Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) for Operative Shoulder Outcomes

Abstract

Background: Few studies have investigated the relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy patient-reported outcome (PRO) measurements. Purpose: To compare patient-reported outcomes from the PROMIS physical function (PF) and upper extremity (UE) platforms against one another and against legacy PRO measurements to assess the potential strengths and weaknesses of the National Institutes of Health PROMIS initiative and expand on the use of PRO measurements in clinical orthopaedic practice. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted following PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. All English-language studies published between 2017 and 2019 using PROMIS to evaluate patients for shoulder surgery were analyzed. PROs were compared based on survey administered and the shoulder condition being investigated. Study quality was evaluated using the Modified Coleman Methodology Score and the Methodological Index for Non-Randomized Studies score. Results: We included 9 studies (5 studies were level 2; 3 studies were level 3; 1 study was level 4) encompassing a total of 1130 patients (60.2% male; mean age, 52.6 ± 16.5 years; mean BMI, 29.8 ± 2.8 kg/m2). Of these, 6 studies administered the PROMIS PF, and 6 studies administered the PROMIS UE. The strongest correlation was between PROMIS PF computer adaptive test and the 36-Item Short Form Health Survey Global Health (SF-36 GH) ( r = 0.75). The highest overall correlation with the PROMIS UE was found with the American Shoulder and Elbow Surgeons (ASES) Shoulder Score ( r = 0.70). The lowest correlations were found between PROMIS PF and the Marx Shoulder Activity Scale ( r = 0.08) and the PROMIS UE and the Marx Shoulder Activity Scale ( r = 0.18). Conclusion: From available data, the PROMIS PF and PROMIS UE were most closely correlated with outcomes measured by the SF-36 GH. The PROMIS UE alone was most correlated with ASES Shoulder Score. Thus, either PROMIS PF or UE may provide a possible alternative to legacy PRO measurements but with a lower overall number of questions and higher generalizability. Future research should compare the time and question burden of the various PROMIS platforms with a more consistent evaluation of standard PRO measurements.

Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS

“…14,15 Similar to the hip, PROMIS scores generally correlate with legacy instruments. 31,33,35 In patients with foot and ankle pathology 15 and those after knee arthroscopy, 12,17 the PROMIS-PF and PROMIS-PI subscales demonstrated similar responsiveness to legacy PROMs with group-level statistics. However, further studies are needed to investigate the accuracy of CIOVs for the PROMIS in identifying, grading, and classifying changes in scores at the individual level.…”

“…There is evidence to support the PROMIS for various orthopaedic conditions in joints other than the hip, including the spine, 35 shoulders, 31 , 33 knees, 12 , 17 foot, and ankle. 14 , 15 Similar to the hip, PROMIS scores generally correlate with legacy instruments.…”

Determining the Time Required to Achieve Clinically Significant Outcomes on the PROMIS Upper Extremity Questionnaire After Arthroscopic Rotator Cuff Repair

“…The PROMIS–UE form has been extensively evaluated for its psychometric properties and efficacy against legacy PROs. 39 , 42 Backed by the National Institutes of Health, it is currently used in numerous point-of-care practices across the United States, given its dynamically efficient short form and computer adaptive testing format. 27 Nonetheless, as patients become increasingly interested in the results of the surveys completed during their care, future iterations of the PROMIS–UE should consider providing results in plain language for patients to easily interpret, including graphical representations and contextualized statistics.…”

Analysis of factors associated with patient-reported outcome (PRO) score completion rate one year after shoulder surgeries

“…Patients completed PROMIS, a validated assessment tool which utilizes CAT to minimize survey burden and provides standardized scores allowing an individual's scores to be compared to all test takers. 12 , 42 , 45 , 58 Each subject completed P-UE CAT version 2.0, P-Interference, and P-Intensity which assess physical function, limitations in function secondary to pain, and pain severity, respectively. PROMIS scores are normalized from 0 to 100, utilizing T-scores with a population mean of 50 and standard deviation of 10.…”