Association of Physical Function, Anxiety, and Pain Interference in Nonshoulder Upper Extremity Patients Using the PROMIS Platform

Abstract

Purpose The relationship between psychosocial factors and self-reported physical function among hand and upper extremity patients is complex. The Patient-Reported Outcomes Measurement Information System (PROMIS) platform has attempted to create a variety of specifically-targeted metrics which can be administered using computer adaptive testing (CAT). Three metrics measuring self-reported physical function (herein referred to in combination as “functional” metrics) include the PROMIS Physical Function (PF) CAT, PROMIS Upper Extremity (UE) CAT, and the quick-Dash (qDASH). Two metrics assessing psychosocial factors include the PROMIS Anxiety and Pain Interference (PI) CATs (“non-functional” metrics). This study evaluates whether the functional metrics were correlated with non-functional metrics. Methods The five questionnaires were administered prospectively on a tablet computer to all consecutive adult patients presenting to outpatient hand and upper extremity (non-shoulder) clinic at a tertiary academic medical center from 1/1/2014 – 11/1/2014. For patients with multiple visits during the study period, only the first was included. Data were evaluated retrospectively to assess the relationship between functional and non-functional measures, with Pearson correlation coefficients to understand the relationship between continuous variables, and one-way ANOVAs to examine for differences in outcome measures across demographic groups. Multivariable linear regression analyses were performed to determine factors predicting functional disability. Results We included 1299 patients: mean age was 46.8 years, 53% were female, and 23% were unemployed or on disability. The PROMIS PF CAT, PROMIS UE CAT, and qDASH scores were all significantly correlated with PROMIS Anxiety CAT (Pearson correlation coefficients −0.46, −0.48, and 0.53, respectively) and PROMIS PI CAT (−0.60, −0.65, and 0.76, respectively) scores. Multivariable regression analyses demonstrated that increased PROMIS Anxiety and Pain Interference CAT scores each independently and adversely influenced PROMIS PF CAT, PROMIS UE CAT, and qDASH scores. Conclusions Increasing levels of patient anxiety and pain interference are independently associated with decreased patient-reported upper extremity function. Clinical Relevance Statement This study provides further support of the biopsychosocial model by highlighting that increased anxiety is associated with decreased self-reported function using the PROMIS platform.

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

“…10 Similarly, in a study of patients with nonshoulder upper extremity pain, Kazmers and colleagues 9 reported Pearson correlation coefficients between PROMIS-PI and both PROMIS-PF and PROMIS-UE of –0.60 and –0.65, respectively. 9 Similar findings were reported in patients with hallux valgus, in which PROMIS-PI and PROMIS-PF demonstrated a correlation of –0.76, compared with a correlation of –0.44 between PROMIS-Depression and PROMIS-PF. 15 These 3 studies included a largely adult-aged population.…”

Determinants of Pain and Predictors of Pain Relief after Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

“…As such, patients with improved pain are less likely to report perceived disability and impaired function. 34 Improvement in range of motion did not correlate with pain relief. In the present cohort, there was no significant improvement in ROM, and preoperative ROM was well within the functional range of motion of the wrist.…”

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

“…These values were similar to those previously published in patients with upper extremity injuries, with PROMIS-UE scores ranging from 34 to 37 and PROMIS-PI scores ranging from 57 to 59. 5,11,16 Baseline PROMIS-UE and PROMIS-PI scores in our study showed higher impairment, as only preoperative scores were considered, which provides a clearer picture of what an impaired patient with upper extremity injuries may demonstrate compared with the other cross-sectional correlation studies. The mean PROMIS-D score in this cohort was 48.4, approximately the mean score across the normative population and similar to previously reported PROMIS-D outcomes in patients with upper extremity injuries.…”

“…The correlation we found between the PROMIS-UE and PROMIS-PI was similar to that previously reported in patients with upper extremity injuries ( R = –0.60 and –0.65, respectively). 11,16 However, aiming for more generalizable results, those studies included all new, returning, and postoperative patients. The relationship between upper extremity physical function and depression found in our study is unlike previous reports that found depression and patient distress to negatively affect preoperative PROs in patients with rotator cuff injuries.…”

“…Several prior studies have already demonstrated a good correlation between PROMIS physical function scores and these legacy PRO measures. 1,2,4,12,16,22,23 Second, baseline MHI data were estimated based on the patient’s ZIP code of residence. These aggregate income data are commonly used because household income is not commonly reported in the EMR.…”