1
|
Karlin EA, McCann J, Panish BJ, Geng X, Wei L, Argintar E. Anterior Cruciate Ligament Repair Leads to Improved Patient-Reported Outcomes Compared to Anterior Cruciate Ligament Reconstruction. Cureus 2024; 16:e60693. [PMID: 38903336 PMCID: PMC11187451 DOI: 10.7759/cureus.60693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Anterior cruciate ligament (ACL) tears occur frequently in young athletes, and ligament repair and reconstruction are surgical treatments. Although there are suggested benefits for both approaches, there is a lack of direct comparisons between ACL repair and reconstruction.This study aims to compare the mid-term functional outcomes and quality of life measures between patients that have undergone ACL repair versus reconstruction. Methods A retrospective review was conducted for demographic and operative report data of patients who underwent an ACL repair or reconstruction between 2012 and 2018. Patients were contacted over the phone and underwent a Patient-Reported Outcomes Measurement Information System (PROMIS) survey evaluating pain interference, mobility, and function. Patients were excluded from the study if there was an incomplete operative note, missing contact information, or failure to answer phone calls. Results A total of 74 eligible patients were included, with n = 54 in the ACL reconstruction group (73.0%) and n = 20 in the ACL repair group (27.0%). Reconstruction patients had a PROMIS (median (IQR)) physical function score of 22.50 (16.00-59.00), as compared to repair patients' physical function score of 60.00 (21.50-60.00). There was a significant difference favoring repair (p = 0.040). In addition, ACL reconstruction patients had a significantly higher rate of additional procedures, with 63.0% of reconstruction patients receiving an additional operation as compared to 30.0% of repair patients (p = 0.017). The surgery type did not show a significant effect on physical function scores, while additional procedures remained significant in the linear regression analysis. Conclusion Although ACL repair is associated with improved physical function scores as compared to reconstruction in the univariate analysis, surgery type did not show significance when controlling for other variables. Further studies are necessary to compare patients with similar injuries to account for differences in additional procedures, but the results remain promising in assisting with patient-driven treatment decisions.
Collapse
Affiliation(s)
- Elan A Karlin
- Orthopedics, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Julia McCann
- Orthopedics, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Brian J Panish
- Orthopedics, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, D.C., USA
| | - Linlin Wei
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, D.C., USA
| | - Evan Argintar
- Orthopedics, MedStar Washington Hospital Center, Washington, D.C., USA
| |
Collapse
|
2
|
Danilkowicz RM, Hurley ET, Hinton ZW, Meyer LE, Cheah JW, Hutyra C, Poehlein E, Green CL, Mather RC. Association between sleep dysfunction and Patient-Reported Outcomes Measurement Information System scores in patients with rotator cuff tears. J ISAKOS 2024; 9:143-147. [PMID: 38104945 DOI: 10.1016/j.jisako.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The purpose of this study was to utilize Patient-Reported Outcomes Measurement Information System (PROMIS) sleep scores to determine the prevalence of sleep dysfunction and its association with other PROMIS scores in patients with rotator cuff tears (RCT). METHODS Patients were retrospectively identified using the International Classification of Diseases-10 codes for RCT pathology, and PROMIS outcomes were assessed at multiple visits between November 2017 and February 2020. Generalized linear mixed effects models were fitted with PROMIS sleep score as the predictor variable and other PROMIS scores as the response variable. Additionally, models were fit using a clinically significant dichotomization of PROMIS sleep scores to assess differences in average PROMIS scores. RESULTS The study cohort included 481 patients, 201 (41.8 %) of whom had disrupted sleep at first visit. A higher percentage of those with disrupted sleep at first visit were female, nonwhite, and not married compared to those with normal sleep. PROMIS scores at first visit differed by sleep category. Higher PROMIS sleep scores were associated with higher anxiety, depression, fatigue, pain intensity, and pain interference scores and lower physical function, social participation, and upper extremity scores. Relationships were similar when dichotomous PROMIS sleep scores were considered. CONCLUSION There was a high prevalence of sleep dysfunction in patients with RCT. Sleep disturbance is associated with increased anxiety, depression, fatigue, pain intensity, pain interference and decreased physical function, social participation, and upper extremity function in patients with RCTs. LEVEL OF EVIDENCE III Retrospective Cohort Study.
Collapse
Affiliation(s)
- Richard M Danilkowicz
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Eoghan T Hurley
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA.
| | - Zoe W Hinton
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Lucy E Meyer
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Jonathan W Cheah
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Carolyn Hutyra
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Emily Poehlein
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, 311 Trent Drive, Durham, NC 27710, USA
| | - Cynthia L Green
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, 311 Trent Drive, Durham, NC 27710, USA
| | - Richard C Mather
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| |
Collapse
|
3
|
Czerwonka N, Gupta P, Desai SS, Hickernell TR, Neuwirth AL, Trofa DP. Patient-reported outcomes measurement information system instruments in knee arthroplasty patients: a systematic review of the literature. Knee Surg Relat Res 2023; 35:27. [PMID: 38041197 PMCID: PMC10690965 DOI: 10.1186/s43019-023-00201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The purpose of this study is to provide a systematic review of the literature pertaining to Patient-Reported Outcome Measurement Information System (PROMIS) validation and utilization as an outcomes metric in total knee arthroplasty (TKA) patients. This is the first systematic review on PROMIS use in total knee arthroplasty patients. METHODS A systematic search of the Pubmed/MEDLINE and Embase databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study characteristics, patient demographics, psychometric properties (Pearson and Spearman correlation) with legacy patient-reported outcome measurement (PROM) instruments, floor and ceiling effects, responsiveness, and minimum clinically important difference (MCID) and PROMIS outcomes were recorded and analyzed. RESULTS Fifteen studies investigating PROMIS in 11,140 patients were included. The weighted-average Pearson correlation coefficient comparing PROMIS domains with legacy patient-reported outcome measurements in total knee arthroplasty patients was 0.62 [standard error (SE) = 0.06] and the weighted-average Spearman correlation comparing PROMIS domains with legacy patient-reported outcome measurements in total knee arthroplasty patients was 0.59 (SE = 0.06), demonstrating moderate-to-strong correlation and validity. There were no differences in weighted average floor [0.03% (SE = 3.1) versus 0% (SE = 0.1) versus 0.01% (SE = 1.1); p = 0.25] or ceiling effects [0.01% (SE = 0.7) versus 0.02% (SE = 1.4) versus 0.04% (SE = 3.5); p = 0.36] between PROMIS and legacy instruments. The weighted average for percentage of patients achieving MCID was 59.1% for global physical health (GPH), 26.0% for global mental health (GMH), 52.7% for physical function (PF), 67.2% for pain interference (PI), and 37.2% for depression. CONCLUSION Notably, PROMIS global physical health, physical function, and pain interference were found to be significantly responsive, with PROMIS pain interference most effectively capturing clinical improvement as evidenced by the achievement of MCID.
Collapse
Affiliation(s)
- Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA.
| | - Puneet Gupta
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
- George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA
| | - Sohil S Desai
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - Thomas R Hickernell
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| |
Collapse
|
4
|
Huddleston HP, Lavoie-Gagne O, Mehta N, Walsh JM, Fu MC, Forsythe B, Verma NN, Cole BJ, Yanke AB. PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5067-5076. [PMID: 37823904 DOI: 10.1007/s00167-023-07535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/28/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The purpose of this study was to assess the validity, floor and ceiling effects, and dimensionality of PROMIS Physical Function (PF) and Pain compared to legacy patient reported outcome (PRO) measures in patients undergoing medial patellofemoral ligament (MPFL) reconstruction. METHODS Patients who underwent MPFL reconstruction between 2018 to 2020 were retrospectively reviewed. Preoperatively, patients completed the IKDC, VR-12, Kujala, SF-12, KOOS JR, PROMIS PF and Pain surveys. Inter-survey convergence was assessed with Spearman correlations. Psychometric analysis included investigations of inter-survey convergent validity, intra-survey floor and ceiling effects, and Rasch analyses with person-item fit and iterative question elimination model fit testing. RESULTS A total of 76 patients (mean age: 22.6 ± 8.4 years) who completed preoperative surveys were included (compliance: 91.7-96.2%). Preoperatively, age was significantly associated with both PROMIS PF (coefficient: - 0.291, P = 0.005) and Pain scores (coefficient: 0.294, P = 0.002). PROMIS PF had a Very Good correlation with IKDC and PROMIS Pain had a Very Good correlation with KOOS JR. Other correlations ranged from Poor to Good. No significant floor or ceiling effects were observed for any PRO. On iterative question elimination Rasch modelling, only two questions from PROMIS PF remained after 6 rounds of elimination while PROMIS Pain had no questions remaining after 3 rounds of elimination. CONCLUSION Preoperative PROMIS PF and Pain provided only Fair to Good correlations with most legacy PROs. Although no significant floor and ceiling effects were observed, PROMIS PF and Pain did not perform well psychometrically in this population of patients undergoing MPFL reconstruction. These results suggest PROMIS questionnaires should be used with caution in this population, especially if used in isolation, when discussing clinical expectations with patients. The authors recommend continued use of legacy PROs specific to assessment of patellar instability and function that have established validity in patellar instability populations. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Hailey P Huddleston
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
- Hospital for special surgery, New York, NY, USA
| | - Ophelie Lavoie-Gagne
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
- Harvard, Cambridge, MA, USA
| | - Nabil Mehta
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Justin M Walsh
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
- Houston Methodist, Houston, TX, USA
| | - Michael C Fu
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Brian Forsythe
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Nikhil N Verma
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Brian J Cole
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Adam B Yanke
- Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA.
| |
Collapse
|
5
|
Berk AN, Piasecki DP, Fleischli JE, Trofa DP, Saltzman BM. Trends in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231174472. [PMID: 37284137 PMCID: PMC10240869 DOI: 10.1177/23259671231174472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 06/08/2023] Open
Abstract
Background Despite the prevalence of patient-reported outcomes (PROs) to evaluate results after anterior cruciate ligament (ACL) reconstruction, there exists little standardization in how these metrics are reported, which can make wider comparisons difficult. Purpose To systematically review the literature on ACL reconstruction and report on the variability and temporal trends in PRO utilization. Study Design Systematic review. Methods We queried the PubMed Central and MEDLINE databases from inception through August 2022 to identify clinical studies reporting ≥1 PRO after ACL reconstruction. Only studies with ≥50 patients and a mean 24-month follow-up were considered for inclusion. Year of publication, study design, PROs, and reporting of return to sport (RTS) were documented. Results Across 510 studies, 72 unique PROs were identified, the most common of which were the International Knee Documentation Committee score (63.3%), Tegner Activity Scale (52.4%), Lysholm score (51.0%), and Knee injury and Osteoarthritis Outcome Score (35.7%). Of the identified PROs, 89% were utilized in <10% of studies. The most common study designs were retrospective (40.6%), prospective cohort (27.1%), and prospective randomized controlled trials (19.4%). Some consistency in PROs was observed among randomized controlled trials, with the most common PROs being the International Knee Documentation Committee score (71/99, 71.7%), Tegner Activity Scale (60/99, 60.6%), and Lysholm score (54/99, 54.5%). The mean number of PROs reported per study across all years was 2.89 (range, 1-8), with an increase from 2.1 (range, 1-4) in studies published before 2000 to 3.1 (range, 1-8) in those published after 2020. Only 105 studies (20.6%) discretely reported RTS rates, with more studies utilizing this metric after 2020 (55.1%) than before 2000 (15.0%). Conclusion There exists marked heterogeneity and inconsistency regarding which validated PROs are used in studies related to ACL reconstruction. Significant variability was observed, with 89% of measures being reported in <10% of studies. RTS was discretely reported in only 20.6% of studies. Greater standardization of outcomes reporting is required to better promote objective comparisons, understand technique-specific outcomes, and facilitate value determination.
Collapse
Affiliation(s)
- Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - David P. Trofa
- Department of Orthopaedics, NewYork–Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| |
Collapse
|
6
|
Day MA, Hancock KJ, Selley RS, Olsen RJ, Antao VC, Ranawat AS, Nawabi DH, Kelly BT. Patient-Reported Outcomes Measurement Information System Mobility Computerized Adaptive Testing Maintains High Correlation and Low Test Burden Compared With Legacy Hip-Specific Instruments in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2022; 38:3023-3029. [PMID: 35469995 DOI: 10.1016/j.arthro.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/06/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the reliability, construct validity, and responsiveness of the lower extremity-specific Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility (MO) bank in patients who underwent hip arthroscopic surgery for femoroacetabular impingement. METHODS Patients who underwent primary hip arthroscopic surgery at a large academic musculoskeletal specialty center between November 2019 and November 2020 completed the following baseline and 6-month measures: PROMIS MO, PROMIS Pain Interference (PI), PROMIS Physical Function (PF), modified Harris Hip Score, International Hip Outcome Tool 33, visual analog scale, and Single Assessment Numeric Evaluation. Construct validity was evaluated using Spearman correlation coefficients. The number of questions until completion was recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) for each measure was recorded to measure inclusivity. Responsiveness was tested by comparing differences between baseline and 6-month measures, controlling for age and sex, using generalized estimating equations. Magnitudes of responsiveness were assessed through the effect size (Cohen d). RESULTS In this study, 660 patients (50% female patients) aged 32 ± 14 years were evaluated. PROMIS MO showed a strong correlation with PROMIS PF (r = 0.84, P < .001), the International Hip Outcome Tool 33 (r = 0.73, P < .001), PROMIS PI (r = -0.76, P < .001), and the modified Harris Hip Score (r = 0.73, P < .001). Neither PROMIS MO, PROMIS PI, nor PROMIS PF met the conventional criteria for floor or ceiling effects (≥15%). The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS MO, 4.1 ± 0.6 for PROMIS PI, and 4.1 ± 0.6 for PROMIS PF. From baseline to 6 months, the PROMIS and legacy measures exhibited significant responsiveness (P < .05), with similar effect sizes between the patient-reported outcome measures. CONCLUSIONS This longitudinal study reveals that in patients undergoing hip arthroscopy, PROMIS MO computerized adaptive testing maintains high correlation with legacy hip-specific instruments, significant responsiveness to change, and low test burden compared with legacy measures, with no ceiling or floor effects at 6-month postoperative follow-up. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Molly A Day
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A; Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, U.S.A.
| | - Kyle J Hancock
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A; Department of Sports Medicine, Desert Orthopaedic Center, Las Vegas, Nevada, U.S.A
| | - Ryan S Selley
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Reena J Olsen
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Vinicius C Antao
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| |
Collapse
|
7
|
Schaffer JC, Kuhns B, Reuter J, Sholtis C, Karnyski S, Goldblatt JP, Bronstein RD, Maloney MD, Baumhauer J, Mannava S. Clinically Depressed Patients Having Anterior Cruciate Ligament Reconstruction Show Improved but Inferior Rate of Achieving Minimum Clinically Important Difference for Patient-Reported Outcomes Measurement Information System Compared With Situationally Depressed or Nondepressed Patients. Arthroscopy 2022; 38:2863-2872. [PMID: 35550418 DOI: 10.1016/j.arthro.2022.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the preoperative diagnosis of depression predicted worse postoperative outcomes, including physical therapy (PT) compliance, return-to-sport, and patient-reported outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) after anterior cruciate ligament (ACL) reconstruction. METHODS A multisurgeon series of consecutive patients who had undergone ACL reconstruction with minimum 2-year follow-up were included. Chart review was conducted to determine depression diagnosis status, demographic data, rehabilitation PT compliance, return to sports, and patient-reported outcome data using PROMIS. Patients who met the PROMIS threshold for mild depression but did not carry a clinical diagnosis of depression were classified as "situationally depressed." RESULTS Ninety-five of 115 consecutive patients (81%) met inclusion criteria with an average follow-up of 34 ± 1.9 months. Fourteen patients (15%) had a preoperative diagnosis of depression, whereas 21 (22%) were considered situationally depressed. Clinically depressed patients had a greater rate of PT noncompliance (33.2% ± 17.6% vs 21.9% ± 12.6%; P = .02) and a lower postoperative PROMIS Physical Function (50.8 ± 7.7 vs 57.8 ± 11.0; P = .03 compared with patients without depression. Situationally depressed patients had lower preoperative physical function (35.4 vs 42.5; P = .04) with no differences in postoperative outcomes scores compared to the non-depressed cohort.19/21 (90.5%) of situationally depressed patients had postoperative resolution of their depressive symptoms. CONCLUSIONS Situationally depressed patients without a clinical diagnosis of depression can expect significant improvements in both pain and function, as well as a resolution of their depressed mood based on PROMIS scores as they progress through recovery after ACL reconstruction. Clinically depressed patients also experience significant improvements; however, their rate of achieving the minimum clinically important difference for PROMIS outcomes may be less than their nondepressed or situationally depressed counterparts. LEVEL OF EVIDENCE III, prognostic comparative trial.
Collapse
Affiliation(s)
- Joseph C Schaffer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Benjamin Kuhns
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A.
| | - John Reuter
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Connor Sholtis
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Steven Karnyski
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - John P Goldblatt
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Robert D Bronstein
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael D Maloney
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Judith Baumhauer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| |
Collapse
|
8
|
The Current Utilization of Patient-reported Outcome Measurement Information System in Shoulder, Elbow, and Sports Medicine. J Am Acad Orthop Surg 2022; 30:554-562. [PMID: 35653279 DOI: 10.5435/jaaos-d-22-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023] Open
Abstract
Clinical research using patient-reported outcome measures has been critical within the field of shoulder, elbow, and sports medicine in helping clinicians deliver evidence-based and value-based medicine. Recently, however, clinicians have advocated for improving the process of obtaining clinically meaningful information from patients while decreasing survey fatigue and increasing compliance. To that end, the National Institutes of Health created the Patient-Reported Outcome Measures Information System (PROMIS) in which a number of institutions and research investigations have adopted for reporting outcomes. A special focus has also been placed on PROMIS Computer Adaptive Testing forms, which tailor questioning through item response theory. The purpose of this study was to provide insight into the utilization, advantages, and disadvantages of PROMIS within the field of shoulder, elbow, and sports medicine and provide a comparison with legacy patient-reported outcome measure measurements.
Collapse
|
9
|
Patient Reported Outcomes in Metastatic Spine Disease: Concurrent Validity of PROMIS with the Spine Oncology Study Group Outcome Questionnaire. Spine (Phila Pa 1976) 2022; 47:591-596. [PMID: 35102119 DOI: 10.1097/brs.0000000000004327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional prospective study. OBJECTIVE To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression domains in comparison to the Spine Oncology Study Group-Outcomes Questionnaire (SOSG-OQ) in patients with metastatic spine disease. SUMMARY OF BACKGROUND DATA While there remains a significant movement toward incorporating patient-reported outcome measures (PROMs) into clinical care, there are few validated PROMs for patients with metastatic spine disease. The SOSG-OQ was designed and validated for metastatic spine tumor patients. However, the use of general symptom-based PROMs, such as PROMIS domains, may reduce both patient and physician burden and improve interdisciplinary care if shown to be concurrently valid. METHODS Metastatic spine tumor patients from January 2017 to July 2021 at a single academic medical center were asked to complete PROMIS PF, PI, and Depression domains and the SOSG-OQ. Spearman correlation (p) coefficients were calculated. RESULTS A total of 103 unique visits, representing 79 patients met our inclusion criteria. A majority were men (59; 57%) and Caucasian (93; 90%), and the average age was 64-years-old (range: 34-87). There were 13 different types of histologies reported, with multiple myeloma, breast cancer, and prostate cancer representing 28 (27%), 26 (25%), and 13 (13%), respectively. Additional cancers included renal cell carcinoma, lung cancer, colon cancer, thyroid cancer, large B-cell lymphoma, nonHodgkin lymphoma, esophageal cancer, plasmacytoma, metastatic paraganglioma, and metastatic spindle cell sarcoma. SOSG-OQ was strongly correlated with PROMIS PI (ρ = 0.78) and PROMIS PF (ρ = 0.71), and moderately correlated with PROMIS Depression (ρ = 0.58). CONCLUSION PROMIS PF, PI, and Depression appear to capture similar clinical insight as the SOSG-OQ. Spine surgeons can consider using these PROMIS domains in lieu of the SOSG-OQ in metastatic spine tumor patients. UNLABELLED Level of Evidence: NA.
Collapse
|
10
|
Cheah JW, Danilkowicz R, Hutyra C, Lewis B, Olson S, Poehlein E, Green CL, Mather R. High Prevalence of Sleep Disturbance Is Associated with Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2022; 4:e495-e501. [PMID: 35494310 PMCID: PMC9042751 DOI: 10.1016/j.asmr.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/01/2021] [Indexed: 10/24/2022] Open
|
11
|
Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Ziedas AC, Abed V, Swantek AJ, Rahman TM, Cross A, Thomashow K, Makhni EC. Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Instruments Compare Favorably With Legacy Patient-Reported Outcome Measures in Upper- and Lower-Extremity Orthopaedic Patients: A Systematic Review of the Literature. Arthroscopy 2022; 38:609-631. [PMID: 34052370 DOI: 10.1016/j.arthro.2021.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) with traditional ("legacy") patient-reported outcome measures (PROMs) in regard to correlations, ease of use, and quality criteria for upper (UE) and lower extremity (LE) orthopaedic conditions. METHODS A systematic search of the PubMed/MEDLINE database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify published articles that referenced the various PROMIS PF measures. Two authors independently reviewed selected studies. The search returned 857 studies, 85 of which were selected for independent review by 2 authors. Of these, 54 were selected for inclusion. Mixed linear models were performed to assess for differences between legacy PROMs and PROMIS measures. RESULTS The combined sample size of all included studies yielded 6,074 UE and 9,366 LE patients. Overall, PROMIS PF measures demonstrated strong correlations with legacy PROMs among UE (weighted Pearson correlation, 0.624, standard error [SE] = 0.042; weighted Spearman correlation, 0.566, SE = 0.042) and LE patients (weighted Pearson correlation, 0.645, SE = 0.062; weighted Spearman correlation, 0.631, SE = 0.041). PROMIS PF questionnaires completed by UE patients had fewer questions than legacy PROMs (5.9 vs 17.7, P = .0093) and were completed in less time (90.5 vs 223.8 seconds, P = .084). PROMIS PF questionnaires completed by LE patients had fewer questions than legacy PROMs (4.81 vs 15.33, P < .001) and were completed in less time (63.6 vs 203.2 seconds, P = .0063). The differences for the reliability measures were not significant. CONCLUSIONS PROMIS PF scores correlate strongly with commonly used legacy PROMs in orthopaedics, particularly in UE and LE patients. PROMIS PF forms can be administered efficiently and to a broad patient population while remaining highly reliable. Therefore, they can be justified for standardized use among orthopaedic patients with UE and LE conditions, improving the ability to aggregate and compare outcomes in orthopaedic research. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV evidence.
Collapse
Affiliation(s)
- Alexander C Ziedas
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Varag Abed
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Alexander J Swantek
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Austin Cross
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Katherine Thomashow
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A..
| |
Collapse
|
13
|
Gruner MP, Hogaboom N, Hasley I, Hoffman J, Gonzalez-Carta K, Cheville AL, Li Z, Sellon JL. Prospective, Single-blind, Randomized Controlled Trial to Evaluate the Effectiveness of a Digital Exercise Therapy Application Compared With Conventional Physical Therapy for the Treatment of Nonoperative Knee Conditions. Arch Rehabil Res Clin Transl 2022; 3:100151. [PMID: 34977534 PMCID: PMC8683841 DOI: 10.1016/j.arrct.2021.100151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness and adherence of a home exercise therapy program using a digital exercise therapy application (DETA) compared with conventional physical therapy (PT). Design Parallel group, randomized controlled trial. Setting Two clinics in a tertiary care academic center. Participants Participants (N=60) were enrolled within 1 week after a provider visit for knee pain. Inclusion criteria: age 18-75 years, knee pain diagnosis, and clinician-prescribed PT. Interventions Participants were randomized to complete either an 8-week intervention of conventional PT (enrolled n=29; complete n=26) or the DETA (enrolled n=31; completed n=24). Main Outcome Measures Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores implemented via computer adaptive tests; number of exercise sessions completed per week (adherence). Results Compared with the PT group, the DETA group reported significant decreases in PROMIS-PI scores (−6.1±6.7 vs −1.5±6.6, P<.05, d=0.78) and increases in PROMIS-PF scores (6.0±6.6 vs −0.8±5.8, P<.01, d=0.89) after 8 weeks. No group differences in adherence were observed (P>.05). Conclusions Use of this DETA resulted in greater pain and functional improvements compared with PT, with no differences in adherence. It is possible this application may be a viable alternative to conventional PT in certain cases. A larger sample from various geographic locations is needed to improve generalizability and for subgroup analysis. Further investigation is warranted to determine the factors responsible for the differences observed between the groups.
Collapse
Affiliation(s)
- Marc P. Gruner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
- Corresponding author Marc P. Gruner, DO, MBA, 6608 Rivertrail Ct, Bethesda, MD 20817.
| | - Nathan Hogaboom
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ
| | - Ike Hasley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jared Hoffman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Karina Gonzalez-Carta
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jacob L. Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| |
Collapse
|
14
|
Patient-Reported Outcomes Measurement Information System Test Is Less Responsive Than Legacy Hip-Specific Patient-Reported Outcome Measures in Patients Undergoing Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2021; 3:e1645-e1650. [PMID: 34977616 PMCID: PMC8689206 DOI: 10.1016/j.asmr.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/24/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate and compare the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) computerized adaptive test and PROMIS Pain Interference (PI) instruments versus legacy patient-reported outcome measures (PROMs) in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome at 1-year follow-up. Methods Patients undergoing primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome without concomitant procedures performed by a single surgeon between August 2018 and January 2019 were identified. The PROMIS PF score, PROMIS PI score, Hip Outcome Score–Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool 12 (iHOT-12), and visual analog scale (VAS) pain score were obtained preoperatively and at 6 months and 1 year postoperatively. Bivariate correlation analyses between PROMIS and legacy PROMs were performed. The floor and ceiling effects, responsiveness, and relative efficiency (RE) of each PROM were calculated. Results This study included 124 patients with an average age of 32.7 ± 12.3 years. The PROMIS PF score showed very good correlations with the HOS-ADL (r = 0.73, P < .001) and mHHS (r = 0.70, P < .001) and good correlations with the HOS-SS (r = 0.62, P < .001), iHOT-12 score (r = 0.62, P < .001), and VAS pain score (r = –0.64, P < .001). The PROMIS PI score showed very good inverse correlations with the HOS-ADL (r = –0.72, P < .001) and mHHS (r = –0.79, P < .001) and good correlations with the HOS-SS (r = –0.64, P < .001), iHOT-12 score (r = –0.65, P < .001), and VAS pain score (r = 0.65, P < .001). No floor effect was observed for any measure. Ceiling effects were not observed in the PROMIS PROMs but were detected for the HOS-ADL (16.1%) and mHHS (19.3%). The effect size was large for all outcomes: iHOT-12 score, d = 1.77; HOS-ADL, d = 1.37; HOS-SS, d = 1.45; PROMIS PI score, d = 1.05; and PROMIS PF score, d = 1.01. The iHOT-12 score was more responsive than the PROMIS PI score (RE = 1.69), PROMIS PF score (RE = 1.75), HOS-ADL (RE = 1.29), and HOS-SS (RE = 1.22). Conclusions At 1-year follow-up, PROMIS PROMs displayed very good correlations with legacy PROMs. However, PROMIS PROMs had lower effect sizes and were not as responsive as legacy PROMs. Level of Evidence Level II, development of diagnostic criteria on the basis of consecutive patients.
Collapse
|
15
|
Baron JE, Parker EA, Wolf BR, Duchman KR, Westermann RW. PROMIS Versus Legacy Patient-Reported Outcome Measures for Sports Medicine Patients Undergoing Arthroscopic Knee, Shoulder, and Hip Interventions: A Systematic Review. THE IOWA ORTHOPAEDIC JOURNAL 2021; 41:58-71. [PMID: 34924871 PMCID: PMC8662933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS®) was designed to monitor the global wellbeing of patients, with the Physical Function Computer-Adaptive Test (PF-CAT) component focused specifically on functional outcome. PROMIS aims for increased item-bank accuracy, lower administrative burden, and decreased floor and ceiling effects compared to legacy patient-reported outcome measures (PROMs). Our primary research outcomes focused on sports medicine surgical populations, which may skew younger or have wide-ranging functional statuses. Specifically, for this population, we questioned if PROMIS PF-CAT was equal to legacy PROMs in (1) construct validity and (2) convergent/divergent validities; and superior to legacy PROMs with respect to (3) survey burden and (4) floor and ceiling effects. METHODS Searches were performed in April 2019 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing PubMed, Cochrane Central, and Embase databases for Level I-III evidence. This resulted in 541 records, yielding 12 studies for inclusion. PROM data was available for patients undergoing arthroscopic orthopaedic procedures of the knee, shoulder, and hip. Measures of construct validity, convergent/divergent validity, survey burden, and floor/ceiling effects were evaluated for PROMIS PF-CAT versus legacy PROMs. RESULTS PROMIS PF-CAT demonstrated excellent or excellent-good correlation with legacy PROMS for physical function and quality of life for patients undergoing arthroscopic interventions of the knee, shoulder, and hip. Compared to legacy PROM instruments, PROMIS PF-CAT demonstrated the lowest overall survey burden and had the lowest overall number of floor or ceiling effects across participants. CONCLUSION PROMIS PF-CAT is an accurate, efficient evaluation tool for sports medicine surgical patients. PROMIS PF-CAT strongly correlates with legacy physical function PROMs while having a lower test burden and less incidence of floor and ceiling effects. PROMIS PF-CAT may be an optimal alternative for traditional physical function PROMs in sports medicine patients undergoing arthroscopic procedures. Further studies are required to extend the generalizability of these findings to patients during postoperative timepoints after shoulder and hip interventionsLevel of Evidence: III.
Collapse
Affiliation(s)
- Jacqueline E. Baron
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Emily A. Parker
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Brian R. Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Kyle R. Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Robert W. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| |
Collapse
|
16
|
Preoperative Evaluation of the Lower Extremity-Specific PROMIS Mobility Bank in Patients with ACL Tears. Arthrosc Sports Med Rehabil 2021; 3:e1025-e1029. [PMID: 34430881 PMCID: PMC8365215 DOI: 10.1016/j.asmr.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to preoperatively assess the Patient-Reported Outcomes Measurement Information System (PROMIS) Item Bank v2.0–Mobility in patients with anterior cruciate ligament (ACL) tears to (1) determine construct validity by correlating with legacy patient-reported outcomes (PROs), (2) evaluate test burden, (3) determine the presence of floor or ceiling effects, and (4) revisit the conventional threshold for inclusiveness (floor/ceiling effects) in the modern era of computer adaptive testing (CAT)–based PROs. Methods Patients at a large academic musculoskeletal specialty center diagnosed with ACL tears indicated for surgery were administered the following outcomes measures before surgery: PROMIS Mobility CAT, PROMIS Pain Interference CAT (PROMIS PI), International Knee Documentation Committee (IKDC), the Marx Knee Activity Rating Scale (Marx), and Single Assessment Numeric Evaluation (SANE). Construct validity was evaluated using Spearman correlation coefficients. Correlation strengths were defined as high (≥0.7), high-moderate (0.61-0.69), moderate (0.4-0.6), moderate-weak (0.31-0.39) and weak (≤0.3). Number of questions to completion were recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) of each measure was recorded to measure inclusivity. Results A total of 1126 patients were evaluated. The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS Mobility and 4.5 ± 1.9 for PROMIS PI. PROMIS Mobility demonstrated a high correlation with IKDC, (r = 0.81, P < .001), a high-moderate correlation with PROMIS PI (r = −0.63), and a moderate correlation with SANE (r = 0.46, P < .01). Neither PROMIS Mobility nor PROMIS PI met conventional criteria for floor or ceiling effects (>15%). Conclusions The PROMIS Mobility measure maintains construct validity, because its scores correlate strongly with other PROs measuring physical function with high efficiency among preoperative patients with ACL injuries. Although ceiling effects of PROMIS Mobility CAT were below the conventional significance threshold of 15% at the preoperative timepoint in this population, this study provides critical feedback for redesigning the Mobility bank. Level of Evidence Level III (Diagnostic study).
Collapse
|
17
|
Bodendorfer BM, DeFroda SF, Clapp IM, Newhouse A, Nwachukwu BU, Nho SJ. Defining Clinically Significant Improvement on the Patient-Reported Outcomes Measurement Information System Test at 1-Year Follow-up for Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome. Am J Sports Med 2021; 49:2457-2465. [PMID: 34097552 DOI: 10.1177/03635465211015687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient-reported outcome measures, these metrics have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy. PURPOSE To define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients were administered the PROMIS-PF, PROMIS-PI, Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports Subscale, modified Harris Hip Score, and International Hip Outcome Tool-12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, whereas PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared with those who did not achieve CSOs via chi-square and independent-samples t tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement. RESULTS 124 patients with a mean age of 32.7 ± 12.3 years were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (-3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively, compared with 87.1%, 76.6%, and 71.8% for legacy patient-reported outcome measurements. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3 ± 12 vs 35.6 ± 12 years; P = .017) with significantly lower body mass index (BMI) (24.7 ± 6.4 vs 27.9 ± 7; P = .009). Preoperative chronic pain and history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement, whereas higher (worse) preoperative PROMIS-PI scores were a positive predictor. CONCLUSION Our study defined the MCID, PASS, and SCB for the PROMIS-PF CAT and PROMIS-PI CAT at 1 year postoperatively. Patients with higher preoperative PROMIS scores, younger age, and lower BMI were more likely to achieve CSO, whereas preoperative chronic pain and history of orthopaedic surgery were negative predictors of CSO achievement.
Collapse
Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Newhouse
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
18
|
Gulbrandsen TR, Khazi ZM, Bollier M, Wolf B, Larson C, Duchman K, An Q, Westermann RW. Preoperative Performance of Patient-Reported Outcomes Measurement Information System in Patients with Meniscal Root Tears. J Knee Surg 2021; 34:913-917. [PMID: 31887762 DOI: 10.1055/s-0039-3402076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to establish preoperative validity of the Patient-Reported Outcomes Measurement Information System physical function computer adaptive test (PROMIS PF-CT) with legacy patient-reported outcome measures (PROMs) for meniscal root tears (MRTs). Our study included 51 patients (52 knees) with MRT. Patients completed PROMIS PF-CT, Short Form 36 (SF-36 physical function, pain, general health, vitality, social function, emotional well-being, role limitations due to physical health, and role limitations due to emotional problems), Knee Injury and Osteoarthritis Outcome Score (KOOS pain, symptoms, activities of daily living [ADLs], sports, and quality of life [QOL]), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC pain, stiffness, and function), EuroQol-5 dimensions (EQ-5D), and Knee Activity Scale questionnaires at their preoperative visit. Correlations between the PROMs listed above were evaluated along with floor and ceiling effects. Correlations were defined as weak (0.2-0.39), moderate (0.4-0.59), strong (0.6-0.79), and very strong (0.8-1.0). Preoperative data showed that PROMIS PF-CT has a strong correlation with SF-36 PF, KOOS-ADL, WOMAC-function, and EQ-5D; and moderate correlation with KOOS-sport, KOOS-pain, KOOS-symptoms, KOOS-QOL, WOMAC-pain, and WOMAC-stiffness. The Knee Activity Scale did not show any significant correlation with PROMIS PF-CT (r = 0.12, p = 0.2080). Of all the PROMs administered, PROMIS PF-CT demonstrated no floor or ceiling effects compared with 11.54% ceiling effect in KOOS-sports, and 5.77% floor effect in KOOS-ADL. On average, patients answered fewer PROMIS PF-CT questions (4.15 ± 0.72). PROMIS PF-CT is a valuable tool to assess preoperative patient-reported physical function in patients that may undergo MRT repair. It correlates strongly with other well-established PROMs. It also demonstrated no floor or ceiling effects and demonstrated a low test burden in our sample of 52 knees. This is a level III, prognostic retrospective comparative study.
Collapse
Affiliation(s)
- Trevor R Gulbrandsen
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Zain M Khazi
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Matthew Bollier
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Brian Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher Larson
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota
| | - Kyle Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| |
Collapse
|
19
|
Karsalia M, Zhang T, Aneizi A, Foster MJ, Schneider MB, Sajak PM, Nadarajah V, Meredith SJ, Henn RF. Predictors of postoperative pain using PROMIS pain interference two-years following knee surgery. J Orthop 2021; 25:271-277. [PMID: 34099956 DOI: 10.1016/j.jor.2021.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The purpose of this study was to identify preoperative factors associated with worse PROMIS Pain Interference (PI) two years following knee surgery. Methods Participants completed surveys preoperatively and two years postoperatively. Data collected included demographics, medical history, and multiple patient-reported outcomes measures, including PROMIS PI. Results After controlling for confounders, lower income, smoking, worse PROMIS Anxiety, worse Numeric Pain Score body pain, and worse Marx Activity Rating Scale were independent predictors for worse PROMIS PI two years after surgery. Conclusion Worse PROMIS PI two years after elective knee surgery is associated with multiple socio-demographic patient identifiers.
Collapse
Affiliation(s)
- Moli Karsalia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Mj Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
20
|
Stevens KN, Nadarajah V, Jauregui JJ, Song X, Medina SH, Smuda MP, Packer JD, Henn RF. Preoperative Expectations of Patients Undergoing Knee Surgery. J Knee Surg 2021; 34:612-620. [PMID: 31639850 DOI: 10.1055/s-0039-1698805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7-89.3) and median of 91.7 (95% CI, 89.2-94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The level of evidence for the study is IV.
Collapse
Affiliation(s)
- Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate College of Medicine, Brooklyn, New York
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xuyang Song
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shaun H Medina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
21
|
Gulledge CM, Koolmees D, Smith DG, Pietroski A, Franovic S, Moutzouros V, Makhni EC. The PROMIS CAT Demonstrates Responsiveness in Patients After ACL Reconstruction Across Numerous Health Domains. Orthop J Sports Med 2021; 9:2325967120979991. [PMID: 33553461 PMCID: PMC7841687 DOI: 10.1177/2325967120979991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a dynamic, efficient, and validated patient-reported outcome measure in the field of orthopaedics. However, the responsiveness, which is defined as the ability to detect changes in scores over time, of PROMIS computer adaptive tests (CATs) after anterior cruciate ligament reconstruction (ACLR) has not been well documented. Purpose: To investigate the responsiveness up to 1 year postoperatively of multiple PROMIS CAT domains in patients undergoing ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: All patients who underwent ACLR by 1 of 2 fellowship-trained sports medicine orthopaedic surgeons, with preoperative and at least 6 months postoperative visits, were included in this study. PROMIS CAT physical function (PF), pain interference (PI), and depression (D) scores from each visit were collected and analyzed. Preoperative patient-centric factors, including demographic factors and meniscal pathology, were analyzed for associations with improvements in PROMIS scores. Results: A total of 100 patients (62 male patients and 38 female patients; mean age, 27.6 ± 11.8 years) with an average follow-up of 338.5 ± 137.5 days were included in this study. Preoperative PF, PI, and D scores improved significantly from 38.5 ± 7.3, 60.3 ± 7.0, and 47.9 ± 9.1, respectively, to 53.6 ± 10.3, 48.1 ± 8.5, and 41.0 ± 9.9, respectively (P < .001 for each domain). Lower preoperative PF scores, PI scores, and a lower body mass index (BMI) were predictive for greater improvements in PF. Higher preoperative PI scores and a lower BMI were predictors for greater improvements in PI. Meniscal pathology was not predictive of improvement in PROMIS scores. Conclusion: PROMIS CAT assessments of PF, PI, and D demonstrated responsiveness in patients undergoing ACLR up to 1 year. Worse preoperative PROMIS scores and a lower BMI were predictive of greater improvements in PROMIS scores.
Collapse
|
22
|
PROMIS is a Valid Patient-Reported Outcome Measure for Patients undergoing ACL Reconstruction with Multi-ligament Knee Reconstruction and Repair Procedures. Knee 2021; 28:294-299. [PMID: 33453517 DOI: 10.1016/j.knee.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/02/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to (1) compare PROMIS with previously validated legacy instruments and (2) to assess between group differences of PROMIS PF-CAT [Physical Function Computer Adaptive Test] for patients undergoing isolated primary ACL reconstruction [ACLR] vs. primary ACL reconstruction with additional ligamentous intervention [MLIK]. LEVEL OF EVIDENCE II; Prospective Cohort Study. METHODS At a single preoperative timepoint, 42 [MLIK] and 73[ACLR] patients completed: Short Form 36 Health Survey (SF-36) Mental (MCS) and Physical Component Summary (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 dimensions (EQ-5D) and Marx Knee Scale. Spearman correlation coefficients (non-parametric data) assessed correlations between PROMIS PF-CAT and legacy PROs [Patient-Reported Outcome instruments]. Floor and ceiling effects were assessed using chi-square tests. Between group differences were assessed (Wilcoxon Rank sum test). RESULTS PROMIS PF-CAT for the MLIK cohort [Table 2] demonstrated an excellent-good correlation with SF-36 Physical Function (PCS; r = 0.64, p < 0.01), EQ-5D (r = 0.68, p < 0.01), and KOOS Quality of Life (QOL) (r = 0.68, p < 0.01); good correlation with KOOS ADL (r = 0.52, p = 0.01), KOOS Sports (r = 0.44, p < 0.01), KOOS Pain (r = 0.44, p < 0.01) and WOMAC Function (r = 0.52,p = 0.01). PROMIS PF-CAT scores differed for ACL vs. MLIK cohorts (41.9 ± 6.6 vs. 37.6 ± 9.0, p < 0.01). PROMIS PF-CAT demonstrated the fewest floor and ceiling effects [Table 4] versus legacy PRO instruments. CONCLUSION PROMIS PF-CAT demonstrated strong correlations with previously validated PRO instruments and offers a favorable alternative for patients undergoing ACLR with MLIK repair/reconstruction procedures. Preoperative PROMIS PF-CAT scores were greater for patients undergoing primary ACLR versus MLIK intervention.
Collapse
|
23
|
Nwachukwu BU, Rasio J, Beck EC, Okoroha KR, Sullivan SW, Makhni EC, Nho SJ. Patient-Reported Outcomes Measurement Information System Physical Function Has a Lower Effect Size and is Less Responsive Than Legacy Hip Specific Patient Reported Outcome Measures Following Arthroscopic Hip Surgery. Arthroscopy 2020; 36:2992-2997. [PMID: 32679295 DOI: 10.1016/j.arthro.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the use and responsiveness of Patient Reported Outcomes Measurement Information System (PROMIS) to legacy patient-reported outcome measures (PROMs) in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 6-month follow-up. METHODS Data from patients who underwent primary hip arthroscopy with routine capsular closure between August 2018 and January 2019 for the treatment of FAIS were analyzed. Preoperative outcomes, 6-month postoperative outcomes, and demographics were recorded. Primary outcome measures included PROMIS Physical Function (PROMIS-PF), PROMIS Pain Interference (PROMIS-PI), and PROMIS Depression. The legacy PROMs included Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport Subscale (HOS-SS), and the international hip outcome tool 12 questions (iHOT-12). Floor and ceiling effects along with the responsiveness and Cohen's d effect size of each PROM tool were calculated. RESULTS Ninety-six patients with an average age and body mass index of 32.4 ± 11.9 years and 25.9 ± 6.1 kg/m2, respectively, were included in the final analysis. All outcomes were significantly higher at 6 months compared with the preoperative level (P < .001) except for PROMIS Depression (P = .873). PROMIS-PF demonstrated excellent correlation with HOS-SS (r = 0.81; P < .001), very good correlation with HOS-ADL (r = 0.73; P < .001), and good correlation with iHOT-12 (r = 0.68; P < .001). No floor was observed for any measure. The effect size was large for all outcomes, except PROMIS Depression (d = 0.04), but largest for iHOT12 (d = 1.87) followed by HOS-ADL (d = 1.29). The iHOT-12 was more responsive than PROMIS-PI (relative efficiency [RE] = 3.95), PROMIS-PF (RE = 4.13), HOS-ADL (RE = 2.26), and HOS-SS (RE = 3.84). HOS-SS was similarly responsive to PROMIS-PI (RE=1.03) and PROMIS-PF (RE=1.08). However, PROMIS-PF was overall the least responsive. CONCLUSIONS In patients at 6 months postoperatively from hip arthroscopy for FAIS, iHOT-12 was the most responsive and had the largest effect size. In contrast, PROMIS-PF had a lower effect size compared with legacy hip-specific PROMs. Additionally, PROMIS-PF did not correlate as well with iHOT-12 compared with HOS-SS. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Jonathan Rasio
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health Center, Detroit, Michigan, U.S.A
| | - Spencer W Sullivan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health Center, Detroit, Michigan, U.S.A
| | - Shane J Nho
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
24
|
Horn ME, Reinke EK, Couce LJ, Reeve BB, Ledbetter L, George SZ. Reporting and utilization of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures in orthopedic research and practice: a systematic review. J Orthop Surg Res 2020; 15:553. [PMID: 33228699 PMCID: PMC7684926 DOI: 10.1186/s13018-020-02068-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information SystemⓇ (PROMISⓇ) is a dynamic system of psychometrically sound patient-reported outcome (PRO) measures. There has been a recent increase in the use of PROMIS measures, yet little has been written about the reporting of these measures in the field of orthopedics. The purpose of this study was to conduct a systematic review to determine the uptake of PROMIS measures across orthopedics and to identify the type of PROMIS measures and domains that are most commonly used in orthopedic research and practice. METHODS We searched PubMed, Embase, and Scopus using keywords and database-specific subject headings to capture orthopedic studies reporting PROMIS measures through November 2018. Our inclusion criteria were use of PROMIS measures as an outcome or used to describe a population of patients in an orthopedic setting in patients ≥ 18 years of age. We excluded non-quantitative studies, reviews, and case reports. RESULTS Our final search yielded 88 studies published from 2013 through 2018, with 57% (50 studies) published in 2018 alone. By body region, 28% (25 studies) reported PROMIS measures in the upper extremity (shoulder, elbow, hand), 36% (32 studies) reported PROMIS measures in the lower extremity (hip, knee, ankle, foot), 19% (17 studies) reported PROMIS measures in the spine, 10% (9 studies) reported PROMIS measures in trauma patients, and 6% (5 studies) reported PROMIS measures in general orthopedic patients. The majority of studies reported between one and three PROMIS domains (82%, 73 studies). The PROMIS Computerized Adaptive Test (CAT) approach was most commonly used (81%, 72 studies). The most frequently reported PROMIS domains were physical function (81%, 71 studies) and pain interference (61%, 54 studies). CONCLUSION Our review found an increase in the reporting of PROMIS measures over the recent years. Utilization of PROMIS measures in orthopedic populations is clinically appropriate and can facilitate communication of outcomes across different provider types and with reduced respondent burden. REGISTRATION The protocol for this systematic review was designed in accordance with the PRISMA guidelines and is registered with the PROSPERO database (CRD42018088260).
Collapse
Affiliation(s)
- Maggie E Horn
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA
| | - Logan J Couce
- University of Utah Orthopaedic Center, University of Utah Health, Salt Lake City, UT, USA
| | - Bryce B Reeve
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Duke University, Durham, NC, USA
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA
| |
Collapse
|
25
|
Lu Y, Beletsky A, Nwachukwu BU, Patel BH, Okoroha KR, Verma N, Cole B, Forsythe B. Performance of PROMIS Physical Function, Pain Interference, and Depression Computer Adaptive Tests Instruments in Patients Undergoing Meniscal Surgery. Arthrosc Sports Med Rehabil 2020; 2:e451-e459. [PMID: 33134980 PMCID: PMC7588601 DOI: 10.1016/j.asmr.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 04/23/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare the performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PIF), and depression computer adaptive tests (CAT) relative to legacy instruments in patients undergoing meniscal surgery. Methods Patients scheduled to undergo meniscal surgery completed legacy knee function PROMs (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] subscores), Marx Activity Rating Scale (MARS), Veterans-Rand 12 (VR12), Short Form 12 (SF12), and the Brief Resilience Scale (BRS) alongside PROMIS PF, PIF, and Depression preoperatively. Spearman rank correlations were calculated, and score distributions were examined for floor and ceiling effects. Results 152 patients (46.6 ± 14.9 years, 67.1% male) completed PROMs for appropriate inclusion. PROMIS PF yielded high-moderate to high correlations with the IKDC and KOOS subscales (r = 0.61 to 0.73), demonstrating similar performance to the IKDC. PROMIS PIF demonstrated moderately high-moderate to high correlations with the IKDC, KOOS subscales, VR-12 Physical Component Score (PCS), and SF12 PCS (r = 0.62 to 0.71), performing comparably to KOOS Pain (r = 0.55 to 0.92). PROMIS Depression demonstrated moderate to high-moderate correlations with the mental health legacies (r = 0.46 to 0.66). Significant ceiling effects were observed for MARS (n = 29, 18.8%), and significant floor effects were exhibited by PROMIS Depression (n = 38, 25%) and MARS (n = 27, 17.6%). Conclusion The PROMIS PF, PIF CAT, and Depression instruments exhibit comparable performance profiles relative to legacy knee PROMs. PROMIS PF and PIF demonstrated no floor and ceiling effects, whereas PROMIS Depression exhibited a significant relative floor effect. PROMIS PF and PIF may be appropriately used to establish functional baselines preoperatively. Level of Evidence IV, diagnostic case series.
Collapse
Affiliation(s)
- Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U. Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bhavik H. Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kelechi R. Okoroha
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Brian Forsythe, MD, Midwest Orthopaedics at Rush, Division of Sports Medicine, 1611 W Harrison St, Chicago, IL 60612, U.S.A.
| |
Collapse
|
26
|
Cross-Cultural Adaptation and Validation of the Romanian Marx Activity Rating Scale for Anterior Cruciate Ligament Reconstruction. Healthcare (Basel) 2020; 8:healthcare8030318. [PMID: 32899598 PMCID: PMC7551582 DOI: 10.3390/healthcare8030318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
AIM We aimed to translate, cross-cultural adapt and validate the Marx activity rating scale (MARS) of the knee for Romanian patients with anterior cruciate ligament (ACL) injury. METHOD The original English form was translated according to guidelines. We included patients with ACL injury undergoing reconstruction in two centers over 3 years. Subjects completed the translated MARS, International Knee Documentation Committee (IKDC) subjective knee form and EuroQol EQ5D. The examining physician completed the Tegner Lysholm scale as an objective evaluation. Re-testing was obtained after one month. We used Spearman`s correlation to evaluate construct validity and reproducibility, Cronbach's alpha for internal consistency and intraclass correlation for test-retest reliability. RESULTS We collected valid forms from 99 patients (32.1 ± 8.8 years, 64.6% males) during the preoperative evaluation and 45 were re-tested. Significant, very good correlations were found between the MARS and Tegner Lysholm (Spearman's r = 0.712, p < 0.0001) and IKDC (Spearman's r = 0.801, p < 0.0001). Cronbach's alpha was 0.893 at the initial completion and 0.799 at re-test. The intraclass correlation coefficient was 0.895. CONCLUSIONS The Romanian-translated MARS is a valid, consistent and reliable physical activity outcome measure in patients with anterior cruciate ligament reconstruction.
Collapse
|
27
|
Nwachukwu BU, Beletsky A, Naveen N, Southworth TM, Okoroha KR, Forsythe B, Verma N, Yanke A, Cole BJ. Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments Correlate Better With Legacy Measures in Knee Cartilage Patients at Postoperative Than at Preoperative Assessment. Arthroscopy 2020; 36:1419-1428. [PMID: 32035174 DOI: 10.1016/j.arthro.2020.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/13/2019] [Accepted: 01/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To define the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression computer adaptive tests (CATs) in patients undergoing knee cartilage surgical procedures. METHODS The PROMIS PF, PI, and Depression CATs were administered preoperatively and at 6 months alongside legacy knee patient-reported outcome measures (PROMs) in patients undergoing knee cartilage surgical procedures. Statistical analysis consisted of the time to completion, psychometric analysis for correlative strengths, absolute and relative floor and ceiling effects, and Cohen effect size. RESULTS Our study included 250 patients (57.2% male patients), averaging 1.87, 1.53, and 1.91 minutes for completion of the PF, PI, and Depression CATs, respectively. Preoperatively, the PROMIS PF and PI CATs showed wide ranges of correlation coefficients with respect to function (r = 0.14-0.72 and r = 0.29-0.77, respectively) and health-related quality-of-life PROMs (r = 0.64-0.70). At 6 months, the PROMIS PF CAT (r = 0.82-0.93) and PI CAT (r = 0.77-0.93) both exhibited excellent correlations with respect to legacy function and health-related quality-of-life PROMs except for the Marx Activity Rating Scale (r = 0.36-0.44). None of the PROMIS instruments exhibited any significant floor or ceiling effects. CONCLUSIONS The PROMIS PF, PI, and Depression CATs performed better with respect to legacy PROMs in the postoperative period than the preoperative period. In addition, the PROMIS PF and PI measures performed best with respect to the International Knee Documentation Committee questionnaire, and no floor or ceiling effects were identified for the PROMIS instruments. The PROMIS instruments may be more suited to track outcomes postoperatively than to establish preoperative baselines in cartilage surgery patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Neal Naveen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Taylor M Southworth
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kelechi R Okoroha
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Adam Yanke
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
28
|
Hajewski CJ, Baron JE, Glass NA, Duchman KR, Bollier M, Wolf BR, Westermann RW. Performance of the Patient-Reported Outcome Measurement Information System in Patients With Patellofemoral Instability. Orthop J Sports Med 2020; 8:2325967120915540. [PMID: 32341932 PMCID: PMC7175058 DOI: 10.1177/2325967120915540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The Patient-Reported Outcome Measurement Information System (PROMIS) was developed to improve patient-reported outcome measures (PROMs) and administration through a computer adaptive test (CAT). The PROMIS physical function-CAT (PF-CAT) has not been investigated in patients with patellofemoral instability (PFI). Purpose/Hypothesis: The purpose of this study was to evaluate the construct validity of the PROMIS PF-CAT with previously validated tools for measuring PROMs in patients with a diagnosis of PFI. We hypothesized that the PF-CAT will have the strongest correlations with other PROMs that evaluated PF as well as moderate correlations with PROMs that measured other health domains. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients enrolled in this study who underwent operative intervention for PFI completed the following evaluations preoperatively: PROMIS PF-CAT, 36-Item Short Form Health Survey (SF-36), Knee injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5 dimensions (EQ-5D), and Kujala Anterior Knee Pain Scale (AKPS). Correlation coefficients and the percentage of patients achieving the highest and lowest possible outcome score of each instrument were calculated to assess floor and ceiling effects. Statistical significance was defined as P < .05. Results: In total, 91 participants (63.7% females; mean age, 20.1 ± 7.2 years) completed the questionnaires. PF-CAT had the lowest number of questions (4.3 ± 1.1). The strongest correlations were between the PF-CAT and SF-36 PF subscale (r = 0.78; P < .01), AKPS (r = 0.68; P < .01), and KOOS Activities of Daily Living subscale (r = 0.68; P < .01). Correlation was moderate between the PF-CAT and the KOOS subscales of Sports/Recreation (r = 0.58; P < .01), Quality of Life (r = 0.53; P < .01), and Symptoms (r = 0.47; P < .01). The PROMIS PF-CAT demonstrated no floor or ceiling effects. Conclusion: In patients with PFI, construct validity of the PROMIS PF-CAT was supported by strong correlations demonstrated between the PF-CAT and PROMs evaluating PF and moderate correlations with those assessing other health domains. Our results demonstrated a low respondent burden and no floor or ceiling effects associated with the PROMIS PF-CAT. The PROMIS PF-CAT may be considered a beneficial alternative to previously established PF PROMs for preoperative evaluation of patients with PFI.
Collapse
Affiliation(s)
- Christina J Hajewski
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jacqueline E Baron
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kyle R Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Matthew Bollier
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian R Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
29
|
Gulledge CM, Lizzio VA, Smith DG, Guo E, Makhni EC. What Are the Floor and Ceiling Effects of Patient-Reported Outcomes Measurement Information System Computer Adaptive Test Domains in Orthopaedic Patients? A Systematic Review. Arthroscopy 2020; 36:901-912.e7. [PMID: 31919023 DOI: 10.1016/j.arthro.2019.09.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review to answer the following: (1) What are the floor and ceiling (F/C) effects of the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) domains of physical function (PF), upper extremity physical function (UE), pain interference (PI), and depression (D) in adult orthopaedic patients? (2) Do the PROMIS-PF and PROMIS-PI domains have differing F/C effects depending on use in upper extremity, lower extremity, spine, neck, and back, or trauma patients?. METHODS (Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed, the review was registered on PROSPERO, and the methodological index for non-randomized studies was used for this systematic review. Studies reporting the F/C effects of at least 1 of 4 PROMIS CAT domains in orthopaedic patient cohorts accessed through PubMed and Embase on October 30, 2018, were included. F/C effects for each study were reported within forest plots. RESULTS Forty-three studies were included. Generally, varying cohorts demonstrated no F/C effects for PROMIS-PF (0%-9.0%), variable ceiling effects for PROMIS-UE (lower in v2.0; 0%-28.2%), variable floor effects for PROMIS-PI (0%-19.0%), and significant floor effects for PROMIS-D (0.4%-23.4%). CONCLUSIONS The orthopaedic literature demonstrated generally favorable floor and ceiling effects for PROMIS CAT domains, with the exception of variable ceiling effects for PROMIS-UE (the newer version exhibits only minor effects), variable floor effects for PROMIS-PI, and significant floor effects for PROMIS-D. In addition, the F/C effects of PROMIS-PF did not vary based on patient population. Although the floor effects of PROMIS-PI did vary based on patient population, the variability does not appear to be based solely on anatomic location. The PROMIS-PF and PROMIS-UE v2.0 demonstrate consistently low floor and ceiling effects. However, the PROMIS-PI and PROMIS-D may need modification before widespread adoption for clinical and research purposes. LEVEL OF EVIDENCE III; systematic review of Level I-III studies.
Collapse
Affiliation(s)
- Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Vincent A Lizzio
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - D Grace Smith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Eric Guo
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
| |
Collapse
|
30
|
Shamrock AG, Wolf BR, Ortiz SF, Duchman KR, Bollier MJ, Carender CN, Westermann RW. Preoperative Validation of the Patient-Reported Outcomes Measurement Information System in Patients With Articular Cartilage Defects of the Knee. Arthroscopy 2020; 36:516-520. [PMID: 31901394 DOI: 10.1016/j.arthro.2019.08.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To validate the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive test (PF CAT) with current patient-reported outcome (PRO) instruments in patients with cartilage injuries of the knee. METHODS Patients scheduled for osteochondral autograft or allograft transplant, microfracture, autologous chondrocyte implantation, allograft cartilage resurfacing, and chondroplasty were prospectively enrolled in the study and completed PROMIS PF CAT, Knee Injury and Osteoarthritis Outcome Score (KOOS activities of daily living, pain, symptoms, sport, and quality of life), Short Form-36 Health Survey (SF-36 physical function [PF] and Physical Component Summary), and EuroQol-5 Dimension questionnaires. The Spearman correlation coefficient was used to compare instruments. Instrument correlations were defined as excellent (>0.7), excellent to good (0.61-0.69), good (0.4 to 0.6), and poor (<0.39), with significance defined as P < .05. RESULTS A total of 293 knees in 275 patients (54.5% male) undergoing 319 cartilage procedures were analyzed. The most commonly performed cartilage procedure was chondroplasty (n = 118; 37.0%), followed by microfracture (n = 100; 31.3%). The mean age was 34.0 ± 14.7 and the mean body mass index was 30.0 ± 6.9. The PROMIS PF CAT had an excellent correlation with the SF-36 PF (r = 0.819; P < .001), SF-36 Physical Component Summary (r = 0.766; P < .001), KOOS activities of daily living (r = 0.733; P < .001), KOOS Sport (r = 0.709; P < .001), and EuroQol-5 Dimension (r = 0.752; P < .001) instruments; an excellent-good correlation with the KOOS pain (r = 0.662; P < .001), and KOOS quality of life (r = 0.640; P < .001) scores; and a good correlation with the KOOS symptoms (r = 0.519; P < .001) scale. The PROMIS PF CAT had no floor or ceiling effects and the smallest question burden (mean 4.17 ± 0.93 questions). Dimensionality analyses demonstrated that the smallest amount of unexplained variance was present in the PROMIS PF CAT (3.6%). CONCLUSION The PROMIS PF CAT is an effective tool for preoperative outcome assessment in patients with cartilage defects of the knee. It correlates strongly with legacy PRO measures of physical function with no ceiling and floor effects and a minimal time burden for completion. Further study is warranted to determine postoperative performance and to evaluate the responsiveness of PROMIS to change within a patient. LEVEL OF EVIDENCE III; Prognostic retrospective comparative study.
Collapse
Affiliation(s)
- Alan G Shamrock
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Shannon F Ortiz
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Kyle R Duchman
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Matthew J Bollier
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Christopher N Carender
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Robert W Westermann
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
31
|
Franovic S, Gulledge CM, Kuhlmann NA, Williford TH, Chen C, Makhni EC. Establishing "Normal" Patient-Reported Outcomes Measurement Information System Physical Function and Pain Interference Scores: A True Reference Score According to Adults Free of Joint Pain and Disability. JB JS Open Access 2019; 4:e0019. [PMID: 32043056 PMCID: PMC6959908 DOI: 10.2106/jbjs.oa.19.00019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Numerous recent studies have demonstrated the validity and efficiency of the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) forms in patients undergoing orthopaedic surgical procedures. It is assumed that a score of 50 in each domain represents the health state of a “reference” population, but this threshold has not been definitively proven. In order to truly assess whether a given orthopaedic intervention is successful, the comparative scores of healthy individuals must be known for any given health domain measured. Therefore, the purpose of this study was to determine baseline scores for the PROMIS general physical function (PROMIS-PF), pain interference (PROMIS-PI), and upper-extremity physical function (PROMIS-UE) domains in physically healthy, asymptomatic adult individuals. We hypothesized that, in individuals <40 years old, the mean PROMIS-PF and PROMIS-UE scores would be >50 and PROMIS-PI scores would be <50. We further hypothesized that these scores would be impacted by participant age.
Collapse
Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Noah A Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Tyler H Williford
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Chaoyang Chen
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
32
|
Gulledge CM, Smith DG, Ziedas A, Muh SJ, Moutzouros V, Makhni EC. Floor and Ceiling Effects, Time to Completion, and Question Burden of PROMIS CAT Domains Among Shoulder and Knee Patients Undergoing Nonoperative and Operative Treatment. JB JS Open Access 2019; 4:JBJSOA-D-19-00015. [PMID: 32043052 PMCID: PMC6959920 DOI: 10.2106/jbjs.oa.19.00015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) have emerged as an efficient technique for measuring patient-reported outcomes among orthopaedic patients. The purpose of this study was to investigate the floor and ceiling (F/C) effects, time to completion (TTC), and question burden of PROMIS CATs administered to patients presenting to a shoulder and sports medicine orthopaedic clinic.
Collapse
Affiliation(s)
- Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - D Grace Smith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Alexander Ziedas
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
33
|
Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release. Clin Orthop Relat Res 2019; 477:2544-2551. [PMID: 31107341 PMCID: PMC6903856 DOI: 10.1097/corr.0000000000000773] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Patient-reported Outcome Measurement Information System (PROMIS) continues to be an important universal patient-reported outcomes measure (PROM) in orthopaedic surgery. However, there is concern about the performance of the PROMIS as a general health questionnaire in hand surgery compared with the performance of region- and condition-specific PROMs such as the Michigan Hand Questionnaire (MHQ) and the Boston Carpal Tunnel Questionnaire (BCTQ), respectively. To ensure that PROMIS domains capture patient-reported outcomes to the same degree as region- and condition-specific PROMs do, comparing PROM performance is necessary. QUESTIONS/PURPOSES (1) Which PROMs demonstrate high responsiveness among patients undergoing carpal tunnel release (CTR)? (2) Which of the PROMIS domains (Physical Function [PF], Upper Extremity [UE], and Pain Interference [PI]) demonstrate concurrent validity with the HHQ and BCTQ domains? METHODS In this prospective study, between November 2014 and October 2016, patients with carpal tunnel syndrome visiting a single surgeon who elected to undergo CTR completed the BCTQ, MHQ, and PROMIS UE, PF, and PI domains at each visit. A total of 101 patients agreed to participate. Of these, 31 patients (31%) did not return for a followup visit at least 6 weeks after CTR and were excluded, leaving a final sample of 70 patients (69%). We compared the PROMIS against region- and condition-specific PROMs in terms of responsiveness and concurrent validity. Responsiveness was determined using Cohen's d or the effect-size index (ESI). The larger the absolute value of the ESI, the greater the effect size. Using the ESI allows surgeons to better quantify the impact of CTR, with a medium ESI (that is, 0.5) representing a visible clinical change to a careful observer. Concurrent validity was determined using Spearman's correlation coefficient with correlation strengths categorized as excellent (> 0.7), excellent-good (0.61-0.70), good (0.4-0.6), and poor (< 0.4). Significance was set a priori at p < 0.05. RESULTS Among PROMIS domains, the PI demonstrated the best responsiveness (ESI = 0.74; 95% CI, 0.39-1.08), followed by the UE (ESI = -0.66; 95% CI, -1.00 to -0.31). For the MHQ, the Satisfaction domain had the largest effect size (ESI = -1.48; 95% CI, -1.85 to -1.09), while for the BCTQ, the Symptom Severity domain had the best responsiveness (ESI = 1.54; 95% CI, 1.14-1.91). The PROMIS UE and PI domains demonstrated excellent-good to excellent correlations to the total MHQ and BCTQ-Functional Status scores (preoperative UE to MHQ: ρ = 0.68; PI to MHQ: ρ = 0.74; UE to BCTQ-Functional Status: ρ = 0.74; PI to BCTQ-Functional Status: ρ = 0.67; all p < 0.001), while the PROMIS PF demonstrated poor correlations with the same domains (preoperative PF to MHQ; ρ = 0.33; UE to BCTQ-Functional Status: ρ = 0.39; both p < 0.01). CONCLUSIONS The PROMIS UE and PI domains demonstrated slightly worse responsiveness than the MHQ and BCTQ domains that was nonetheless acceptable. The PROMIS PF domain was unresponsive. All three PROMIS domains correlated with the MHQ and BCTQ, but the PROMIS UE and PI domains had notably stronger correlations to the MHQ and BCTQ domains than the PF domain did. We feel that the PROMIS UE and PI can be used to evaluate the clinical outcomes of patients undergoing CTR, while also providing more robust insight into overall health status because they are general PROMs. However, we do not recommend the PROMIS PF for evaluating patients undergoing CTR. LEVEL OF EVIDENCE Level II, diagnostic study.
Collapse
|
34
|
Trasolini NA, Korber S, Gipsman A, San AE, Weber AE, Hatch GFR. Performance of PROMIS Computer Adaptive Testing As Compared With Established Instruments for Multiple-Ligament Knee Injuries. Orthop J Sports Med 2019; 7:2325967119867419. [PMID: 31523692 PMCID: PMC6728687 DOI: 10.1177/2325967119867419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS)
computer adaptive testing (CAT) is a patient-reported outcome metric that
has been validated for anterior cruciate ligament (ACL) injuries, ACL
reconstructions, and meniscal injuries. Thus far, the system has not been
validated for multiligament knee injuries. The Multiligament Quality of Life
(MLQOL) questionnaire is a validated, disease-specific patient-reported
outcome instrument for this population that can serve as a gold standard for
validation of the newer PROMIS. Purpose/Hypothesis: The purpose of this study was to further validate the PROMIS CAT for
multiligament knee reconstruction. We hypothesized that the PROMIS CAT
modules would correlate with the Lysholm knee score (Lysholm), Tegner
activity scale (Tegner), and MLQOL for postoperative multiligamentous knee
injury patients and that the PROMIS CAT would use fewer question items than
the Lysholm, Tegner, and MLQOL while still avoiding floor and ceiling
effects. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 30 patients meeting the inclusion criteria were retrospectively
identified and agreed to participate (87% male; mean ± SD age, 36.3 ± 13.5
years). Consenting patients were administered the Lysholm, Tegner, MLQOL,
and PROMIS CAT for Physical Function, Mobility, and Pain Interference.
Spearman correlations were used to test agreement across survey instruments.
Floor and ceiling effects were assessed for all instruments. Results: PROMIS Pain Interference had excellent correlation with MLQOL Activity
Limitations (r = 0.71, P < .0001).
Excellent-good correlations were detected between PROMIS Physical Function
and MLQOL Activity Limitations (r = –0.63,
P = .0002) and PROMIS Mobility and MLQOL Activity
Limitations (r = –0.62, P < .0002).
Good correlations were found between the Lysholm and the PROMIS Physical
Function and PROMIS Mobility (for each, r = 0.50,
P = .005). Additional correlations were present with
other subsections. There were no floor or ceiling effects for the PROMIS CAT
instrument in any category. Conclusion: The PROMIS CAT correlates well with existing outcome measures for
multiligament knee injury patients without floor or ceiling effects. The
PROMIS CAT is a concise adjunct to the validated injury-specific outcome
tool for multiligament knee injury. Surgeons should consider implementing
the PROMIS CAT because of its broad validity, including ACL injuries,
meniscal tears, and now multiligament knee injuries.
Collapse
Affiliation(s)
- Nicholas A Trasolini
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shane Korber
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aaron Gipsman
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Austin E San
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexander E Weber
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - George F Rick Hatch
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
35
|
Rothrock NE, Kaat AJ, Vrahas MS, OʼToole RV, Buono SK, Morrison S, Gershon RC. Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity. J Orthop Trauma 2019; 33:377-383. [PMID: 31085947 DOI: 10.1097/bot.0000000000001493] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the reliability, convergent validity, known-groups validity, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Computer Adaptive Test (CAT) and PROMIS Physical Function 8a Short Form. DESIGN Prospective cohort study. SETTING Two Level-I trauma centers. PATIENTS Eligible adults with an isolated lower extremity trauma injury receiving treatment were approached consecutively (n = 402 consented at time 1, median = 80 days after treatment). After 6 months, 122 (30.3%) completed another assessment. INTERVENTION Cross-sectional and longitudinal monitoring of patients. MAIN OUTCOME MEASUREMENTS Floor and ceiling effects, reliability (marginal reliability and Cronbach's alpha), convergent validity, known-groups discriminant validity (weight-bearing status and fracture severity), and responsiveness (Cohen's d effect size) were evaluated for the PROMIS Mobility CAT, PROMIS Physical Function 8a Short Form, and 5 other measures of physical function. RESULTS PROMIS PFSF8a and Foot and Ankle Ability Measure Activities of Daily Living Index had ceiling effects. Both PROMIS measures demonstrated excellent internal consistency reliability (mean marginal reliability 0.94 and 0.96; Cronbach's alpha = 0.96). Convergent validity was supported by high correlations with other measures of physical function (r = 0.70-0.87). Known-groups validity by weight-bearing status and fracture severity was supported as was responsiveness (Mobility CAT effect size = 0.81; Physical Function Short Form 8a = 0.88). CONCLUSIONS The PROMIS Mobility CAT and Physical Function 8a Short Form demonstrated reliability, convergent and known-groups discriminant validity, and responsiveness in a sample of patients with a lower extremity orthopaedic trauma injury.
Collapse
Affiliation(s)
- Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Mark S Vrahas
- Department of Orthopaedics, Cedars Sinai Medical Center, Los Angeles, CA
| | - Robert V OʼToole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Sarah K Buono
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Suzanne Morrison
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| |
Collapse
|
36
|
Cheung EC, Moore LK, Flores SE, Lansdown DA, Feeley BT, Zhang AL. Correlation of PROMIS with Orthopaedic Patient-Reported Outcome Measures. JBJS Rev 2019; 7:e9. [DOI: 10.2106/jbjs.rvw.18.00190] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
37
|
Nwachukwu BU, Beck EC, Chapman R, Chahla J, Okoroha K, Nho SJ. Preoperative Performance of the PROMIS in Patients Undergoing Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome. Orthop J Sports Med 2019; 7:2325967119860079. [PMID: 31384620 PMCID: PMC6664637 DOI: 10.1177/2325967119860079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is
being increasingly evaluated for use in orthopaedic surgery. The performance
of the PROMIS in patients undergoing hip preservation surgery is
unknown. Purpose: To investigate the psychometric performance of the PROMIS compared with
legacy patient-reported outcome measures (PROMs) in patients indicated for
hip arthroscopic surgery for femoroacetabular impingement syndrome
(FAIS). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data from consecutive patients who underwent primary hip arthroscopic surgery
between January and October 2018 for the treatment of FAIS were collected
and analyzed. Baseline data, including preoperative PROM scores and
demographics, were recorded. PROMs included the PROMIS Physical Function
(PF), the Hip Outcome Score (HOS), the modified Harris Hip Score (mHHS), the
International Hip Outcome Tool–12 (iHOT-12), and the Veterans RAND 12-item
health survey (VR-12). Pearson and Spearman coefficient analyses were used
to identify correlations between continuous and noncontinuous variables,
respectively. Correlation was defined as excellent (>0.80), very good
(0.71-0.80), good (0.61-0.70), fair (0.41-0.60), or poor (0.21-0.40). A
multivariate linear regression analysis was used to identify preoperative
predictors of having higher preoperative PROMIS scores. Results: A total of 197 patients with a mean age and body mass index (BMI) of 32.8 ±
12.6 years and 25.7 ± 5.6 kg/m2, respectively, were included in
the final analysis. There were no ceiling or floor effects for the PROMIS PF
score observed in the study group. With regard to hip-specific measures,
PROMIS PF scores demonstrated excellent correlation with HOS–Activities of
Daily Living (r = 0.801; P < .001)
scores, very good correlation with mHHS (r = 0.721;
P < .001) and iHOT-12 (r = 0.722;
P < .001) scores, and good correlation with
HOS–Sports Specific (r = 0.675; P <
.001) scores. With regard to general health–related quality of life (HRQoL)
measures, PROMIS PF scores demonstrated very good correlation with VR-12
mental (r = 0.721; P < .001) scores,
good correlation with VR-12 physical (r = 0.618;
P < .001) scores, and poor correlation with visual
analog scale for pain (r = –0.365; P <
.001) scores. Patients who reported being physically active were more likely
to have a higher preoperative PROMIS score (β = 3.216; P =
.004). Lower PROMIS scores were found in patients with a higher BMI (β =
–0.236; P = .005) and in female patients (β = –2.608;
P = .014). Conclusion: In patients with FAIS, the preoperative PROMIS PF scores demonstrated
excellent to good correlation with legacy hip-specific instruments as well
as with HRQoL measures. No ceiling or floor effects were identified.
Notably, of the hip-specific PROMs administered, the PROMIS PF demonstrated
the weakest correlation with the HOS–Sports Specific subscale. Physical
activity, BMI, and sex were predictors of preoperative PROMIS scores in our
patient population.
Collapse
Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Reagan Chapman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kelechi Okoroha
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
38
|
Carender CN, Bollier MJ, Wolf BR, Duchman KR, An Q, Westermann RW. Preoperative Performance of PROMIS in Patients With Patellofemoral Malalignment and Chondral Disease. Orthop J Sports Med 2019; 7:2325967119855001. [PMID: 31317048 PMCID: PMC6620728 DOI: 10.1177/2325967119855001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument has not yet been validated in patients undergoing operative treatment for patellofemoral malalignment and chondral disease. PURPOSE To evaluate the PROMIS Physical Function Computer Adaptive Testing (PF CAT) instrument in a population of patients with patellofemoral malalignment and chondral disease relative to established patient-reported outcome (PRO) instruments. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Eligible patients were prospectively enrolled at the time of indication for surgery and completed 5 PRO instruments preoperatively: 36-Item Short Form Health Survey (SF-36); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); Marx activity rating scale (Marx); EuroQol 5-dimension, 5-level instrument (EQ-5D-5L); and PROMIS PF CAT. Convergent and discriminant validity was assessed by measuring correlations between PROMIS PF CAT and other PRO instruments, including the Knee injury and Osteoarthritis Outcome Score (KOOS). Strength of correlation was measured by use of Spearman correlation coefficients. RESULTS In total, 37 patients (40 knees) were enrolled in the study. All knees underwent Fulkerson osteotomy and concomitant cartilage procedure (29 chondroplasty, 6 allograft, 5 microfracture). Mean patient age was 33.4 years, and 73% of knees were in female patients. Correlations (r) between PROMIS PF CAT and knee PRO instruments were as follows: SF-36 PF (r = 0.80; P < .01); KOOS Pain (r = 0.74; P < .01); KOOS Symptoms (r = 0.47; P < .01); KOOS Quality of Life (r = 0.68; P < .01); KOOS Sports and Recreation (r = 0.72; P < .01); KOOS Activities of Daily Living (ADL) (r = 0.80; P < .01); WOMAC Function (r = 0.80; P < .01); WOMAC Pain (r = 0.72; P < .01); WOMAC Stiffness (r = 0.38; P = .02); Marx (r = 0.22; P = .31); and EQ-5D-5L (r = 0.72; P < .01). Neither floor nor ceiling effects were observed in PROMIS PF CAT or KOOS ADL. Mean (±SD) question burden with PROMIS PF CAT was 5.6 ± 0.6 questions. CONCLUSION In patients with patellofemoral malalignment and chondral disease, PROMIS PF CAT is an efficient and reliable PRO instrument to preoperatively assess patients across a spectrum of knee function without floor or ceiling effects.
Collapse
Affiliation(s)
- Christopher N. Carender
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| | - Matthew J. Bollier
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| | - Kyle R. Duchman
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| | - Qiang An
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| | - Robert W. Westermann
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, USA
| |
Collapse
|