Article

Global ratings of change (GROCs) are commonly used in research and
clinical practice to determine which patients respond to therapy, but their
validity as a criterion for change has not been firmly established. One factor
related to their validity is the length of the recall period. The
study objective was to examine the influence of the length of the recall period
on the validity of a GROC for determining true change over time in the clinical
setting. DESIGN: This was a longitudinal, single-cohort observational study.
METHODS: Data from the Focus on Therapeutic Outcomes clinical database were
collected for 8,955 patients reporting for physical therapy treatment of a knee
disorder. Computerized adaptive testing was used to assess knee functional status
(FS) at the initial and final (discharge) physical therapy visits. Each patient's
GROC was obtained at discharge. Correlation and linear regression analyses of
knee FS and GROC, stratified by length of time between intake and discharge, were
conducted. RESULTS: Correlations of GROC with knee FS change scores were modest
even for the shortest period of recall (0-30 days) and were slightly lower for
longer recall periods. Regression analyses using knee FS to predict GROC scores
revealed similar findings. Correlations of GROC with intake and discharge scores
indicated a strong bias toward discharge status, with little or no influence of
baseline status. Standardized regression coefficients fitted the pattern expected
for a valid measure of change but confirmed the strong bias toward discharge
status. LIMITATIONS: One version of the GROC administered serially in a cohort of
patients seen in clinical practice was examined. CONCLUSIONS: These results call
into question the validity of GROCs for measuring change over time in routine
clinical practice.

Langue : ANGLAIS