PTOTOtherArchives of physical medicine and rehabilitation2022

Can Proxy Ratings Supplement Patient Report to Assess Functional Domains Among Hospitalized Patients?

David J Weiss, Chun Wang, King Yiu Suen and 2 others

PMID 34678294

WHAT IT FOUND

Proxy ratings on a tablet-based functional measure were similar to patient self-ratings for daily activity and mobility on average, but proxies reported less cognitive impairment than patients.

Proxy ratings may supplement patient report when patients cannot complete the measure.

Key findings

01For Applied Cognition, proxy scores were higher than patient scores (mean 0.42 versus 0.00), so proxies reported less impairment than patients.

02At the combined profile level, 47%, 48%, and 49% of patient-proxy dyads showed reliable differences by the test methods.

03When FAMCAT domains were examined separately, reliable patient-proxy differences were less common: Applied Cognition 14%, Daily Activity 25%, and Basic Mobility 25%.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The study was done at a large quaternary medical center, so it may not match your hospital's patient mix or proxy relationships. Spouse status, co-residence duration, and recency did not predict agreement, so there is no reliable way to know when a proxy rating will match the patient. The FAMCAT was compared with patient self-report, not with therapist assessments or clinical outcomes, so it shows agreement with the patient's own report, not accuracy for care planning. Patients could be approached later if sedation, distressing news, upcoming tests, or intense symptoms were present, so the findings may not apply to patients too impaired to self-report.

Declared interests

The supplied metadata lists NIH extramural research support. The supplied text does not include an author conflict-of-interest statement.

The easy way to misread this

Do not treat proxy FAMCAT scores as interchangeable with patient self-report across all domains. Proxies reported less applied cognition impairment than patients, and many patient-proxy profiles differed.

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