A Comparison of PROMIS Physical Function and Pain Interference Scores in Patients With Carpal Tunnel Syndrome: Research Collection Versus Routine Clinical Collection

Background: There is a concern that patients may answer patient-reported outcome (PRO) questionnaires differently depending on the purpose—clinical care or research (eg, “Hawthorne effect”). We sought to determine whether Patient-Reported Outcomes Management Information System (PROMIS) scores differ at the same clinic visit based on whether a patient was completing the PRO tool for study or clinical care purposes. Methods: Patients presenting to one surgeon at an academic medical center hand clinic were asked to complete PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires as part of routine care. Those diagnosed with carpal tunnel syndrome from February 2015 to April 2017 were then asked to participate in a clinical research project, which had them complete PROMIS PF and PROMIS PI again. Data from those who completed both routine and research PROs at each visit were compared. Between the 2 settings, test-retest reliability was determined using Pearson correlation coefficients ( r), and internal consistency was evaluated using Cronbach α. Results: A total of 128 unique office visits representing 67 patients fit our inclusion criteria. There was a strong correlation between PROMIS PF and PI in the research and patient care setting (PF: r = 0.82, P < .01; PI: r = 0.83, P < .01). Both domains had a Cronbach α of 0.90. The PROMIS PF scores were not different between the 2 groups ( P = .19), but the PROMIS PI scores were slightly different ( P < .01). Conclusions: Patients appear to be consistent when completing PROMIS for both clinical care and research, supporting the idea that data obtained in either setting are generalizable and appropriate for research purposes.

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Identification of Clinical and Demographic Predictors for Treatment Modality in Patients With Carpal Tunnel Syndrome

Hand ◽

10.1177/15589447211060448 ◽

2021 ◽

pp. 155894472110604

Author(s):

Richard D. Lander ◽

Courtney Marie Cora Jones ◽

Warren C. Hammert

Keyword(s):

Treatment Group ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Treatment Modality ◽

Pain Interference ◽

Treatment Modalities ◽

Demographic Predictors ◽

Patient Reported ◽

Tunnel Syndrome ◽

To Receive

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. There are multiple treatment modalities for CTS. This study examines both clinical and demographic predictors for initial treatment modality of CTS. Methods: Patients diagnosed with CTS between February 2015 and October 2020 with a hand clinic visit within 6 weeks before treatment were included in our study. Patients completed Patient-Reported Outcomes Measurement Information System Pain Interference, Physical Function, and Depression and had complete data on relevant predictor variables. Primary outcomes were treatment group: (1) injection only; (2) release only; and (3) injection followed by release. Bivariate analyses and multinomial logistic regression was used to identify statistically significant variables and independent predictors associated with the treatment groups, respectively. Results: A total of 1409 patients fit our inclusion criteria. Sex, age, body mass index (BMI), race, ethnicity, Pain Interference, and Depression were statistically significant predictors for treatment group in bivariate analysis ( P < .05). In multivariable analysis, adults older than 65 years were less likely to receive either injection only or injection followed by release (odds ratio [OR]: 0.56 and OR: 0.52, respectively; P < .01). Overweight (BMI: ≥25) individuals were less likely to receive injection only (OR: 0.45; P < .01). Women were more likely to have either injection only or injection followed by released (OR: 1.50 and 1.55; P < .01). Similarly, black, Indigenous, or Persons of Color had an increased odds of injection only and injection followed by release (OR: 1.61 and OR: 1.69, respectively; P < .05). Conclusions: Sex, age, BMI, race, and ethnicity were found to be independent predictors of treatment modality for CTS.

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Testing proposed quality measures for treatment of carpal tunnel syndrome: feasibility, magnitude of quality gaps, and reliability

BMC Health Services Research ◽

10.1186/s12913-020-05704-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Alex H. S. Harris ◽

Esther L. Meerwijk ◽

Qian Ding ◽

Amber W. Trickey ◽

Andrea K. Finlay ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Medical Center ◽

Carpal Tunnel Release ◽

Academic Medical Center ◽

Quality Measures ◽

Treatment Quality ◽

Veterans Health ◽

Health Administration ◽

Tunnel Syndrome

Abstract Background The American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand recently proposed three quality measures for carpal tunnel syndrome (CTS): Measure 1 - Discouraging routine use of Magnetic resonance imaging (MRI) for diagnosis of CTS; Measure 2 - Discouraging the use of adjunctive surgical procedures during carpal tunnel release (CTR); and Measure 3 - Discouraging the routine use of occupational and/or physical therapy after CTR. The goal of this study were to 1) Assess the feasibility of using the specifications to calculate the measures in real-world healthcare data and identify aspects of the specifications that might be clarified or improved; 2) Determine if the measures identify important variation in treatment quality that justifies expending resources for their further development and implementation; 3) Assess the facility- and surgeon-level reliability of measures. Methods The measures were calculated using national data from the Veterans Health Administration (VA) Corporate Data Warehouse for three fiscal years (FY; 2016–18). Facility- and surgeon-level performance and reliability were examined. To expand the testing context, the measures were also tested using data from an academic medical center. Results The denominator of Measure 1 was 132,049 VA patients newly diagnosed with CTS. The denominators of Measures 2 and 3 were 20,813 CTRs received by VA patients. The median facility-level performances on the three measures were 96.5, 100, and 94.7%, respectively. Of 130 VA facilities, none had < 90% performance on Measure 1. Among 111 facilities that performed CTRs, only 1 facility had < 90% performance on Measure 2. In contrast, 21 facilities (18.9%) and 333 surgeons (17.8%) had lower than 90% performance on Measure 3 (Median facility- and surgeon-level reliability for Measure 3 were very high (0.95 and 0.96 respectively). Conclusions Measure 3 displayed adequate facility- and surgeon-level variability and reliability to justify its use for quality monitoring and improvement purposes. Measures 1 and 2 lacked quality gaps, suggesting they should not be implemented in VA and need to be tested in other healthcare settings. Opportunities exist to refine the specifications of Measure 3 to ensure that different organizations calculate the measure in the same way.

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Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

Hand ◽

10.1177/15589447211028921 ◽

2021 ◽

pp. 155894472110289

Author(s):

Amy Phan ◽

Warren Hammert

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Postoperative Period ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Measurement Information ◽

Level Of Evidence ◽

Patient Reported ◽

Tunnel Syndrome ◽

Measurement Information System

Background: Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). Methods: There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Results: Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. Conclusions: PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level of Evidence: Level IV.

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A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome

Muscle & Nerve ◽

10.1002/mus.26297 ◽

2018 ◽

Vol 58 (6) ◽

pp. 784-789 ◽

Cited By ~ 7

Author(s):

Angela Bowman ◽

Stephan Rudolfer ◽

Peter Weller ◽

Jeremy D. P. Bland

Keyword(s):

Surgical Treatment ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Prognostic Model ◽

Patient Reported Outcome ◽

Patient Reported ◽

Tunnel Syndrome

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Using item response theory improved responsiveness of patient-reported outcomes measures in carpal tunnel syndrome

Journal of Clinical Epidemiology ◽

10.1016/j.jclinepi.2011.08.009 ◽

2012 ◽

Vol 65 (3) ◽

pp. 325-334 ◽

Cited By ~ 9

Author(s):

Per-Erik Lyrén ◽

Isam Atroshi

Keyword(s):

Item Response Theory ◽

Carpal Tunnel Syndrome ◽

Item Response ◽

Carpal Tunnel ◽

Patient Reported Outcomes ◽

Response Theory ◽

Outcomes Measures ◽

Patient Reported ◽

Tunnel Syndrome

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Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417721456 ◽

2017 ◽

Vol 42 (9) ◽

pp. 932-936 ◽

Cited By ~ 2

Author(s):

C. Q. Y. Tang ◽

S. W. H. Lai ◽

S. C. Tay

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Complete Resolution ◽

Patient Reported Outcomes ◽

Operative Time ◽

Carpal Tunnel Release ◽

Level Of Evidence ◽

Patient Reported ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery

This retrospective study examined whether the presenting complaint of numbness is relieved post-operatively in severe carpal tunnel syndrome and also assessed any correlation between outcomes of the first and second procedures in staged bilateral carpal tunnel releases. Carpal tunnel release (60 open and 38 endoscopic) was done in 49 patients with bilateral severe carpal tunnel syndrome. There was complete resolution of numbness post-operatively in 77% ( n = 75) of hands. The median post-operative time before complete resolution of numbness was 21 days (IQR 8 to 21; range 3 to 482). The likelihood of complete resolution of symptoms after the second carpal tunnel release in patients with complete resolution of symptoms after the first carpal tunnel release was 22 (95% CI: 4 to 131) times that of the likelihood of improvement in patients with incomplete resolution of symptoms after the first carpal tunnel release. Level of evidence: IV

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119851100 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985110 ◽

Cited By ~ 5

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.

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Correlation between the Oswestry Disability Index and the 4-item short forms for physical function and pain interference from PROMIS

Journal of Neurosurgery Spine ◽

10.3171/2019.5.spine19400 ◽

2019 ◽

Vol 31 (5) ◽

pp. 691-696 ◽

Cited By ~ 1

Author(s):

Timothy J. Yee ◽

Brandon W. Smith ◽

Jacob R. Joseph ◽

Yamaan S. Saadeh ◽

Jay K. Nathan ◽

...

Keyword(s):

Lumbar Spine ◽

Physical Function ◽

Spine Surgery ◽

Oswestry Disability Index ◽

Short Form ◽

Pearson Correlation ◽

Pain Interference ◽

Lumbar Spine Surgery ◽

Time Points ◽

Patient Reported

OBJECTIVEThe Oswestry Disability Index (ODI) is one of the most commonly used patient-reported outcome instruments, but completion of this 10-question survey can be cumbersome. Tools from the Patient-Reported Outcomes Measurement Information System (PROMIS) are an alternative, and potentially more efficient, means of assessing physical, mental, and social outcomes in spine surgery. Authors of this retrospective study assessed whether scores on the 4-item surveys of function and pain from the PROMIS initiative correlate with those on the ODI in lumbar spine surgery.METHODSPatients evaluated in the adult neurosurgery spine clinic at a single institution completed the ODI, PROMIS Short Form v2.0 Physical Function 4a (PROMIS PF), and PROMIS Short Form v1.0 Pain Interference 4a (PROMIS PI) at various time points in their care. Score data were retrospectively analyzed using linear regressions with calculation of the Pearson correlation coefficient.RESULTSThree hundred forty-three sets of surveys (ODI, PROMIS PF, and PROMIS PI) were obtained from patients across initial visits (n = 147), 3-month follow-ups (n = 107), 12-month follow-ups (n = 52), and 24-month follow-ups (n = 37). ODI scores strongly correlated with PROMIS PF t-scores at baseline (r = −0.72, p < 0.0001), 3 months (r = −0.79, p < 0.0001), 12 months (r = −0.85, p < 0.0001), and 24 months (r = −0.89, p < 0.0001). ODI scores also correlated strongly with PROMIS PI t-scores at baseline (r = 0.71, p < 0.0001), at 3 months (r = 0.82, p < 0.0001), at 12 months (r = 0.86, p < 0.0001), and at 24 months (r = 0.88, p < 0.0001). Changes in ODI scores moderately correlated with changes in PROMIS PF t-scores (r = −0.68, p = 0.0003) and changes in PROMIS PI t-scores (r = 0.57, p = 0.0047) at 3 months postoperatively.CONCLUSIONSA strong correlation was found between the ODI and the 4-item PROMIS PF/PI at isolated time points for patients undergoing lumbar spine surgery. Large cohort studies are needed to determine longitudinal accuracy and precision and to assess possible benefits of time savings and improved rates of survey completion.

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