scholarly journals Assessing Elite Athletes using PROMIS Tools: The STEALTH Project (Student Athlete Health Assessment)

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001 ◽  
Author(s):  
Shanthan Challa ◽  
Eric Lakey ◽  
Kenneth Smith ◽  
Marissa Holliday ◽  
Jonah Vest ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Computerized Adaptive Testing ◽  
Elite Athletes ◽  
Assessment Tools ◽  
Measurement Information ◽  
Significant Difference ◽  
Patient Reported ◽  
Division 1 ◽  
The Impact ◽  
Academic Year

Category: Sports, Outcomes Introduction/Purpose: Injuries are a major part of elite sports and patient-reported outcomes tools (PROs) are becoming commonplace for the assessment of injury and treatment outcomes. The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools with increasing popularity. The PROMIS metrics utilize computerized adaptive testing (CAT) to capture health status measurements through individualized assessments, with minimal user burden, and without the loss of precision or content validity. The purpose of this study was to evaluate elite athletes using PROMIS scores and assess the impact of injury on those scores in order to gain insight into how participation and injury can impact the health of NCAA Division 1 athletes participating in a variety of sports. Methods: Over a six-month period, athletes from 11 sports at a single Division 1 Athletics program were recruited to participate in longitudinal prospective data collection using four PROMIS CAT scales/domains: Pain Interference (PI), Physical Function (PF), Depression, and Ability to Participate in Social Roles and Activities (PSRA). Using REDCap (Research Electronic Data Capture), athletes completed an assesment that included the PROMIS tools prior to participation in their respective sport’s season for the 2018-2019 academic year and following the completion of their season. Athletes suffering a season-ending injury were asked to complete the PROMIS survey within a week following the injury. De-identified data was analyzed using Student’s T-test. PROMIS outcome measures were analyzed using linear mixed model regression. A p-value of < 0.05 was considered statistically significant. Results: A total of 315 pre-season surveys were collected and of those 139 post-season surveys have been completed at this point in the academic year. PF, Depression and PSRA scores were significantly different in athletes than in the general age-matched population. PI scores were similar to the normal population. The distribution of PI and PF scores were significantly different pre and post-season with a difference in means of 2.2 and -3.2 respectively (p<.01). No significant difference was observed in the Depression and PSRA scores at the end of the season. A total of 23 significant injuries were reported up to this point in the season, resulting in a significant change from both pre-season scores and post-season in uninjured controls (Figure 1). Conclusion: We found significantly worse PI and PF scores after a full season compared to preseason, suggesting that athletic participation alone impacts the athlete’s overall function and condition. Season-altering injuries resulted in clinically significant differences in all four domains, suggesting that injuries greatly affect athletes not only physically, but mentally and socially. These data indicate that consideration should be given to pre-season PROMIS surveys for individual athletes to ensure that subsequent scores are properly interpreted. Additional study will elucidate the impact of specific sports and injuries, providing data to physicians, trainers, and coaches to inform treatment and return to sport protocols.

scholarly journals Assessing Elite Athletes Using PROMIS Tools: The STEALTH Project (Student Athlete Health Assessment)

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
Shanthan Challa ◽  
Marissa Holliday ◽  
Kenneth Bartolomei ◽  
Jonathan Bartolomei
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Computerized Adaptive Testing ◽  
Elite Athletes ◽  
Assessment Tools ◽  
Pain Interference ◽  
Significant Difference ◽  
Patient Reported ◽  
Division 1 ◽  
The Impact

Objectives: Injuries are a major part of elite sports, and patient-reported outcomes tools (PROs) are becoming commonplace for the assessment of injury and treatment outcomes. The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools with increasing popularity. The PROMIS metrics utilize computerized adaptive testing (CAT) to capture health status measurements through individualized assessments, with minimal user burden, and without the loss of precision or content validity. The purpose of this study was to evaluate elite athletes using PROMIS scores and assess the impact of injury on those scores to gain insight into how participation and injury can impact the health of NCAA Division 1 athletes participating in a variety of sports. Methods: Over six months, athletes from 11 sports at a single Division 1 Athletics program were recruited to participate in longitudinal prospective data collection using four PROMIS CAT scales/domains: Pain Interference (PI), Physical Function (PF), Depression, and Ability to Participate in Social Roles and Activities (PSRA). Using REDCap (Research Electronic Data Capture), athletes completed an assessment that included the PROMIS tools before participation in their respective sport’s season for the 2018-2019 academic year and following the completion of their season. Athletes suffering a season-ending injury were asked to complete the PROMIS survey within a week following the injury. De-identified data was analyzed using Student’s T-test. PROMIS outcome measures were analyzed using linear mixed model regression. A p-value of < 0.05 was considered statistically significant. Results: A total of 592 surveys were collected, composed of 320 pre-season surveys, 241 post-season surveys, and 31 season altering injury surveys. PF, Depression, and PSRA scores were significantly different in athletes than in the general age-matched population (Fig 1). PI scores were similar to the normal population. The distribution of PI and PF scores were significantly different pre and post-season with a difference in means of 1.499 (p=0.030) and -2.019 (p=0.005), respectively. No significant difference was observed in the Depression and PSRA scores at the end of the season (Fig 1). A total of 31 significant injuries were reported. Injuries resulted in a significant change from pre-season to post-season scores amongst all participants (Fig 1). Conclusion: There were significantly worse pain interference and physical function scores post-season compared to preseason, suggesting that athletic participation alone may impact the athlete’s overall function and condition. Season-altering injuries resulted in clinically significant differences in all four domains, PI, PF, Depression, and PSRA, suggesting that injuries greatly affect athletes not only physically, but mentally and socially as well. Statistically significant changes were seen in depression and social metrics after injury compared to the athlete’s pre-season scores. Consideration should be given to index pre-season PROMIS scores for individual athletes to make follow-up scores athlete-specific, meaningful, and actionable. There is a clear need for additional investigation into the impact of specific sports and specific injuries, which would be valuable to trainers, coaches, and clinicians to inform treatment and return to sport protocols.

scholarly journals Computerized Adaptive Testing for Patient Reported Outcomes in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1192-1198 ◽  
Author(s):  
Elizabeth B. Gausden ◽  
Ashley Levack ◽  
Benedict U. Nwachukwu ◽  
Danielle Sin ◽  
David S. Wellman ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Patient Reported Outcomes ◽  
Computerized Adaptive Testing ◽  
Adaptive Testing ◽  
Ceiling Effect ◽  
Significant Difference ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Clinically Significant ◽  
Fracture Surgery

Background: Advantages of using computerized adaptive testing (CAT) include decreased survey-burden, diminished floor and ceiling effect, and improved ability to detect the minimal clinical significant difference (MCID) among patients. The goal of this study was to compare the legacy patient-reported outcome measures (PROMs) to the Patient-Reported Outcomes Measurement Information System (PROMIS) scores in terms of ability to detect clinically significant changes in patients who have undergone surgery for ankle fractures. Methods: Patients who underwent osteosynthesis for an unstable ankle fracture between 2013-2016 and completed legacy outcome scores (Foot and Ankle Outcome Score [FAOS], Olerud and Molander Ankle Score [OMAS], and Weber Score) along with the PROMIS Physical Function (PF) and PROMIS Lower Extremity (LE) CATs postoperatively were included. Correlation between the scores at 3-month, 6-month, and 1-year intervals, as well as floor and ceiling effects, in addition to MCIDs were calculated for each instrument. A total of 132 patients were included in the study. Results: There was no observed floor or ceiling effect in either the PROMIS PF or the PROMIS LE scores. Clinically significant changes in the PROMIS LE score were detected in patients between 6-month and 12-month postoperative visits ( P = .0006), whereas the reported OMAS score and Weber scores did not identify a clinically significant difference between patients at their 6-month and 12-month visit. Conclusion: The results of this study indicate that the PROMIS LE was superior for evaluating patients following ankle fracture surgery in terms of lower floor and ceiling effects and greater ability to distinguish clinically significant changes in patients between time points following surgery. Level of Evidence: Level III, comparative study.

scholarly journals Cross-cultural adaptation to Portuguese of a measure of satisfaction with participation of the Patient-Reported Outcomes Measurement Information System (PROMIS(r))

2015 ◽  
Vol 37 (2) ◽  
pp. 94-99
Author(s):  
Maria Cristina Lima e Silva ◽  
Tânia Maria da Silva Mendonça ◽  
Carlos Henrique Martins da Silva ◽  
Rogério de Melo Costa Pinto
Keyword(s):  
Information System ◽  
Cultural Adaptation ◽  
Patient Reported Outcomes ◽  
Item Bank ◽  
Self Report ◽  
Measurement Information ◽  
Outcomes Measurement ◽  
Patient Reported ◽  
Measurement Information System ◽  
The Impact

Background: Mental disorders often impair functioning in several areas of life and lead to unhappiness and suffering that may affect health-related quality of life (HRQoL). Satisfaction with participation is an indicator of HRQoL, and its measurement by patients reflects the impact of disease on their social, emotional and professional life. The Patient-Reported Outcomes Measurement Information System (PROMIS(r)) offers an item bank based on item response theory. This system provides efficient, reliable and valid self-report instruments of satisfaction with participation, a measure that is both scarce and useful in the assessment of mental disorder outcomes.Objective:To cross-culturally adapt the PROMIS(r) satisfaction with participation item bank to Portuguese.Methods:Cross-cultural adaptation followed the Functional Assessment of Chronic Illness Therapy (FACIT) multilingual translation method and was achieved through steps of forward and backward translations, review by bilingual experts (one of them a native of Portugal) and pretesting in a group of 11 adult native Brazilians. Instrument adaptation followed a universal approach to translation, with harmonization across languages.Results: Equivalence of meaning was achieved. As two of the 26 translated items, which asked about leisure and social activities, were not understood by less educated participants, an explanation in parentheses was added to each item, and the problem was solved. All items were appropriate and did not cause embarrassment to the participants.Conclusions: The satisfaction with participation item bank is culturally and linguistically suitable to be used in Brazil. After the pretest is applied in Portugal and in other Portuguese-speaking countries, the same instrument will be ready to be used in multinational studies.

scholarly journals Application of Patient Reported Outcomes Measurement Information System (PROMIS) in Elite Athletes

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Kenneth Hunt ◽  
Eric Lakey ◽  
Jesse Roberts ◽  
Pam Kumparatana
Keyword(s):  
Global Health ◽  
Normal Values ◽  
Elite Athletes ◽  
Short Form ◽  
Measurement Information ◽  
P Value ◽  
Patient Reported ◽  
Division 1 ◽  
History Of ◽  
Measurement Information System

Category: Sports Introduction/Purpose: Since its introduction into clinical practice, the Patient-Reported Outcome Measurement Information System (PROMIS) has become commonplace across multiple different orthopaedic sub-specialties for a wide variety of patient populations. PROMIS computer adaptive tests (CATs) are increasingly administered following injury and/or surgical intervention. Yet, a gap in the literature remains with regard to the results of PROMIS scores in populations that may not conform to mean normal values in the NIH PROMIS scoring database. Examples include young, healthy patients and young, elite athletes. Our objective was to evaluate the performance of scoring tools in six PROMIS domains in young, healthy non-athlete individuals and young, uninjured elite athletes, comparing both to National Institute of Health (NIH) developed normal PROMIS means and Standard deviations. Methods: In an IRB approved prospective cohort study, healthy subjects were recruited from a large University with a National Collegiate Athletic Association (NCAA) Division 1 athletics program between May and November 2017. Subjects were administered a one-time survey, including the following six PROMIS domains: Pain Interference CAT, Physical Functioning CAT, Mobility CAT, Social Functioning CAT, Depression CAT, and Global Health Short Form. Demographics included age, gender, sport and level of participation (where applicable), self-reported health status, history of recent orthopaedic injury, and history of foot/ankle surgery. Elite athletes were defined as participants > 18 years old actively participating in NCAA Division 1 athletics. Young people were defined as non-NCAA Division 1 athletes ages 18 to 35 years old. Following completion of data collection, results were analyzed using SAS 9.4. Results: The final cohort consisted of a total of 206 participants, which included 39 elite athletes, and 167 healthy non-athletes. All six PROMIS domains demonstrated statistically significant differences (p-value < 0.01) comparing elite athletes to NIH normal values. Compared to healthy non-athletes, elite athletes’ scores were all significant different (p-value < 0.01) except for the PROMIS Social Functioning CAT (p = 0.0766) and PROMIS Global Health Short Form Physical Functioning T-score (p = 0.0916). Furthermore, when elite athletes were compared to similar age undergraduates students (n = 25) only PROMIS Depression CAT and Global Health Short Form Mental Health T-score were statistically significant (p-value < 0.01). Conclusion: Elite athletes’ baseline PROMIS scores are significantly different than both the NIH normal values, and young healthy non-athletes across PROMIS domains. This highlights the need to interpret the results of elite athletes’ scores in the context of normal values for this specific population, and taking this into account over the of course of care following injury and/or surgery. There is a need for further research to establish baseline normal values for PROMIS scores for elite athletes and other populations of specific interest to the orthopaedic foot and ankle surgeon, to ensure proper interpretation of scores throughout the course of treatment.

scholarly journals High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery

2019 ◽  
Author(s):  
Nicholas J Drayer ◽  
Christopher S Wallace ◽  
Henry H Yu ◽  
Taylor D Mansfield ◽  
Danielle L Cummings ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Short Form ◽  
International Knee Documentation Committee ◽  
Active Duty ◽  
Knee Surgery ◽  
Postoperative Outcomes ◽  
Measurement Information ◽  
Significant Difference ◽  
Patient Reported ◽  
Arthroscopic Knee

Abstract Introduction Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes. Materials and Methods We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared. Results We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group. Conclusions Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.

scholarly journals Should Chopart Amputation be Performed in Diabetic Foot Ulcer Patients?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0011
Author(s):  
James D. Brodell ◽  
Judith F. Baumhauer ◽  
Benefict F. DiGiovanni ◽  
A. Samuel Flemister ◽  
John P. Ketz ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Patient Reported Outcomes ◽  
High Rate ◽  
Measurement Information ◽  
Prosthesis Fitting ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Syme Amputation

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Diabetic foot ulcers (DFU) with deep infections and osteomyelitis often lead to partial or complete limb loss. Determination of the appropriate level for amputation is challenging, and is a complex decision based on the patient’s function at baseline, extent of infection, vascular patency and comorbidities. Although Chopart amputation preserves greater limb length than Syme amputation, additional procedures, such as Achilles tenectomy and tendon transfers are necessary to optimize residual foot function. Challenges with wound healing and prosthesis fitting have been reported. We aimed to investigate the functional and clinical outcomes including patient reported outcomes of Chopart and Syme amputations. Methods: A query utilizing current procedural terminology (CPT) codes was performed to identify patients who had undergone Syme or Chopart amputations for diabetic foot infections by an academic orthopaedic group between August 2013 and September 2018. Twenty-two patients with average age of 59.8 (range, 28-79) years, comprising 18 Chopart amputations and 4 Syme amputations were identified. Demographic characteristics, body mass index, hemoglobin A1c, medical comorbidities, major and minor post-operative complications, unplanned admission or return to OR, revision surgeries, and time to receiving a brace or prosthesis information were compiled. After informed consent was obtained, subjects completed three Patient-Reported Outcomes Measurement Information Systems (PROMIS) instruments (Pain Interference (PI), Physical Function (PF), and Depression), and the SF-36. Unpaired student t-tests and Fisher’s exact test were utilized to compare patient cohorts. Statistical analysis was performed using Stata®. Results: The majority (17/18) of Chopart and half (2/4) of Syme patients developed complications including wound dehiscence and recurrent/persistent infection. Readmission and unexpected return to the OR for irrigation and debridement or revision occurred in 11/18 (61%) of Chopart and 2/4 (50%) of Syme patients. Revision amputations occurred in 10/18 (56%) Chopart patients (2 Syme, 8 BKA), and 1/4 (25%) Syme patients (BKA). Half of Chopart patients never received a prosthesis due to delayed wound healing and revision amputation. All Syme amputation patients received a prosthesis and resumed ambulation. The average time to prosthesis was 4.5 and 6.5 months for Syme and Chopart patients, respectively. There was no significant difference between Syme and Chopart patients in all PROMIS domains, or the SF-36 (p-values > 0.05) (Table 1). Conclusion: We found a high rate of complications and revision procedures in Chopart amputation patients. In our patient cohort, there was a high likelihood that a patient who underwent a Chopart amputation ultimately received a below knee amputation. Even after wound healing, patients with Chopart amputations may struggle with obtaining a prosthesis suitable for ambulation. Syme amputation patients were less likely to require revision amputation, and received a prosthesis more rapidly relative to Chopart amputation patients. The complication and revision rates of Chopart amputations indicate that surgeons should exercise judicious patient selection prior to performing these procedures.

scholarly journals Patient-reported outcomes in RA care improve patient communication, decision-making, satisfaction and confidence: qualitative results

Rheumatology ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 1662-1670 ◽  
Author(s):  
Susan J Bartlett ◽  
Elaine De Leon ◽  
Ana-Maria Orbai ◽  
Uzma J Haque ◽  
Rebecca L Manno ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Patient Reported Outcomes ◽  
Medical Decision ◽  
Measurement Information ◽  
Shared Decision ◽  
Clinic Staff ◽  
Patient Reported ◽  
The Impact

Abstract Objective To evaluate the impact of integrating patient-reported outcomes (PROs) into routine clinics, from the perspective of patients with RA, clinicians and other staff. Methods We conducted a prospective cohort study using a mixed methods sequential explanatory design at an academic arthritis clinic. RA patients completed selected Patient-Reported Outcomes Measurement Information System measures on tablets in the waiting room. Results were immediately available to discuss during the visit. Post-visit surveys with patients and physicians evaluated topics discussed and their impact on decision making; patients rated confidence in treatment. Focus groups or interviews with patients, treating rheumatologists and clinic staff were conducted to understand perspectives and experiences. Results Some 196 patients and 20 rheumatologists completed post-visit surveys at 816 and 806 visits, respectively. Focus groups were conducted with 24 patients, 10 rheumatologists and 4 research/clinic staff. PROs influenced medical decision-making and RA treatment changes (38 and 18% of visits, respectively). Patients reported very high satisfaction and treatment confidence. Impact on clinical workflow was minimal after a period of initial adjustment. PROs were valued by patients and physicians, and provided new insight into how patients felt and functioned over time. Reviewing results together improved communication, and facilitated patient-centred care, shared decision making, and the identification of new symptoms and contributing psychosocial/behavioural factors. Conclusion PRO use at RA visits was feasible, increased understanding of how disease affects how patients feel and function, facilitated shared decision-making, and was associated with high patient satisfaction and treatment confidence.

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