Pediatric PROMIS Computer Adaptive Tests Are Highly Correlated With Adult PROMIS Computer Adaptive Tests in Pediatric Sports Medicine Patients

2020 ◽  
Vol 48 (14) ◽  
pp. 3620-3625
Author(s):  
David N. Bernstein ◽  
Sreten Franovic ◽  
D. Grace Smith ◽  
Luke Hessburg ◽  
Nikhil Yedulla ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Depressive Symptoms ◽  
Physical Function ◽  
Upper Extremity ◽  
Sports Medicine ◽  
Pain Interference ◽  
Adaptive Tests ◽  
Care Research ◽  
Patient Reported ◽  
Computer Adaptive Tests

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a powerful set of patient-reported outcome measures (PROMs) that are gaining popularity throughout orthopaedic surgery. The use of both adult and pediatric PROMIS questionnaires in orthopaedic sports medicine limits the value of the PROMIS in routine sports medicine clinical care, research, and quality improvement. Because orthopaedic sports medicine surgeons see patients across a wide age range, simplifying the collection of PROMIS computer adaptive tests (CATs) to a single set of questionnaires, regardless of age, is of notable value. Purpose/Hypothesis: The purpose was to determine the strength of the correlation between the pediatric and adult PROMIS questionnaires. We hypothesized that there would be a high correlation between the adult and pediatric versions for each PROMIS domain, thereby justifying the use of only the adult version for most sports medicine providers, regardless of patient age. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between December 2018 and December 2019, all pediatric sports medicine patients presenting to a single, academic, orthopaedic sports medicine clinic were asked to participate in the present study with their parents’ consent. Patients were asked to complete a set of adult PROMIS domains (Physical Function and/or Upper Extremity, Pain Interference, and Depression) as well as a set of pediatric PROMIS domains (Mobility and/or Upper Extremity, Pain Interference, and Depressive Symptoms). Concurrent validity was assessed using Pearson correlation coefficients ( r). Ceiling and floor effects were determined. Results: A total of 188 patients met our inclusion criteria. The correlation between the adult and pediatric PROMIS Upper Extremity, Physical Function and Mobility, Pain Interference, and Depression and Depressive Symptoms forms were high-moderate ( r = 0.68; P < .01), high-moderate ( r = 0.69; P < .01), high ( r = 0.78; P < .01), and high ( r = 0.85; P < .01), respectively. Both adult and pediatric depression-related PROMIS domains demonstrated notable floor effects (adult: 38%; pediatric: 24%). The pediatric PROMIS Upper Extremity domain demonstrated a ceiling effect (20%). Conclusion: Adult PROMIS CATs may be used in an orthopaedic sports medicine clinic for both adult and pediatric patients. Our findings will help decrease the amount of resources needed for the implementation and use of PROMs for patient care, research, and quality improvement in orthopaedic sports medicine clinics.

scholarly journals Patient-Reported Outcomes Demonstrate The Value Of Non-Operative And Operative Orthopedic Treatments And Predict The Odds Of Improvement With Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Andrew Haskell ◽  
Todd S. Kim
Keyword(s):  
Pain Intensity ◽  
Patient Reported Outcomes ◽  
Pain Interference ◽  
Surgical Patients ◽  
Final Visit ◽  
Adaptive Tests ◽  
Item Banks ◽  
Patient Reported ◽  
Computer Adaptive Tests ◽  
Better Than

Category: Outcomes Measurement Introduction/Purpose: The importance of patient reported outcomes (PROs) has become increasingly recognized as an important tool to measure our clinical value. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks, to help clinicians and researches measure key clinical domains. The PROMIS computer adaptive tests (CAT) may be administered with minimal resources or administrative burden. This study describes the results of administering computer adaptive tests (CAT) to every patient in a high volume Orthopedic Surgery practice. We test the hypotheses that both non-operative treatment and operative treatments improve PRO scores. Furthermore, we test the hypothesis that preoperative scores in these domains may be used to predict chances of improvement after surgery. Methods: The PROMIS CAT was administered prospectively for all patients as part of standard clinic intake and recorded in the patient’s electronic medical record (EMR) at each clinic visit. The PROMIS item banks are normalized to mean 50±10 for the US population. De-identified data was retrospectively extracted from the EMR including PROMIS scores, demographic information, as well as surgery specific information. As of this submission, 1688 PROMIS CATs from March 2015 to September 2016 have been analyzed. Data for initial and final clinic visits, as well as for the final preoperative visit for patients who had surgery, are compared using Wilcoxon Matched Pairs Test for paired samples and Mann-Whitney U Test for unpaired samples. Linear regression is used to assess the association of initial values to change in value after treatment. The effect of stratified initial clinic domain value on odds of improving with surgery is assessed using Analysis of Variance. Results: Non-surgical and surgical patients present with similar pain intensity (49.6±7.9 vs. 49.4±7.8). Surgical patients do not improve prior to surgery, but both improve by their final visit (45.7±7.5, 43.7±8.8, p<0.05). Non-surgical and surgical patients present with similar pain interference (60.0±8.4 vs. 60.3±8.9). Surgical patients do not improve prior to surgery, but both improve by their final visit (56.9±8.8, 54.3±9.4, p<0.05). For surgical patients, change in pain intensity and pain interference correlate with initial values (R2 0.32 and 0.27, p<0.05). The percentage whose pain intensity improves after surgery when initial value is over one SD worse than mean is 96%, within one SD worse than mean is 81%, within one SD better than mean is 56%, and over one SD better than mean is 40% (p<0.05). Conclusion: Both non-operative and operative orthopedic treatments improve patient reported pain intensity and pain interference. For patients that have surgery, patients that present with more severe symptoms tend to improve more with surgery. Furthermore, the odds of improving after surgery can be calculated based on preoperative PRO scores. This may allow surgeons to counsel patients about the potential benefits of surgery with personalized precision that is currently unavailable. Measuring PROs using PROMIS CATs demonstrates the value of both non-operative and operative Orthopedic Surgery care for our patients. Preoperative PRO scores may predict the odds of successful surgical intervention.

scholarly journals Correlation of PROMIS Physical Function, Pain Interference, and Depression in Pediatric and Adolescent Patients in the Ambulatory Sports Medicine Clinic

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985110 ◽  
Author(s):  
Eric C. Makhni ◽  
Jason E. Meldau ◽  
Jacob Blanchett ◽  
Peter Borowsky ◽  
Jeffrey Stephens ◽  
...  
Keyword(s):  
Physical Function ◽  
Negative Correlation ◽  
Sports Medicine ◽  
Pearson Correlation ◽  
Pain Interference ◽  
Measurement Information ◽  
Patient Demographic ◽  
Medicine Clinic ◽  
Patient Reported ◽  
Adolescent Patients

Background: Recently, interest has increased in incorporating the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes into clinical and research applications in sports medicine. The PROMIS forms have not been studied in pediatric and adolescent sports medicine patients. Purpose/Hypothesis: The goal of this study was to determine the correlation between PROMIS Computer Adaptive Test (CAT) forms measuring physical function, pain interference, and depression in pediatric and adolescent patients seen in the ambulatory sports medicine clinic. We hypothesized that there would be a negative correlation between physical function and pain interference as well as depression, as has been demonstrated in adult patient populations. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients aged 8 to 17 years seen by 3 shoulder and sports medicine providers were included in this study. Patients completed a series of PROMIS CAT forms at clinic visits, including the PROMIS-PF and PROMIS-UE (Physical Function and Upper Extremity; depending on the nature of the complaint), PROMIS-PI (Pain Interference), and PROMIS-Depression subscales. Pearson correlation coefficients were calculated between the PROMIS forms as well as with other patient demographic data. Results: A total of 236 patient visits (152 patients) were included in the study, comprising 712 total PROMIS CAT forms. A negative correlation was found between PROMIS-PF and both PROMIS-Depression ( R = –0.34) and PROMIS-PI ( R = –0.76). These correlations with PROMIS-Depression and PROMIS-PI were –0.21 and –0.75, respectively, when considering the PROMIS-UE CAT. Patient demographic information had minimal impact on PROMIS scores as well as on correlations between scores. Conclusion: Correlations between physical function, pain interference, and depression were found to be similar in pediatric patients as they are in adult patients, as measured by PROMIS CAT forms.

scholarly journals Impact of Patient Demographic Factors on Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Interference, and Depression Computer Adaptive Testing Scores in Patients Undergoing Shoulder and Elbow Surgery

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988454
Author(s):  
Jason E. Meldau ◽  
Peter Borowsky ◽  
Jacob Blanchett ◽  
Jeffrey Stephens ◽  
Stephanie Muh ◽  
...  
Keyword(s):  
Physical Function ◽  
Upper Extremity ◽  
Negative Correlation ◽  
Demographic Factors ◽  
Pain Interference ◽  
Measurement Information ◽  
Patient Demographic ◽  
Patient Reported ◽  
Elbow Surgery ◽  
The Impact

Background: There has been a growing emphasis in orthopaedics on providing patient-centered care. The US National Institutes of Health launched the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative that incorporates patient-reported outcome measures across a number of medical domains. The relationship between PROMIS domains and the impact of patient demographic factors in those undergoing upper extremity surgery remains unclear. Purpose/Hypothesis: The goal of this study was to investigate the correlation between physical function, pain interference, and depression in patients undergoing shoulder and elbow surgery as measured by PROMIS computer adaptive testing (CAT) forms and to determine the impact of patient demographic factors. We hypothesized that there would be a significant negative correlation between physical function and both pain interference and depression in this patient population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent elective shoulder or elbow surgery by 3 shoulder, elbow, and/or sports medicine fellowship–trained orthopaedic surgeons were included in the study. Preoperative PROMIS–Upper Extremity (PROMIS-UE), PROMIS–Pain Interference (PROMIS-PI), and PROMIS-Depression (PROMIS-D) CAT scores were analyzed. Pearson correlations were calculated between PROMIS domains as well as between PROMIS outcomes with patient demographic factors. Results: Preoperative PROMIS CAT scores for all 3 domains were collected and analyzed from 172 unique patients (516 individual CAT forms) with shoulder and elbow injuries. A negative correlation of moderate strength was found between the PROMIS-UE and PROMIS-PI ( R = –0.61; P < .001), and a negligible correlation was found between the PROMIS-UE and PROMIS-D ( R = –0.28; P < .001). When stratified by patient demographic factors, the correlation between the PROMIS-UE and PROMIS-PI was stronger in female patients compared with male patients ( R = –0.77 vs –0.46, respectively; P < .001 for both), stronger in black patients compared with white patients ( R = –0.72 vs –0.56, respectively; P < .001 for both), and highest in current tobacco users ( R = –0.80; P < .001). Conclusion: Before shoulder and elbow surgery, patients demonstrated impairments in physical function and pain interference as measured by CAT forms, with a moderate negative correlation between baseline upper extremity physical function and pain interference scores. In certain subpopulations, such as female patients, black patients, and current tobacco users, the correlations between these tested domains were stronger than in other groups.

scholarly journals Performance of PROMIS Physical Function, Pain Interference, and Depression Computer Adaptive Tests Instruments in Patients Undergoing Meniscal Surgery

2020 ◽  
Vol 2 (5) ◽  
pp. e451-e459
Author(s):  
Yining Lu ◽  
Alexander Beletsky ◽  
Benedict U. Nwachukwu ◽  
Bhavik H. Patel ◽  
Kelechi R. Okoroha ◽  
...  
Keyword(s):  
Physical Function ◽  
Pain Interference ◽  
Adaptive Tests ◽  
Meniscal Surgery ◽  
Computer Adaptive Tests

scholarly journals The PROMIS CAT Demonstrates Responsiveness in Patients After ACL Reconstruction Across Numerous Health Domains

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097999
Author(s):  
Caleb M. Gulledge ◽  
Dylan Koolmees ◽  
D. Grace Smith ◽  
Alexander Pietroski ◽  
Sreten Franovic ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Cruciate Ligament ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Adaptive Tests ◽  
Patient Reported ◽  
Health Domains ◽  
Meniscal Pathology ◽  
Computer Adaptive Tests

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.

scholarly journals Normative Promis Scores In Healthy Collegiate Athletes: Establishing A Target For Return To Normal Function

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0041
Author(s):  
Arya Minaie ◽  
David L. Bernholt ◽  
Ronak Patel ◽  
Rick W. Wright ◽  
Matthew J. Matava ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Physical Function ◽  
Upper Extremity ◽  
Collegiate Athletes ◽  
Pain Interference ◽  
Extremity Function ◽  
Patient Reported ◽  
Floor Effects ◽  
Upper Extremity Function ◽  
Domain Scores

Objectives: Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has been shown to be a valid and reliable means to assess patient-reported outcomes and is increasingly utilized within orthopedic research and clinical care. All PROMIS domain scores are standardized to a population mean of 50 with 10 points representing one standard deviation. Normal scores and distributions for a subset of a healthy young athletic population have not been established and may be different from the general population where PROMIS was validated. The purpose of this study is 1) to establish normative PROMIS domain scores for Physical Function, Mobility, Upper Extremity, and Pain Interference and 2) to determine if differences exist by sex or age. Methods: Healthy collegiate athletes (18 to 23 years of age) were prospectively enrolled to complete a battery of PROMIS CAT domains including Mobility (v2.0), Upper Extremity Function (v2.0), Pain Interference (v1.1), and Physical Function (v2.0). Athletes were excluded if currently affected by an injury. In addition, the athletes provided information regarding their age, gender, primary sport, and secondary sport(s). Mean scores (± standard deviation), distribution of data, as well as identify any ceiling or floor effects were calculated. Ceiling and floor effects were assessed by the percentage of participants with the highest or lowest possible score on a domain. A significant ceiling or floor effect was present when greater than 15% met this criteria. Results: A total of 194 healthy athletes were included in the study, including 118 (60.8%) males and 76 (39.2%) females. Mean PROMIS scores as follows: Mobility: 58.2 ± 4.1, Upper Extremity Function: 57.4 ± 5.8, Pain Interference: 43.2 ± 6.2, and Physical Function: 62.9 ± 6.7. Distributions of scores for Mobility and Upper Extremity observed strong ceiling effects by 77.3% and 66% of subjects respectively scoring the maximal score (Figure 1). Similarly, 63.9% of subjects exhibited a floor effect for Pain Interference. However, Physical Function scores were not found to be affected by ceiling nor floor effects (8.8%). The Physical Function domain differed most from expected population-based mean (50) with the mean being more than one standard deviation above (62.9). Sex and age showed no statistically significant differences in any of the PROMIS domain scores. Conclusion: While PROMIS domains have been shown to be valid and reliable in quantitatively evaluating the baseline and subsequent rehabilitation of the average adult, differences in healthy athletic populations are important to understand. PROMIS domains of Mobility, Upper Extremity Function and Pain Interference demonstrate significant ceiling and floor effects in more than 2/3 of healthy athletes. The Physical Function domain did not demonstrate floor and ceiling effects but did demonstrate the largest difference between the healthy athletic population and the general population mean. [Figure: see text]

Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

2020 ◽  
Author(s):  
Ali Aneizi ◽  
Patrick M. J. Sajak ◽  
Aymen Alqazzaz ◽  
Tristan Weir ◽  
Cameran I. Burt ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Knee Surgery ◽  
The Body ◽  
Pain Interference ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Social Satisfaction ◽  
Patient Reported ◽  
Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

Abstract P238: Importance of Self-Efficacy in the Patient-Reported Physical Function of Patients With Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Irene L Katzan ◽  
Dolora R Wisco ◽  
Brittany Lapin
Keyword(s):  
Physical Function ◽  
Indirect Effect ◽  
Self Efficacy ◽  
Total Effect ◽  
Pain Interference ◽  
Study Cohort ◽  
Stressful Situation ◽  
Study Objective ◽  
Patient Reported ◽  
The Relationship

Background: Self-efficacy is the belief that one is able to respond to demands of a stressful situation and it has both direct and indirect effects on health. The study objective is to investigate the amount of variance in patient-reported physical function (PF) that is explained by self-efficacy compared to clinician-reported disability and other patient-reported domains of health, and evaluate whether self-efficacy mediates the relationship between PF and other domains of health. Methods: Observational cohort study of 248 patients who were seen in a cerebrovascular clinic 3/18/20 - 7/7/20 and completed the following patient-reported outcome measures (PROMs) as part of the routine office visit: PROMIS PF, general self-efficacy, fatigue, and pain interference. Linear regression models were constructed to determine the amount of variance (adjusted R 2 ) in PROMIS PF score explained by the modified Rankin Scale (mRS) and additional PROM scores. The mRS and individual PROMs were added separately to a base model adjusted for demographic characteristics. Mediation analysis was conducted to determine the extent to which self-efficacy mediated the relationship between PF and other PROMs. Results: Mean age of study cohort was 61.5 (SD=13.5) years and 48.4% were female. The base model explained 4.5% of the variance of PF. Adding PROMIS fatigue resulted in the largest increase in the proportion of variance explained (adj R 2 = 47.7%), followed by PROMIS self-efficacy (40.7%), PROMIS pain interference (38.7%), and mRS (26.6%). Self-efficacy significantly mediated the relationship between fatigue and PF (standardized indirect effect: 0.11 (bias-corrected 95% CI: 0.05-0.18), 20.9% of total effect) and pain interference and PF (standardized indirect effect 0.10 (95% CI: 0.06-0.17), 27.1% of total effect). Conclusion: PROMIS self-efficacy explains more variance in stroke patients’ perceived physical function than their disability. This suggests that interventions to improve self-efficacy could have a significant effect on patient’s perceived health. Patients’ fatigue, despite being partially mediated by self-efficacy, was a large contributor to self-reported PF and should be included as part of an evaluation of patient’s physical health.

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