PROMIS Correlates With Legacy Outcome Measures in Patients With Neck Pain and Improves Upon NDI When Assessing Disability in Cervical Deformity

Abstract

Study Design. Retrospective cohort study. Objective. To evaluate the ability of patient reported outcome measurement information system (PROMIS) assessments to capture disability related to cervical sagittal alignment and secondarily to compare these findings to legacy outcome measures. Summary of Background Data. PROMIS is a validated patient-reported outcome metric that is increasing in popularity due to its speed of administration relative to legacy metrics. The ability of PROMIS to capture disability from sagittal alignment and baseline health status in patients with neck pain has not been investigated. Methods. Patients presenting with a chief complaint of neck pain from December 2016 to July 2017 were included. Demographics and comorbidities were retrospectively collected. All patients prospectively completed the neck disability index (NDI), EQ-5D, visual analog scale (VAS) neck, VAS arm, PROMIS physical function, PROMIS pain intensity, and PROMIS pain interference metrics. Cervical sagittal alignment parameters were measured on standing X-rays. The correlations between outcome measures, health status indexes, psychiatric diagnoses, and sagittal alignment were analyzed. Results. Two hundred twenty-six patients were included. The sample was 58.4% female with a mean age of 55.1 years. In patients with neck pain, PROMIS physical function correlated strongly with the NDI (r = −0.763, P < 0.01), EQ-5D (r = 0.616, P < 0.01), VAS neck pain (−0.466, P < 0.01), and VAS arm pain (r = −0.388, P < 0.01). One hundred seventy-seven patients (69.96%) were included in the radiographic analysis. 20.3% of the radiographic cohort had cervical deformity and in this group, less cervical lordosis correlated with PROMIS pain intensity and EQ-5D but not NDI. In patients without cervical deformity, no outcome metric was found to correlate significantly with cervical alignment parameters. Conclusion. PROMIS domains correlated strongly with legacy outcome metrics. For the whole cohort, sagittal alignment was not correlated with outcomes. In patients with sagittal cervical deformity, worsening alignment correlated with PROMIS pain intensity and EQ-5D but not NDI. Level of Evidence: 3

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

“…However, it should be noted that by the 2-year timepoint, VAS arm demonstrated significant correlations with PROMIS that were similar to those of other PROMs in our study and were in line with findings of previous research. 32 Our findings support the convergent validity of PROMIS PF as a tool to evaluate patient health status. Unlike NDI, PROMIS is a general health measure that can be utilized among various patient populations and conditions.…”

Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature

“…McGregor slope was significantly correlated with NDI. Johnson et al found C1-C2 lordosis did not correlate significantly with any PROMIS domain or legacy metric 22 . However, Zhong et al reported a significant correlation between the change in C1-C2 lordosis after surgery and JOA (r=-.060), NDI (r=0.676), and SF-12 (r=−0.592) 29 .…”

“…Eight studies investigated the relationship between cervical lordosis minus T1 slope (TS-CL) and PROs 4,16,19,22,24,25,27,28 . Meta-analyses of correlation coefficients showed that NDI and EQ-5D correlated poorly with TS-CL [NDI Random Effect; Zr = 0.04 [95% CI: -0.23, 0.30]; P =.001] and EQ-5D Random Effect; r = 0.07 [95% CI: -0.24, 0.37]; P =0.02) (Figure 3 25 at baseline.…”

“…Meta-analyses of correlation coefficients showed that NDI and EQ-5D correlated poorly with TS-CL [NDI Random Effect; Zr = 0.04 [95% CI: -0.23, 0.30]; P =.001] and EQ-5D Random Effect; r = 0.07 [95% CI: -0.24, 0.37]; P =0.02) (Figure 3 25 at baseline. Fair (r=0.327 22 ) and weak (r=0.14 31 ; r=-0.218 16 ) correlations between TS-CL and EQ-5D were reported in three studies indicating that there was a low likelihood that a change TS-CL was associated with a strong change in EQ-5D. 22,31,32 The correlation of chin-brow vertical angle (CBVA) with PROs was examined in 2 studies 24,25 .…”

PROMIS physical health domain scores are related to cervical deformity severity

“…The PROMIS domain of PF specifically has been shown to negatively correlate with the NDI. [910] However, there is a paucity in the literature investigating the relationship between PROMIS physical health domain metrics and established Ames CD radiographic classification.…”