PROMIS Utilization in Pediatric Orthopaedics: A Scoping Review

Abstract

Background: The lack of a common patient-reported outcome metric used among the orthopaedic population is a problem that has been previously identified by the American Academy of Orthopaedic Surgeons. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health with the goal of creating a precise and efficient measurement tool for patient-reported symptoms, functioning, and health-related quality of life to be used in clinical research. A study summarizing its use in the pediatric orthopaedic population has not been previously performed. Methods: We performed a literature search of Ovid Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 2010 to August 2021. There were 1961 unique citations included after the removal of 1756 duplicates. After initial screening, 183 studies were screened under full-text review leaving a final number of 51 studies included in this scoping review. Results: Pediatric PROMIS studies were grouped by body part or sub-speciality: "Hand and Upper Extremity" (25.5%, n = 13), "Sports" (23.5%, n = 12), "Spine" (13.7%, n = 7), "Trauma" (13.7%, n = 7), "General Pediatric Orthopaedics" (11.8%, n = 6), "Lower Extremity" (9.8%, n = 5), and "Orthopaedic Oncology" (2%, n = 1). An increase in studies utilizing PROMIS was seen throughout the study period with only 3 studies published from 2013 to 2016 to 39 in 2020 and 2021 alone. The 3 most frequently used pediatric PROMIS domains were Pain Interference (76.5%, n = 39/51), Mobility (60.8%, n = 31/51), and Upper Extremity (54.9%, n = 28/51). 64.3% (n = 9/14) of the included studies which reported on the floor effects of Pain Interference exhibited a significant floor effect. In all, 77.8% (n = 7/9) of the included studies which reported on ceiling effects of Upper Extremity exhibited a significant ceiling effect. Conclusion: The use of PROMIS increased significantly since the first publication in 2013 suggesting orthopaedic providers have increasingly utilized PROMIS in their day-to-day practice as an outcome measure. Ceiling and floor effects were prominent in several of the included domains (Pain Interference and Upper Extremity). Overall, PROMIS measures are efficient, reliable, and effective to use. Level of Evidence: IV.

Challenges and Opportunities for the Use of Patient-Reported Outcome Measures in Orthopaedic Pediatric and Sports Medicine Surgery

“…Pediatric orthopaedics has also observed an upward trend in the administration of PROMIS as an abbreviated yet responsive metric for assessing outcomes. 33 Regarding novel delivery methods, Mellor et al 34 validated the collection of two PROMs in pediatric sports medicine (Pedi-IKDC and Pedi-Fab scale) with automated text messaging and found that mobile PROM delivery provided a valid assessment of these metrics and may increase compliance while reducing the labor cost of collecting paper PROMs. Continued investigation of the use of metrics that allow for increased access will help understand outcomes in novel manners and potentially resolve limitations with PROM compliance.…”

Validation of Patient-Reported Outcome Measurement Information System for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma

“…16 PROMIS has been used prior in the pediatric orthopaedic population and has continued to increase in popularity, likely due to its efficiency and reliability. 17 The PROMIS Pediatric Anger and Anxiety item banks (both v1.1) contain 22 and 13 items, respectively, and have demonstrated good performance and appropriate psychometric properties in assessing emotional states across a range of medical diagnoses for children as young as 5 years old (Tables 1, 2). [18][19][20][21] Given the lack of efficient and effective PTSD screening tools in pediatric orthopaedics, the purpose of this study was to evaluate measurement properties of the PROMIS Anger and Anxiety instruments in pediatric patients who have undergone procedures or surgery for orthopaedic trauma and to determine the ability of these instruments to detect those children at risk for developing PTSD when compared with the current standard, the Child PTSD Symptom Scale (CPSS).…”

“…[18][19][20][21] Given the lack of efficient and effective PTSD screening tools in pediatric orthopaedics, the purpose of this study was to evaluate measurement properties of the PROMIS Anger and Anxiety instruments in pediatric patients who have undergone procedures or surgery for orthopaedic trauma and to determine the ability of these instruments to detect those children at risk for developing PTSD when compared with the current standard, the Child PTSD Symptom Scale (CPSS). 17…”

“…16 PROMIS has been used prior in the pediatric orthopaedic population and has continued to increase in popularity, likely due to its efficiency and reliability. 17…”