PROMIS Upper Extremity Underperforms Psychometrically Relative to American Shoulder and Elbow Surgeons Score in Patients Undergoing Primary Rotator Cuff Repair

Objectives: To examine the preoperative and postoperative performance of PROMIS Upper Extremity 2.0 across various orthopedic procedures for the upper extremity. Secondarily, to define susceptibility to pre- and post-operative floor and ceiling effects. Methods: Retrospective analysis of prospectively collected patient-reported outcome (PRO) data was conducted utilizing an electronic outcome registry for procedures between May 2017 and August 2018. Current procedural terminology (CPT) codes were utilized to examine cohorts for various upper extremity orthopedic procedures including Bankart repair and arthroscopic rotator cuff repair (ARCR). Shapiro-Wilks normality testing was used to assess score distributions for normalcy; given non-normal score distributions, Spearman correlation coefficients were calculated for preoperative patient-reported outcome (PRO) scores. Absolute floor and ceiling effects were calculated for each time point based on CPT code. Results: A total of 488 patients were included across Bankart repair (n=109, 29.3 + 12.5 years) and ARCR (n=379, 57.5 + 9.5 years) cohorts. In the Bankart repair cohort, PROMIS PI demonstrate strong correlations with ASES (r=-0.63), Constant (r=-0.75), PROMIS UE (r=-0.75), and the VR6D (r=-0.61). PROMIS Depression (r=0.23 vs. 0.17), SF12 MCS (r=0.34 vs. 0.11), and VR12 MCS (r=0.44 vs. 0.15) exhibited poor correlations with PROMIS PI and UE, respectively. In the ARCR cohort, PROMIS PI scores demonstrated a good correlation with PROMIS UE (r=0.61). Constant (r=0.58 vs. 0.67), VR12 PCS (r=0.58 vs. 0.47), and VR6D (r=0.67 vs. 0.53) exhibited good correlations with both PROMIS PI and UE measures, respectively. No significant absolute floor or ceiling effects were observed for the PROMIS instruments except PROMIS Depression; an absolute floor was noted for both Bankart (n=12, 30%) and ARCR (n=38, 14.7%) groups. Conclusions: PROMIS PI and UE instruments perform comparably to legacy outcome instruments in patients receiving Bankart repair, as well as those receiving ARCR. Furthermore, in both populations, the PROMIS Depression instrument exhibits absolute floor effects, whereas PROMIS PI and UE instruments fail to demonstrate any absolute floor or ceiling effects.

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Psychometric properties of visual analog scale assessments for function, pain, and strength compared with disease-specific upper extremity outcome measures in rotator cuff repair

JSES International ◽

10.1016/j.jseint.2020.04.012 ◽

2020 ◽

Vol 4 (3) ◽

pp. 619-624

Author(s):

Alexander Beletsky ◽

Benedict U. Nwachukwu ◽

Tomás Gorodischer ◽

Jorge Chahla ◽

Brian Forsythe ◽

...

Keyword(s):

Rotator Cuff ◽

Psychometric Properties ◽

Upper Extremity ◽

Outcome Measures ◽

Visual Analog Scale ◽

Rotator Cuff Repair ◽

Analog Scale ◽

Cuff Repair ◽

Disease Specific

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Establishing the Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, and Substantial Clinical Benefit of the PROMIS Upper Extremity Questionnaire After Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/0363546520964957 ◽

2020 ◽

Vol 48 (14) ◽

pp. 3439-3446

Author(s):

Eric D. Haunschild ◽

Ron Gilat ◽

Michael C. Fu ◽

Tracy Tauro ◽

Hailey P. Huddleston ◽

...

Keyword(s):

Rotator Cuff ◽

Upper Extremity ◽

Clinical Benefit ◽

Rotator Cuff Repair ◽

Minimal Clinically Important Difference ◽

Outcome Measure ◽

Clinically Important Difference ◽

Substantial Clinical Benefit ◽

Clinically Significant ◽

Cuff Repair

Background: The Patient-Reported Outcome Measurement Information System Upper Extremity (PROMIS UE) questionnaire has been validated as an effective and efficient outcome measure after rotator cuff repair (RCR). However, definitions of clinically significant outcomes used in interpreting this outcome measure have yet to be defined. Purpose: To define clinically significant outcomes of the PROMIS UE questionnaire in patients undergoing arthroscopic RCR. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We reviewed charts of consecutive patients undergoing RCR in our institution between 2017 and 2018 and included patients who were administered the PROMIS UE before surgery and 12 months after surgery. At 12 months postoperatively, patients were asked domain-specific anchor questions regarding their function and satisfaction after surgery, which were then used to determine the minimal clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), and substantial clinical benefit (SCB) using receiver operating characteristic and area under the curve (AUC) analysis. Univariate and multivariate logistic regression analysis was utilized to identify patient factors associated with clinically significant outcomes. Results: A total of 105 patients with RCR and minimum 12-month postoperative PROMIS UE were included in the analysis. The defined clinically significant outcomes were 4.87 for the MCID using a distribution-based method, 7.95 for the SCB (sensitivity, 0.708; specificity, 0.833; AUC, 0.760), and 39.00 for the PASS (sensitivity, 0.789; specificity, 0.720; AUC, 0.815). Among respondents, 79.0%, 62.9%, and 64.8% achieved the MCID, SCB, and PASS score thresholds, respectively. Workers’ compensation was negatively associated with achievement of the PASS. Lower preoperative PROMIS UE scores were associated with obtaining the MCID (odds ratio [OR], 0.871; P = .001) and the SCB (OR, 0.900; P = .040), whereas higher preoperative scores were predictive of achieving the PASS (OR, 1.111; P = .020). Conclusion: This study defines the clinically significant outcomes for the PROMIS UE after RCR, of which the majority of patients achieved the MCID, PASS, and SCB at 12 months after surgery. These thresholds should be considered in future study design and interpretation of PROMIS UE in patients with RCR.

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Uncomplicated Arthroscopic Rotator Cuff Repair in Chronic Ipsilateral Upper Extremity Lymphedema

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00290 ◽

2020 ◽

Vol 10 (4) ◽

pp. e20.00290

Author(s):

Zachary Schwartz ◽

B. Holt Zalneraitis ◽

Brian P. Milam ◽

Marc-Gregory Warhola ◽

Gregory Gasbarro ◽

...

Keyword(s):

Rotator Cuff ◽

Upper Extremity ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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CONCURRENT VALIDITY OF PATIENT RATING SCALES IN ASSESSMENT OF OUTCOME AFTER ROTATOR CUFF REPAIR

Journal of Musculoskeletal Research ◽

10.1142/s021895770000015x ◽

2000 ◽

Vol 04 (02) ◽

pp. 119-127 ◽

Cited By ~ 30

Author(s):

Tajedin Y. Getahun ◽

Joy C. MacDermid ◽

Stuart D. Patterson

Keyword(s):

Rotator Cuff ◽

Upper Extremity ◽

General Health ◽

Rotator Cuff Repair ◽

Concurrent Validity ◽

Worker's Compensation ◽

Worker’S Compensation ◽

Sf 36 ◽

Compensation Status ◽

Cuff Repair

The purpose of this study was to compare the concurrent validity of four questionnaires in the assessment of outcome after rotator cuff repair. Sixty-two patients, who were at least two years post-rotator-cuff repair, completed three upper extremity scales: the Western Ontario Rotator Cuff (WORC) index, the Disabilities of the Arm, Shoulder and Hand (DASH) and the Simple Shoulder Test (SST), and a measure of general health status (SF-36). Internal and external rotation ranges of motion and isometric strength were measured. Pearson correlations were used to evaluate the construct whereby scores should be related to the severity of measured impairments. One-way ANOVA was used to determine the ability of the questionnaires to discriminate between groups expected to have different outcomes based on measured impairment or worker's compensation status. The upper extremity questionnaires demonstrated similar response distributions and were highly correlated (0.88 < r < 0.91). The response distribution of the SF-36 was different from the other scales and its correlation with them was moderate (0.58 < r < 0.75). The upper extremity measures demonstrated better correlations with measured impairments (0.18 < r < 0.56) than the SF-36 (0 < r < 0.40). All the questionnaires were able to discriminate between levels of impairment and worker's compensation status. This study supported the validity of upper extremity scales to measure cuff-related disability and suggests that the use of both specific and general health measures provides a more comprehensive evaluation of patient outcome.

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PROMIS Milestones in Patients Undergoing Rotator Cuff Repair (233)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00341 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0034

Author(s):

Eric Makhni MBA ◽

Nikhil Yedulla ◽

David Bernstein ◽

Kareem Elhage ◽

Vasilios Moutzouros

Keyword(s):

Rotator Cuff ◽

Upper Extremity ◽

Rotator Cuff Repair ◽

Outcome Measurement ◽

Measurement Information ◽

Extremity Function ◽

Patient Reported ◽

Upper Extremity Function ◽

Patient Responses ◽

Cuff Repair

Objectives: Patient Reported Outcome Measurement Information System (PROMIS) has emerged as an effective tool in assessing post-operative outcomes in rotator cuff repair. PROMIS employs computer adaptive testing (CAT) in order to select specific items from a standard question bank based on previous patient responses. In turn, domain-specific PROMIS forms allow optimal tracking of outcomes in specific areas of patient recovery, such as upper extremity function (PROMIS-UE) for rotator cuff repair patients. The objective of this investigation is to analyze the PROMIS-UE CAT question bank to determine the point in recovery at which a patient is able to reach certain milestones and to elucidate the number of days – in increments of 30 (i.e., monthly) – it takes for patients who undergo rotator cuff repair to answer “with some difficulty” or “without any difficulty” for the five most frequently asked questions in the PROMIS-UE CAT questionnaire. Understanding these timepoints will improve clinical monitoring and counseling following surgery and provide standardized measures for appropriate activity progression and restriction. Methods: All patients who underwent rotator cuff repair by one of two sports medicine fellowship-trained orthopedic surgeons between 2/16/17 and 7/13/19 were included in this study. Post-operative PROMIS-UE CAT scores were reviewed with respect to individual item, response, and timing of response (with respect to number of days following surgery using 30-day increments). For each PROMIS-UE CAT item, the following five answer choices were available: “Without any difficulty”, “With a little difficulty”, “With some difficulty”, “With much difficulty”, and “Unable to do”. A task was considered achievable if the patient answered any answer with “Without any difficulty” or “With a little difficulty”. The percentage of patients in each 30-day group who answered with either of these responses was recorded. Chi-square tests were run between the number of days postoperatively the surveys were administered and patient responses to determine whether or not there were statistically significant differences between groups. Results: A total of 1,143 patient responses were included in the final analysis. The five most frequently asked questions in the PROMIS-UE CAT item bank, which were as follows: “Are you able to carry a heavy object (over 10 pounds /5 kg)?” (n=1143), “Are you able to put on and take off a coat or jacket?” (n=932), “Are you able to carry a shopping bag or briefcase?” (n=453), “Are you able to pour liquid from a bottle into a glass?” (n=675), and “Are you able to put on a shirt or blouse?” (n=578). The times at which greater than 50% of respondents answered either “Without any difficulty” or “With a little difficulty” are shown in Table 1. All five questions showed statistically significant associations between number of days postoperatively and patient responses (p<.0005). Conclusions: On average, patients undergoing rotator cuff repair achieved milestones measured by the five most commonly asked questions on the PROMIS-UE CAT by 1-4 months postoperatively. Patients also showed significant improvements in upper extremity function in the same time period. These findings can be utilized in post-operative monitoring, and patients who do not meet these milestones in the appropriate timepoints may require additional supportive care or treatment.

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