scholarly journals Identification of Functioning Domains in the Presurgical Period and Their Relationships with Opioid Use and Pain Catastrophizing

Pain Medicine ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. 1717-1727 ◽  
Author(s):  
Letitia E Travaglini ◽  
Krista B Highland ◽  
Winifred Rojas ◽  
Chester C Buckenmaier ◽  
Michael Kent
Keyword(s):  
Factor Analysis ◽  
Structural Equation ◽  
Rating Scale ◽  
Pain Catastrophizing ◽  
Medical Center ◽  
Measurement Information ◽  
Opioid Use ◽  
Latent Factors ◽  
Targeted Interventions ◽  
Patient Reported

AbstractObjectivesThe National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) is a multidimensional screening system evaluating biopsychosocial factors affecting pain and functioning. Using a military sample, the current study 1) examined the structure and domains of the PROMIS, the Defense and Veterans Pain Rating Scale 2.0 (DVPRS), and the Pain Catastrophizing Scale (PCS) within a presurgical setting and 2) examined the relationship of these variables to pre- and postsurgical opioid use.MethodsThis cross-sectional study included 279 adult patients scheduled for surgery at the Walter Reed National Military Medical Center and a validation sample of 79 additional patients from the Naval Medical Center, San Diego. PROMIS, DVPRS, PCS, and opioid use data were collected before surgery. Exploratory factor analysis and confirmatory factor analysis identified the latent structure for the measures. A structural equation model (SEM) examined their relationship to pre- and postsurgical opioid use.ResultsTwo latent factors represented Psychosocial Functioning (PROMIS Depression, PROMIS Anxiety, and PROMIS Social Isolation) and Pain Impact (DVPRS, PROMIS Pain Interference, PROMIS Physical Functioning). The remaining PROMIS scales did not load onto a single factor. In the SEM, the two latent factors and PCS were significantly related to pre- and postsurgical opioid use.ConclusionsThis study highlights the utility and relative ease of using a convenient multidimensional assessment in presurgical settings. Using such an assessment can help provide targeted interventions for individuals who may be at greatest risk for negative postsurgical outcomes.

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

2020 ◽  
Author(s):  
Darius Hunt ◽  
Tina Zhang ◽  
Scott Koenig ◽  
Ali Aneizi ◽  
Gregory Perraut ◽  
...  
Keyword(s):  
Physical Function ◽  
Rating Scale ◽  
Multivariable Analysis ◽  
Knee Surgery ◽  
Activity Level ◽  
Measurement Information ◽  
Opioid Use ◽  
Body Pain ◽  
Patient Reported ◽  
Preoperative Factors

AbstractThe purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries

Hand ◽  
2021 ◽  
pp. 155894472097412
Author(s):  
Ali Aneizi ◽  
Dominique Gelmann ◽  
Dominic J. Ventimiglia ◽  
Patrick M. J. Sajak ◽  
Vidushan Nadarajah ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Hand Surgery ◽  
Patient Characteristics ◽  
Patient Reported Outcome Measures ◽  
Pain Scale ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Opioid Use ◽  
Patient Reported ◽  
Opioid Users

Background: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. Methods: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. Results: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. Conclusions: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.

scholarly journals Establishing a common metric for patient-reported outcomes in cancer patients: linking patient reported outcomes measurement information system (PROMIS), numerical rating scale, and patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Minji K. Lee ◽  
Benjamin D. Schalet ◽  
David Cella ◽  
Kathleen J. Yost ◽  
Amy C. Dueck ◽  
...  
Keyword(s):  
Information System ◽  
Adverse Events ◽  
Patient Reported Outcomes ◽  
Rating Scale ◽  
Measurement Information ◽  
Outcomes Measurement ◽  
T Score ◽  
Patient Reported ◽  
Measurement Information System ◽  
The Common

Abstract Background Researchers and clinicians studying symptoms experienced by people with cancer must choose from various scales. It would be useful to know how the scores on one measure translate to another. Methods Using item response theory (IRT) with the single-group design, in which the same sample answers all measures, we produced crosswalk tables linking five 0–10 numeric rating scale (NRS) and 15 items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE, scored on a 1–5 scale) to the T-Score metric of six different scales from the NIH Patient reported Outcomes Measurement Information System (PROMIS®). The constructs, for which we conducted linking, include emotional distress-anxiety, emotional distress-depression, fatigue, sleep disturbance, pain intensity, and pain interference. We tested the IRT linking assumption of construct similarity between measures by comparing item content and testing unidimensionality of item sets comprising each construct. We also investigated the correlation of the measures to be linked and, by inspecting standardized mean differences, whether the linkage is invariant across age and gender subgroups. For measures that satisfied the assumptions, we conducted linking. Results In general, an NRS score of 0 corresponded to about 38.2 on the PROMIS T-Score scale (mean = 50; SD = 10); whereas an NRS score of 10 corresponded to a PROMIS T-Score of approximately 72.7. Similarly, the lowest/best score of 1 on PRO-CTCAE corresponded to 39.8 on T-score scale and the highest/worst score of 5 corresponded to 72.0. Conclusion We produced robust linking between single item symptom measures and PROMIS short forms.

scholarly journals The Influence of Psychological Factors on the Michigan Hand Questionnaire

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Yekyoo Oh ◽  
Tessa Drijkoningen ◽  
Mariano E. Menendez ◽  
Femke M. A. P. Claessen ◽  
David Ring
Keyword(s):  
Upper Extremity ◽  
Emotional Health ◽  
Pain Catastrophizing ◽  
Pain Interference ◽  
Measurement Information ◽  
Web Based ◽  
Psychological Measures ◽  
Symptoms Of Depression ◽  
Patient Reported ◽  
Multivariable Regression

Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital–based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.

scholarly journals The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

2020 ◽  
Vol 12 (01) ◽  
pp. 47-55
Author(s):  
Svenna H. W. L. Verhiel ◽  
Sezai Özkan ◽  
Christopher G. Langhammer ◽  
Neal C. Chen
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Rating Scale ◽  
Case Series ◽  
Outcome Evaluation ◽  
Pain Severity ◽  
Measurement Information ◽  
Radial Head Arthroplasty ◽  
Patient Reported ◽  
Essex Lopresti

Abstract Objective The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0–12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33–38). Median NRS score for pain-severity on average was 5 (IQR: 0–6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5–8). Conclusion Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

Evaluation of the PROMIS Physical Function Computer Adaptive Test in Patients Undergoing Knee Surgery

2019 ◽  
Vol 33 (08) ◽  
pp. 810-817
Author(s):  
Megan Miles ◽  
Vidushan Nadarajah ◽  
Julio J. Jauregui ◽  
Andrew G. Dubina ◽  
Michael P. Smuda ◽  
...  
Keyword(s):  
Physical Function ◽  
Knee Surgery ◽  
Charlson Comorbidity Index Score ◽  
Measurement Information ◽  
Opioid Use ◽  
Cross Sectional ◽  
Computer Adaptive Test ◽  
Adaptive Test ◽  
Patient Reported ◽  
Ceiling Effects

AbstractA cross-sectional analysis of data derived from patients undergoing knee surgery at a single institution was conducted. The objectives of the study were to (1) compare how the Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) computer adaptive test performs against the International Knee Documentation Committee (IKDC) Subjective Knee Form in evaluating functional status, and (2) to determine demographic, clinical, and psychosocial correlates of each outcome measure in an urban population undergoing a variety of knee surgeries. We hypothesized that there would be a strong correlation between PROMIS PF and IKDC, with minimal floor and ceiling effects, and similar clinical correlates. The sample consisted of 412 patients undergoing knee surgery. Bivariate and multivariable statistical analyses were performed to identify significant independent predictors. The PROMIS PF and IKDC scores were strongly correlated (r s = 0.71, p < 0.001), and neither exhibited floor nor ceiling effects. Lower body mass index, no preoperative opioid use, lower Charlson comorbidity index score, employment, and lower income were found to be significant independent predictors for better scores on both PROMIS PF and IKDC. Patients undergoing total knee arthroplasty had significantly lower PROMIS PF and IKDC scores (p < 0.05). Potential explanations for these findings are presented, and clinical implications are discussed.

Prescription Opioids and Patient-Reported Outcomes and Satisfaction After Carpal Tunnel Release Surgery

Hand ◽  
2022 ◽  
pp. 155894472110643
Author(s):  
Pragna N. Shetty ◽  
Kavya K. Sanghavi ◽  
Mihriye Mete ◽  
Aviram M. Giladi
Keyword(s):  
Postoperative Pain ◽  
Carpal Tunnel ◽  
Patient Reported Outcomes ◽  
Carpal Tunnel Release ◽  
Prescription Opioid ◽  
Measurement Information ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Patient Reported

Background: Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR. Methods: This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score. Results: Of 505 included patients, 405 received a postoperative prescription and 67 continued use at 2-weeks. These 67 patients reported lower bMHQ, lower satisfaction, and higher postoperative pain compared to those that discontinued. Multivariable regressions showed that receiving postoperative prescriptions did not significantly influence outcomes or satisfaction. However, remaining on the prescription at 2 weeks was associated with significantly lower bMHQ scores, particularly in patients reporting less pain. Conclusions: Patients remaining on a prescription after CTR reported worse outcomes compared to those who discontinued. Unexpectedly, the widest bMHQ score gap was seen across patients reporting lowest pain scores. Further research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures. Level of Evidence: Level III.

Abstract 17004: Using mHealth to Capture Patient-Reported Sexual Satisfaction in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brittany N Taylor ◽  
Meghan Reading Turchioe ◽  
Parag Goyal ◽  
Ruth M Masterson Creber
Keyword(s):  
Heart Failure ◽  
Sexual Satisfaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Burden ◽  
Self Report ◽  
Patient Comfort ◽  
Measurement Information ◽  
Chi Square ◽  
Patient Reported

Introduction: Over 60% of heart failure (HF) patients have reported problems with sexual satisfaction, which is a major reason for medication non-adherence. While many patients are reticent to verbally self-report impaired sexual satisfaction, mobile health (mHealth) technology may improve patient comfort in reporting these symptoms. We aimed to evaluate the feasibility of HF patients using mHealth to self-report sexual satisfaction by comparing responders to non-responders and evaluating symptom burden. Methods: We prospectively recruited HF patients from inpatient and outpatient cardiology clinics at an urban academic medical center from October 2016 to January 2017. Patients completed Patient Reported Outcomes Measurement Information System (PROMIS ® ) questionnaires via an mHealth application, mi.Symptoms . The specific outcomes of interest were fatigue- and pain-related impairment of sexual satisfaction, due to the prevalence of those symptoms in HF. Data were analyzed using descriptive statistics and Chi-square tests to evaluate differences between responders and non-responders. Results: The mean age of participants (n=168) was 59 years (±12.5); 37% were female; 37% were Latino; 32% were Black, 32% White, and 36% Other Race . Few significant differences in demographic characteristics of responders and non-responders were noted ( Table ). Of the 117 participants (69.6%) who responded regarding fatigue, 59 (50.4%) indicated that fatigue affected sexual satisfaction “quite a bit” or “very much.” Of the 114 participants (67.9%) who responded regarding pain, 44 (38.6%) indicated that pain affected sexual satisfaction “quite a bit” or “very much.” Conclusion: This study showed that mHealth can be a feasible way to collect sexual satisfaction data with fairly high response rates and few differences between responders and non-responders. Participants’ reported high burden of impairment underscores the importance of measuring this symptom.

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