reliability, four pairs of raters completed the w-FCI independently from each other.

Results: The ICCs were 0.90 (FCI) and 0.94 (w-FCI) for intra-rater reliability, and 0.61 (FCI) and 0.55 (w-FCI) for inter-rater reliability. Regarding usability of the w-FCI, five meaningful themes emerged from the qualitative data: 1) sources of information; 2) deciding on the presence or absence of disease; 3) severity of comorbidities; 4) usefulness; and 5) content.

Conclusion: The intra-rater reliability of the FCI and the w-FCI was excellent, whereas the inter-rater reliability was moderate for both indices. Based on the present results, a modified w-FCI is proposed that is acceptable and feasible for use in older patients and requires further investigation to study its (predictive) validity.

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References

Extermann M . Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol. 2000; 35(3):181-200. DOI: 10.1016/s1040-8428(00)00090-1. View

CRABTREE H, Gray C, Hildreth A, OConnell J, Brown J . The Comorbidity Symptom Scale: a combined disease inventory and assessment of symptom severity. J Am Geriatr Soc. 2000; 48(12):1674-8. DOI: 10.1111/j.1532-5415.2000.tb03882.x. View

Mandelblatt J, Bierman A, Gold K, Zhang Y, Ng J, Maserejian N . Constructs of burden of illness in older patients with breast cancer: a comparison of measurement methods. Health Serv Res. 2002; 36(6 Pt 1):1085-107. PMC: 1089280. View

Rozzini R, Frisoni G, Ferrucci L, Barbisoni P, Sabatini T, Ranieri P . Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity. Age Ageing. 2002; 31(4):277-85. DOI: 10.1093/ageing/31.4.277. View

de Groot V, Beckerman H, Lankhorst G, Bouter L . How to measure comorbidity. a critical review of available methods. J Clin Epidemiol. 2003; 56(3):221-9. DOI: 10.1016/s0895-4356(02)00585-1. View

Groll D, To T, Bombardier C, Wright J . The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005; 58(6):595-602. DOI: 10.1016/j.jclinepi.2004.10.018. View

Miller M, Paradis C, Houck P, Mazumdar S, Stack J, Rifai A . Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992; 41(3):237-48. DOI: 10.1016/0165-1781(92)90005-n. View

Bayliss E, Ellis J, Steiner J . Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes. 2005; 3:51. PMC: 1208932. DOI: 10.1186/1477-7525-3-51. View

Fortin M, Hudon C, Dubois M, Almirall J, Lapointe L, Soubhi H . Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes. 2005; 3:74. PMC: 1310518. DOI: 10.1186/1477-7525-3-74. View

10.

Bari M, Virgillo A, Matteuzzi D, Inzitari M, Mazzaglia G, Pozzi C . Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc. 2006; 54(2):210-6. DOI: 10.1111/j.1532-5415.2005.00572.x. View

11.

Ferriero G, Franchignoni F, Benevolo E, Ottonello M, Scocchi M, Xanthi M . The influence of comorbidities and complications on discharge function in stroke rehabilitation inpatients. Eura Medicophys. 2006; 42(2):91-6. View

12.

Groll D, Heyland D, Caeser M, Wright J . Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index. Am J Phys Med Rehabil. 2006; 85(7):574-81. DOI: 10.1097/01.phm.0000223220.91914.61. View

13.

Pool J, Hiralal S, Ostelo R, Van der Veer K, de Vet H . Added value of qualitative studies in the development of health related patient reported outcomes such as the Pain Coping and Cognition List in patients with sub-acute neck pain. Man Ther. 2009; 15(1):43-7. DOI: 10.1016/j.math.2009.05.010. View

14.

Koopmans R, Lavrijsen J, Hoek J, Went P, Schols J . Dutch elderly care physician: a new generation of nursing home physician specialists. J Am Geriatr Soc. 2010; 58(9):1807-9. DOI: 10.1111/j.1532-5415.2010.03043.x. View

15.

Oraka E, Kim H, King M, Callahan D . Asthma prevalence among US elderly by age groups: age still matters. J Asthma. 2012; 49(6):593-9. DOI: 10.3109/02770903.2012.684252. View

16.

Fan E, Gifford J, Chandolu S, Colantuoni E, Pronovost P, Needham D . The functional comorbidity index had high inter-rater reliability in patients with acute lung injury. BMC Anesthesiol. 2012; 12:21. PMC: 3517372. DOI: 10.1186/1471-2253-12-21. View

17.

Hoang-Kim A, Busse J, Groll D, Karanicolas P, Schemitsch E . Co-morbidities in elderly patients with hip fracture: recommendations of the ISFR-IOF hip fracture outcomes working group. Arch Orthop Trauma Surg. 2013; 134(2):189-95. DOI: 10.1007/s00402-013-1756-z. View

18.

Levine C, Weaver E . Functional comorbidity index in sleep apnea. Otolaryngol Head Neck Surg. 2014; 150(3):494-500. PMC: 5940928. DOI: 10.1177/0194599813518164. View

19.

Boeckxstaens P, Vaes B, Legrand D, Dalleur O, De Sutter A, Degryse J . The relationship of multimorbidity with disability and frailty in the oldest patients: a cross-sectional analysis of three measures of multimorbidity in the BELFRAIL cohort. Eur J Gen Pract. 2014; 21(1):39-44. DOI: 10.3109/13814788.2014.914167. View

20.

Levine C, Davis G, Weaver E . Functional Comorbidity Index in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016; 6(1):52-7. PMC: 5940841. DOI: 10.1002/alr.21620. View