Leveraging pediatric PROMIS item banks to assess physical functioning in children at risk for severe functional loss

A post pandemic roadmap toward remote assessment for neuromuscular disorders: limitations and opportunities

Recent advances in technology and expanding therapeutic opportunities in neuromuscular disorders has resulted in greater interest in and development of remote assessments. Over the past year, the rapid and abrupt COVID-19 shutdowns and stay-at-home orders imposed challenges to routine clinical management and clinical trials. As in-person services were severely limited, clinicians turned to remote assessments through telehealth to allow for continued care. Typically, disease-specific clinical outcome assessments (COAs) for neuromuscular disorders (NMD) are developed over many years through rigorous and iterative processes to fully understand their psychometric properties. While efforts were underway towards developing remote assessments for NMD before the pandemic, few if any were fully developed or validated. These included assessments of strength, respiratory function and patient-reported outcomes, as well as wearable technology and other devices to quantify physical activity and function. Without many choices, clinicians modified COAs for a virtual environment recognizing it was not yet known how they compared to standard in-person administration. Despite being able to quickly adapt to the demands of the COVID-19 pandemic, these experiences with remote assessments uncovered limitations and opportunities. It became clear that existing COAs required modifications for use in a virtual environment limiting the interpretation of the information gathered. Still, the opportunity for real-world evaluation and reduced patient burden were clear benefits to remote assessment and may provide a more robust understanding and characterization of disease impact in NMD. Hence, we propose a roadmap navigating an informed post-pandemic path toward development and implementation of safe and successful use of remote assessments for patients with NMD.

Correlation Between the PROMIS Pediatric Mobility Instrument and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)

BACKGROUND

Patient-reported outcome measures (PROMs) are an important resource for clinicians wishing to provide high-quality, patient-centered care. Finding PROMs to use in a pediatric clinical practice that are reliable, age appropriate, succinct, and not redundant is challenging.

QUESTIONS/PURPOSES

We sought to determine the degree of correlation between two pediatric PROMs, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) and the PROMIS Pediatric Mobility (PROMIS PM) instrument, when administered at patients' initial visit. We hypothesized that there would be a positive correlation between the two questionnaires because of their focus on physical function.

METHODS

We conducted a retrospective cross-sectional review of 294 pediatric patients (mean age, 13.7 years) with localized lower-extremity joint pathologies at our high-volume urban pediatric sports practice. The patients had been asked to complete both PROMs on a computerized platform.

RESULTS

We found a positive and statistically significant-albeit modest-correlation between the scores obtained on the HSS Pedi-FABS and the PROMIS PM. Neither instrument significantly correlated with patient age, nor were floor and ceiling effects observed.

CONCLUSION

The study shows that although both PROM instruments provide valuable information about pediatric physical function, they are not redundant because they measure slightly different constructs. Future studies should further investigate the correlation between these questionnaires in specific subpopulations of pediatric patients with lower-extremity pathology.

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Background:

The impact of osteochondritis dissecans (OCD) lesions of the knee on a child’s health-related quality of life has not previously been quantified. Preference-based health utility assessment allows patients to assign quality-of-life valuations (utilities) to different health states and conditions.

Purpose:

To determine (1) patient-reported utility scores for health states associated with pediatric OCD lesions of the knee and (2) whether these scores are associated with patient demographics or disease severity.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Children, adolescents, and young adults being treated for OCD of the knee were interviewed to assess utilities for each of the 6 health states commonly encountered in the treatment of OCD: (1) symptomatic lesion, (2) nonoperative rehabilitation, (3) postoperative rehabilitation, (4) intermediate treatment success, (5) early degenerative knee changes, and (6) successful treatment (asymptomatic). Patients were asked to assign health utilities to each state using a standardized feeling thermometer (scale, 0-100), which were converted to a health state utility (scale, 0-1 [1 = perfect health]). Utilities were reported with descriptive statistics, and comparative analyses were performed to test whether assignments were associated with patient age, sex, or whether the OCD lesion required surgical intervention.

Results:

A total of 100 participants treated or undergoing treatment for OCD were prospectively enrolled; 74% were male (n = 74). The median age at the time of survey was 15 years (interquartile range, 13-16.5 years). Utility scores were as follows: symptomatic OCD lesion, 0.15; nonoperative rehabilitation, 0.30; postoperative rehabilitation, 0.30; early degenerative changes, 0.58; intermediate treatment success, 0.65; and successful treatment, 1.0. Utility scores were not associated with age, sex, or whether the participant underwent surgical treatment for the OCD lesion.

Conclusion:

The current study quantified patient-reported utilities for 6 OCD lesion health states, which may be used for future health-related quality of life, decision analysis, and quality/safety/value studies. These utility scores were stable and not affected by patient age, sex, or treatment strategy.