scholarly journals Psychometrics of three Swedish physical pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®: pain interference, fatigue, and physical activity

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Frida Carlberg Rindestig ◽  
Marie Wiberg ◽  
John Eric Chaplin ◽  
Eva Henje ◽  
Inga Dennhag

Abstract Background The Patient-Reported Outcomes Measurement Information System (PROMIS®) aims to provide self-reported item banks for several dimensions of physical, mental and social health. Here we investigate the psychometric properties of the Swedish pediatric versions of the Physical Health item banks for pain interference, fatigue and physical activity which can be used in school health care and other clinical pediatric settings. Physical health has been shown to be more important for teenagers’ well-being than ever because of the link to several somatic and mental conditions. The item banks are not yet available in Sweden. Methods 12- to 19-year-old participants (n = 681) were recruited in public school settings, and at a child- and psychiatric outpatient clinic. Three one-factor models using CFA were performed to evaluate scale dimensionality. We analyzed monotonicity and local independence. The items were calibrated by fitting the graded response model. Differential Item analyses (DIF) for age, gender and language were calculated. Results As part of the three one-factor models, we found support that each item bank measures a unidimensional construct. No monotonicity or local dependence were found. We found that 11 items had significant lack of fit in the item response theory (IRT) analyses. The result also showed DIF for age (seven items) and language (nine items). However, the differences on item fits and effect sizes of McFadden were negligible. After considering the analytic results, graphical illustration, item content and clinical relevance we decided to keep all items in the item banks. Conclusions We translated and validated the U.S. PROMIS item banks pain interference, fatigue and physical activity into Swedish by applying CFA, IRT and DIF analyses. The results suggest adequacy of the translations in terms of their psychometrics. The questionnaires can be used in school health and other pediatric care. Future studies can be to use Computerized Adaptive Testing (CAT), which provide fewer but reliable items to the test person compared to classical testing.

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0001
Author(s):  
Andrew Haskell ◽  
Todd Kim

Category: Other Introduction/Purpose: The use of computerized adaptive testing (CAT) allows measurement of patient reported outcomes (PROs) through the fewest number of questions while achieving a higher precision, diminished floor and ceiling effects, and minimal administration burden compared with traditional methods. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks that measure key clinical domains. Each item bank has as few as 4 questions or up to 12 questions depending on the subject’s answers. This study describes a method of administering the PROMIS CAT in a high volume Orthopedic Surgery practice, reports the administration burden and rate of patient capture, compares this population to previously reported national standards, and compares preoperative to postoperative pain item banks. Methods: The PROMIS CAT was intended to be collected prospectively for all patients as part of a standard intake. Patients used a tablet-based program that accesses the NIH PROMIS server generating a CAT in English or Spanish. Clinical domains include physical function, pain intensity, pain interference, global physical health, and global mental health. Scores for each domain and the time required were recorded in the patient’s electronic medical record (EMR) as part of their clinic visit, preserving confidentiality of the data and preventing the need for a separate database. De-identified data was retrospectively extracted from the EMR of every patient from March to December 2015. Results for each domain were compared to validated national norms using single variable t-test. Linear regression was used to assess the effect of age on outcome variables. Paired t-test was used to compare preoperative and postoperative pain intensity and pain interference when these scores were available. Results: 1688 PROMIS CATs were administered during 5345 visits (32%), reaching 70% as logistical issues were resolved. Patient age was 53±16. Completing the CAT required 157±164 seconds, with older patients taking 10.5 more seconds per decade (p < 0.05). The PROMIS item banks are normalized to mean 50±10 for the US population. Our results were: pain intensity 47.8±8.6*, pain interference 57.9±8.8*, physical function 40.1±9.0*, global physical health 43.3±9.6*, and global mental health 48.4±8.9 (*p < 0.05). Age has a small effect on all domains (p < 0.05). Approximately 20 patients are required to demonstrate a 15% change for a two-tailed, paired study with α=0.05 and 80% power. 109 patients had pre and postoperative PROMIS data. Pain intensity improved from 51.8±7.8 to 44.6±8.6 (p < 0.001) and pain interference improved from 60.1±8.8 to 55.5±9.0 (p < 0.001). Conclusion: Using tablets to access PROMIS CATs and entering the data in the patient’s chart for later retrieval is an effective technique to collect PROs in a busy Orthopedic Surgery practice with limited resources and no research coordinator. The process adds 2.5 minutes to a patient’s intake and does not require a complicated database or expensive equipment or licensing. Adequate number of tablets and “buy in” from staff are needed for acceptable completion rates. Demonstrating improvement in PROs after surgery holds promise for comparative studies of surgical indications and techniques and highlights the value these interventions add to patient care.


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