Purpose The purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs. Methods Participants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey. Results In all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096). Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion PROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients. Level of Evidence II

Background: In young athletes, patient-reported activity level is frequently used to determine return to the same level of sport after treatment. Purpose: To evaluate the validity and score distributions of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) compared with the Tegner Activity Level Scale (Tegner) in pediatric athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A retrospective review of 517 consecutive youth athletes who came to a sports medicine specialty clinic for a knee evaluation was performed. Patients completed the HSS Pedi-FABS, Tegner, and a sports participation survey before evaluation. Scores were compared with reported hours, days, and weeks of participation in sports as well as level of competition. Floor or ceiling effects were identified, and finally, the means and distributions of scores in the 8 most common primary sports were analyzed. Results: A total of 398 participants (54.0% female) with an average age of 14.5 years (range, 10.0-18.8 years) were included in the study. The HSS Pedi-FABS demonstrated correlations with hours per week ( r = 0.302; P < .001), days per week ( r = 0.278; P < .001), and weeks per year ( r = 0.136; P = .014) playing a primary sport. The Tegner only demonstrated a correlation with days per week ( r = 0.211; P = .001). Additionally, club/select-level athletes scored higher than junior high/high school–level athletes on the HSS Pedi-FABS (23.8 vs 21.0; P = .004), but no difference was observed with the Tegner. No floor or ceiling effect was observed for the HSS Pedi-FABS, but a ceiling effect was present for the Tegner (32.8%). The HSS Pedi-FABS demonstrated a varied score distribution between the 8 most common primary sports ( P < .001), with soccer players scoring the highest, on average (23.5). Conclusion: The HSS Pedi-FABS, compared with the Tegner, demonstrated more correlations with an athlete’s participation in sport with no floor or ceiling effect and had a wide distribution of scores even among same-sport athletes. The HSS Pedi-FABS may be a more valuable activity measure than the Tegner in pediatric athletes.

BACKGROUND: Patient reported outcome measures (PROMs) measuring activity level can be crucial to a musculoskeletal provider in both a clinical and research setting. The HSS Pedi-FABS was developed as a generalizable measure of activity in children ages 10-18. However, existing literature validating this scale is limited by small patient populations leading to underrepresentation of multiple sports. The purpose of this study is to assess the validity of the HSS Pedi-FABS when used in a large pediatric population participating in various sports and evaluate the means and distribution of Pedi-FABS amongst common sports. METHODS: A retrospective review of 517 subjects who completed the HSS Pedi-FABS while presenting for knee evaluation was performed. Subjects were seen by one of five providers at a pediatric sport medicine center between October 2016 and June 2017. Subjects were included in analysis if they completed the HSS Pedi-FABS and had reported status as an athlete. Patient demographics, primary sport, multi-sport involvement, level of competition, frequency of play, HSS Pedi-FABS and Tegner Activity Level Scale (Tegner) scores were reviewed. The Tegner asked subjects to classify their activity level prior to injury. To determine validity, the HSS Pedi-FABS was compared to the Tegner. S-correlations were calculated between the two activity scales. Each scale was then correlated with level of activity and frequency of play. A t-test was run between the HSS Pedi-FABS scores and multi-sport involvement. Distributions of the HSS Pedi-FABS scores were calculated across the eight most frequent primary sports reported by the sample population. ANOVA analyses were performed with the HSS Pedi-FABS and Tegner Before scores of the eight primary sports. The ANOVA analyses were followed by t-tests for multiple comparisons. RESULTS: Of the 424 athletes included in the study, 227 (53.5%) were female and 197 (46.5%) were male. The mean age was 14.29 years (range: 6.48-22.35). 207 (48.8%) were multi-sport athletes while 215 (50.7%) were considered single-sport athletes. 2 (0.5%) had an unknown status. There was a significant difference between HSS Pedi-FABS scores of multi-sport athletes versus single-sport athletes (22.0 versus 20.36, respectfully, p=.027). Correlations were found between the HSS Pedi-FABS and days per week playing a primary sport (r=0.273; p<0.001), hours per week playing primary sport (r=0.292, p<0.001), and weeks NOT engaged in sports (r=-0.112, p=0.039). In this data, there was no correlation with perceived level of competition and HSS Pedi-FABS. There was no statistical correlation found between the HSS Pedi-FABS and the Tegner with a similar mean HSS Pedi FABS scores seen in each Tegner group >5. The Tegner scale did not statistically correlate with hours per week or days per week. The HSS Pedi-FABS showed a significant difference in scores between the eight most frequent primary sports (p=0.001). Subjects whose primary sport was Soccer scored significantly higher (23.57 ± 6.27) than those of Dance/Drill Team/Ballet (17.45 ± 6.38) and Track and Field/Running/Cross Country (17.47 ± 5.74, p=.001, .024). Frequency distributions of each sports are seen in Figure 1. CONCLUSION: The HSS Pedi-FABS, as compared to the Tegner, has significant correlation with time spent while playing a primary sport. Normal distribution of the HSS Pedi FABS may be different based on sports. Further analysis of multiple joints could provide a more comprehensive understanding of Pedi-FABS scoring trends in pediatric athletes. [Figure: see text]

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]