Evaluating the Concurrent Validity of PROMIS Physical Function in Anterior Cervical Discectomy and Fusion

Abstract

Study Design: This study was a retrospective cohort analysis. Objectives: This study aims to evaluate the concurrent validity of Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain as compared with legacy measures of patient-reported outcomes (PROs) among patients undergoing anterior cervical discectomy and fusion (ACDF). Summary of Background Data: As PROMIS becomes increasingly utilized, it is important to assess its validity among procedure-specific populations. Methods: Patients undergoing a primary, 1–3 level ACDF were retrospectively identified from a prospectively maintained surgical registry. PROMIS PF and legacy PRO scores were obtained at preoperative, 6-week, 12-week, and 6-month postoperative visits. Legacy PROs included Neck Disability Index (NDI), Short Form-12 (SF-12) physical composite, Visual Analog Scale (VAS) neck pain, and VAS arm pain. Postoperative improvements in PROs were assessed using paired t tests. Correlations between PROMIS and legacy PROs were tested using Pearson correlation coefficient. Results: A total of 57 ACDF patients were analyzed. The mean preoperative PROMIS PF was 40.0±6.4. PROMIS PF significantly improved at 12-week and 6-month follow-up. NDI, VAS neck pain, and VAS arm pain scores demonstrated significant improvement at all postoperative time points. SF-12 scores only exhibited significant improvement at the 6-month follow-up visit. Significant correlations between PROMIS PF, NDI, and SF-12 were identified at all preoperative and postoperative time points. PROMIS PF exhibited strong correlations with VAS neck pain at postoperative time points, and a moderate correlation preoperatively. Conclusions: Patients undergoing a primary 1–3 level ACDF experience significant improvements in PROMIS PF scores at 12-week and 6-month follow-up. Furthermore, PROMIS PF exhibits strong correlations to NDI and SF-12 at all preoperative and postoperative time points. These results suggest that PROMIS PF accurately measures PF and may be used in lieu of legacy PF instruments for patients undergoing ACDF.

Patient-Reported Outcomes Measurement Information System Physical Function Validation for Use in Anterior Cervical Discectomy and Fusion: A 2-Year Follow-up Study

“…12 PROMIS PF is most commonly used in spine surgery and is beneficial for understanding range of motion, mobility, and postoperative coordination. 20 PROMIS PF has been increasingly used to psychometrically evaluate pre and postoperative outcomes of spinal surgery. 11,27 Multiple investigations of multilevel ACDFs have shown that PROMIS PF correlates with NDI and SF-12 during preoperative and short-term postoperative time points.…”

“…11,27 Multiple investigations of multilevel ACDFs have shown that PROMIS PF correlates with NDI and SF-12 during preoperative and short-term postoperative time points. 20 One study further highlighted that PROMIS PF can accurately compare patient improvement from preoperative scores out to 1 year postopera- tively. 28 Vaishnav et al 29 found significant associations between NDI and PROMIS PF, as well as between SF-12 PCS and PRO-MIS PF.…”

“…7 With respect to cervical spine procedures, studies have since confirmed moderate-to-strong correlations of PROMIS with legacy PROMs such as NDI, modified JOA, ODI, SF-36/SF-12, and VAS ranging from 6 to 12 months of follow-up. [18][19][20][21][22][23][24] Among ACDF patients, PROMIS PF exhibits strong correlations with SF-12 and NDI at both preoperative and short-term postoperative time points. 20,25 However, among cervical spine patients the literature is lacking in studies which assess longitudinal correlations between PROMIS and legacy PROMs, which extend past one year.…”

“…[18][19][20][21][22][23][24] Among ACDF patients, PROMIS PF exhibits strong correlations with SF-12 and NDI at both preoperative and short-term postoperative time points. 20,25 However, among cervical spine patients the literature is lacking in studies which assess longitudinal correlations between PROMIS and legacy PROMs, which extend past one year. The purpose of this study is to evaluate the longitudinal correlations between PROMIS PF and legacy PROMs over a 2-year period among ACDF patients.…”

The Relationship Between Preoperative PROMIS Scores With Postoperative Improvements in Physical Function After Anterior Cervical Discectomy and Fusion

“…[9][10][11][12] The development of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) reflects an improvement in many of these shortcomings, and furthermore, is becoming increasingly validated with respect to ACDF procedures. 13,14 An analysis of PROMIS PF scoring is ideal for ACDF procedures because the system allows for a more global health assessment, fewer questions, and without the need to administer different questionnaires for separate anatomical locations (e.g., arm, neck, etc.). These new strengths increase the utility of PROMIS and may reduce clinical burden.…”