BLOG: Details on the Banff Patellofemoral Instability Instrument
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The Banff Patellofemoral Instability Instrument 2.0, known as the BPII 2.0, is a disease-specific patient-reported outcome measure used to measure quality of life in adults and adolescents with lateral patellofemoral instability. The BPII can be used to evaluate patient status and track outcomes from interventions such as surgical stabilization or rehabilitation programs.
The metrics of the BPII as of February 2020 are listed below:
Year initially published: 2013
Revisions: BPII 2.0 completed in 2016 following a factor analysis and item reduction
Original construct: patellofemoral instability
Target population: 10 years to adult (adolescents and adults) (see Lafave MR at al 2018 and Lafave et al 2019).
Number of items: 23
Response options: 100 mm VAS
Scoring: sum of all measured VAS distances (in mm), divided by the number of answered items
Range of scores: 0 to 100 (a lower score is equivalent to a lower quality of life (QoL)
Completion time for patient: 5 to 10 minutes
Normative data available: pending
Original language: English
Available Translations: German (see Becher C, et al 2018), French, Dutch
Pending Translations: Portuguese, Finnish, Spanish, Polish, Swedish, Turkish and Norwegian
Reading Grade Level: 7.1
Standard Error of the Mean: 2.13
Minimally Clinical Important Difference (MCID) = 6.2 (see Lafave MR, et al 2016).
Floor or ceiling effects: none 4 to 6
Responsiveness to change: established 1,4,7 (see Lafave MR, et al 2018; Lafave MR, et al 2016; and Hiemstra LA, et al 2016).
Validity
Face validity: See Hiemstra LA, et al 2013.
Content validity: See Lafave MR, et al 2016; Lafave MR, et al 2018; Hiemstra LA, et al 2013; and Lafave MR, et al 2019.
Concurrent validity: established to the Kujala Score, Norwich Patellar Instability Score (NPI) and Pedi-IKDC (see Lafave MR, et al 2018; and Hiemstra LA, et al 2016).
Predictive validity: to failure 10; to functional testing pending (see Hiemstra LA, et al 2019).
Reliability
Internal consistency: Cronbach’s alpha greater than 0.9: 4,8; measured in patients with recurrent lateral patellofemoral instability, preoperatively and postoperatively. (see Lafave MR, et al 2016; and Hiemstra LA, et al 2013).
Test re-test reliability: (ICC 0.97) (see Lafave MR, et al 2016; Lafave MR, et al 2018; Hiemstra LA, et al 2013; Hiemstra LA, et al 2016; and Lafave MR, et al 2019).
Scoring: The BPII is scored out of 100. The VAS outputs are measured in millimeters for each question and summed. The sum is then divided by the number of questions that are answered. If all questions answered at 100 mm, then the sum of the VAS measures is 2,300. The BPII score will be 2,300/23 = 100/100. Based on an analysis of BPII scores, a minimum of 19/23 questions needs to be completed for the score to be considered valid. If a patient does not answer between one and four questions, these unanswered questions are subtracted from the denominator. In our cohort of more than 800 patients, the average preoperative BPII score of patients who undergo a patellofemoral stabilization procedure is 23/100.
How can you find the BPII? The BPII is freely available for both clinical and research uses. English, French and German versions of the BPII 2.0 can be downloaded from: https://www.bsmfoundation.ca/research/bpii/
This website also includes scoring details and a list of peer-reviewed BPII publications.
References:
Becher C, et al. Knee Surg Sports Traumatol Arthrosc. 2018;doi:10.1007/s00167-017-4673-9.
Hiemstra LA, et al. Am J Sports Med. 2013;doi:10.1177/0363546513487981.
Hiemstra LA, et al. Am J Sports Med. 2016;doi: 10.1177/0363546516635626.
Hiemstra LA, et al. Orthop J Sports Med. 2016;doi:10.1177/2325967116646085.
Hiemstra LA, et al. Orthop J Sports Med. 2019;doi:10.1177/2325967119852627.
Lafave MR, et al. J Pediatr Orthop. 2020;doi:10.1097/BPO.0000000000001407.
Lafave MR, et al. J Pediatr Orthop. 2018;doi:10.1097/BPO.0000000000001250.
Lafave MR, et al. Am J Sports Med. 2016;doi:10.1177/0363546516644605.
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