Editorial Commentary: Patient-Reported Outcomes Measurement Information System (PROMIS) Is Important Part of Future Clinical Research

Can PROMIS measures be used to create subgroups for patients seeking orthopaedic care?

Aims

Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care.

Methods

This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety, Sleep Quality, Participation in Social Roles, and Fatigue) and Cohort #2 (n = 4,638; January 2019 to August 2019) included PROMIS Computer Adaptive Testing instruments for four domains (Physical Function, Pain Interference, Depression, and Sleep Quality). Cluster analysis (K-means method) empirically derived subgroups and subgroup differences in clinical and sociodemographic factors were identified with one-way analysis of variance.

Results

Cluster analysis yielded four subgroups with similar clinical characteristics in Cohort #1 and #2. The subgroups were: 1) Normal Function: within normal limits in Physical Function, Pain Interference, Depression, and Sleep Quality; 2) Mild Impairment: mild deficits in Physical Function, Pain Interference, and Sleep Quality but with Depression within normal limits; 3) Impaired Function, Not Distressed: moderate deficits in Physical Function and Pain Interference, but within normal limits for Depression and Sleep Quality; and 4) Impaired Function, Distressed: moderate (Physical Function, Pain Interference, and Sleep Quality) and mild (Depression) deficits.

Conclusion

These findings suggest orthopaedic patient subgroups differing in physical function, pain, and psychosocial distress can be created from as few as four different PROMIS measures. Longitudinal research is necessary to determine whether these subgroups have prognostic validity.

Cite this article: Bone Jt Open 2021;2(7):493–502.

Pain Is the Primary Factor Associated With Satisfaction With Symptoms for New Patients Presenting to the Orthopedic Clinic

PURPOSE

The purpose of the current study was to (1) determine the percentage of new orthopedic patients reporting their symptoms to be acceptable at presentation, as measured by the Patient Acceptable Symptom State (PASS) question, and (2) evaluate whether patient-reported outcome measures (PROMs), including Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) or Upper Extremity, Pain Interference (PI), and Depression (D), or sociodemographic factors are associated with acceptable symptoms at presentation.

METHODS

Between February 7, 2020, and March 16, 2020, new orthopedic patients who completed PROMs were identified. Patient records were reviewed for those who also completed the PASS question, a yes/no question about whether a patient's current symptom state is satisfactory. Bivariate analysis was conducted to compare patient characteristics, such as area deprivation index (ADI), between those reporting acceptable symptoms and those who did not. Multivariable logistic regression models were used to determine factors associated with acceptable symptoms at presentation.

RESULTS

A total of 570 patients were included, with one-fourth (n = 143 [25%]) reporting acceptable symptoms at presentation. In multivariable regression analysis, only pain, as measured by the PROMIS PI, was associated with acceptable symptoms at presentation (non-upper extremity patient regression: PROMIS PI: odds ratio [OR], 0.84; 95% confidence interval [CI], 0.79-0.90, P < .01; upper extremity patient regression: PROMIS PI: OR, 0.91; 95% CI, 0.85-0.98, P < .01). In both multivariable regression analyses, insurance type (private, Medicare, Medicaid, other), visit subspecialty (sports, hand, joints, foot and ankle, spine, other), PROMIS PF, PROMIS D, and national ADI were not associated with acceptable symptoms at presentation (all P > .05).

CONCLUSIONS

One-fourth of new orthopedic patients reported their symptoms to be acceptable at presentation. Of those who considered their symptom state unsatisfactory, pain-not functional status, mental health, or sociodemographic factors-was the primary determinant.

LEVEL OF EVIDENCE

Level III, diagnostic.