Performance of PROMIS Physical Function, Pain Interference, and Depression Computer Adaptive Tests Instruments in Patients Undergoing Meniscal Surgery

Abstract

Purpose To compare the performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PIF), and depression computer adaptive tests (CAT) relative to legacy instruments in patients undergoing meniscal surgery. Methods Patients scheduled to undergo meniscal surgery completed legacy knee function PROMs (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] subscores), Marx Activity Rating Scale (MARS), Veterans-Rand 12 (VR12), Short Form 12 (SF12), and the Brief Resilience Scale (BRS) alongside PROMIS PF, PIF, and Depression preoperatively. Spearman rank correlations were calculated, and score distributions were examined for floor and ceiling effects. Results 152 patients (46.6 ± 14.9 years, 67.1% male) completed PROMs for appropriate inclusion. PROMIS PF yielded high-moderate to high correlations with the IKDC and KOOS subscales ( r = 0.61 to 0.73), demonstrating similar performance to the IKDC. PROMIS PIF demonstrated moderately high-moderate to high correlations with the IKDC, KOOS subscales, VR-12 Physical Component Score (PCS), and SF12 PCS ( r = 0.62 to 0.71), performing comparably to KOOS Pain ( r = 0.55 to 0.92). PROMIS Depression demonstrated moderate to high-moderate correlations with the mental health legacies ( r = 0.46 to 0.66). Significant ceiling effects were observed for MARS (n = 29, 18.8%), and significant floor effects were exhibited by PROMIS Depression (n = 38, 25%) and MARS (n = 27, 17.6%). Conclusion The PROMIS PF, PIF CAT, and Depression instruments exhibit comparable performance profiles relative to legacy knee PROMs. PROMIS PF and PIF demonstrated no floor and ceiling effects, whereas PROMIS Depression exhibited a significant relative floor effect. PROMIS PF and PIF may be appropriately used to establish functional baselines preoperatively. Level of Evidence IV, diagnostic case series.

Preoperative Patient-Reported Outcomes Measurement Information System Computerized Adaptive Testing (PROMIS CAT) Scores Predict Achievement of Minimum Clinically Important Difference Following Anterior Cruciate Ligament Reconstruction Using an Anchor-Based Methodology

“…PROMIS CAT has been demonstrated to have strong responsiveness and minimal floor and ceiling effects in patients with knee pathology. 7,38 Thus, the use of PROMIS CAT forms as well as the findings of the present investigation can be beneficial in the shared decision-making process with patients who have suffered from ACL tears. For example, a moderately active 50-year-old female with an ACL tear who has pre-operative PROMIS CAT scores consistent with high physical function (PROMIS PF CAT >50.7) and low pain interference (PROMIS PI CAT <51.7) based on the calculated prognostic cutoffs may not receive a significant clinical benefit following ACLR and resultantly can be educated on alternative treatment options to surgical intervention.…”

“…3,4 In addition, PROMIS CAT health domains allow for a multifaceted evaluation of patient outcomes by interpreting pain interference (PROMIS PI CAT), physical function (PROMIS PF CAT), and depression (PROMIS D CAT) separately. 1,6,7 Recently, PROMIS CAT measures have demonstrated utility in measuring responsiveness to treatment following various orthopedic interventions. [8][9][10] However, postoperative statistical score improvements may not indicate clinical improvement.…”

“…3 , 4 In addition, PROMIS CAT health domains allow for a multifaceted evaluation of patient outcomes by interpreting pain interference (PROMIS PI CAT), physical function (PROMIS PF CAT), and depression (PROMIS D CAT) separately. 1 , 6 , 7 …”

Age Significantly Affects Response Rate to Outcomes Questionnaires Using Mobile Messaging Software

“…A majority of studies reporting data on implementing clinic-based PRO measures and mobile applications for postoperative follow-up have enrolled young patients with an average age less than 60 years old 15 , 16 , 17 , 18 , 19 , 20 ; however, there is suggestion that older age may influence response times of patient reported outcomes. In a cross-sectional study of 3658 PROMIS forms administered in ambulatory clinics, Kadri et al.…”

“…for patients >49 years old. Patient age and sex did not significantly affect TTR or TTC for VAS, PROMIS-PI, or side-effect questions.A majority of studies reporting data on implementing clinic-based PRO measures and mobile applications for postoperative follow-up have enrolled young patients with an average age less than 60 years old[15][16][17][18][19][20] ; however, there is suggestion that older age may influence response times of patient reported outcomes. In a crosssectional study of 3658 PROMIS forms administered in ambulatory clinics, Kadri et al14 found that patients from the oldest age quartile (mean AE standard deviation, 70.3 AE 7.5 years) had a statistically significant longer TTC as compared with the second quartile (41.2 AE 4.7 years) (3.70 vs 2.87 minutes; P < .05).…”