PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia

Abstract

Background: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). Purpose: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. Results: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain ( r = −0.66; P < .0001) and mHHS ( r = −0.60; P < .0001) preoperatively and the HOOS pain ( r = −0.64; P < .0001) and mHHS ( r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL ( r = 0.51; P < .0001) and mHHS ( r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL ( r = 0.56; P < .0001) and mHHS ( r = 0.56; P < .0001). Conclusion: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

Editorial Commentary: Patient-Reported Outcomes Measurement Information System (PROMIS) Has Decreased Disease-Specific Responsiveness More Than Legacy Outcome Measures, But PROMIS and Legacy Measures Do Correlate: You Can’t Have Your Cake and Eat It Too

“…The moderately strong correlation at 6 months after surgery reported by Nwachukwu et al 10 is slightly different, given that prior studies have shown a strong correlation of PROMIS PF to the iHOT-12, including the current authors' prior research. [7][8][9] In my opinion, all these studies confirm what multiple authors have concluded: PROMIS PF, which is a general measure of physical function, correlates to legacy hip measures. Nwachukwu et al chose to compare the relative efficiency (RE) of one measure with that of another.…”

“…Multiple authors have shown moderately strong to strong correlations of PROMIS measures to legacy hip scores. [7][8][9] PROMIS, specifically PROMIS Physical Function (PF), has previously been shown to strongly correlate to legacy measures. 7,8 With correlation, we must ask ourselves, Is the correlation meaningful?…”

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

“…Also, the use of several PROs designed for active patients with nonarthritic hips limits a potential ceiling effect. 27,55 The current study aimed for a narrow patient population in the hip preservation field; nonetheless, an adequate sample size based on a priori power analysis was achieved for the study and control groups. Additionally, to surpass statistical significance and demonstrate clinical significance, the fraction of patients who achieved the MCID for the mHHS, NAHS, HOS-SSS, and VAS was calculated.…”

Measures of Hip Function and Symptoms

“…There has been little overall study on psychometric properties of the PROMIS score in relation to hip pathology. In a study of patients who underwent periacetabular osteotomy for symptomatic hip dysplasia, PROMIS showed no floor or ceiling effects both pre‐ and postoperatively . When studied in patients who underwent THA for symptomatic hip osteoarthritis, the PROMIS depression domain showed floor effects up to 20% preoperatively and 30% to 45% postoperatively .…”

“…The HOOS is one of the more common patient‐reported measures of hip function and postoperative outcomes. It has been used extensively in THA clinical studies , hip dysplasia surgery , hip arthroscopy , and even in development of pain management protocols after hip surgery . The HOOS‐JR has only existed since 2016 and is intended mainly for THA, but it has been used in recent trials related to THA outcomes .…”