Defining Clinically Significant Improvement on the Patient-Reported Outcomes Measurement Information System Test at 1-Year Follow-up for Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome

Abstract

Background: Although minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient-reported outcome measures, these metrics have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy. Purpose: To define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients were administered the PROMIS-PF, PROMIS-PI, Hip Outcome Score (HOS)–Activities of Daily Living, HOS–Sports Subscale, modified Harris Hip Score, and International Hip Outcome Tool–12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, whereas PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared with those who did not achieve CSOs via chi-square and independent-samples t tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement. Results: 124 patients with a mean age of 32.7 ± 12.3 years were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (–3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively, compared with 87.1%, 76.6%, and 71.8% for legacy patient-reported outcome measurements. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3 ± 12 vs 35.6 ± 12 years; P = .017) with significantly lower body mass index (BMI) (24.7 ± 6.4 vs 27.9 ± 7; P = .009). Preoperative chronic pain and history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement, whereas higher (worse) preoperative PROMIS-PI scores were a positive predictor. Conclusion: Our study defined the MCID, PASS, and SCB for the PROMIS-PF CAT and PROMIS-PI CAT at 1 year postoperatively. Patients with higher preoperative PROMIS scores, younger age, and lower BMI were more likely to achieve CSO, whereas preoperative chronic pain and history of orthopaedic surgery were negative predictors of CSO achievement.

Determining Clinically Meaningful Outcomes after Isolated Acetabuloplasty in the Context of Age and Arthritic Severity: A Retrospective Review of Prospectively Collected Data

“…Using these values, we found regardless that a notable amount of patients report clinically significant outcomes for PROMIS-PF (71.4%) and PROMIS-PI (54.0%). However, using the values reported by Bodendorfer et al, 33 for example, these numbers would rise to 92.1% for PROMIS-PF and 88.9% for PROMIS-PI. This discrepancy is likely due to differing methodologies, although it could also potentially be explained by the unfavorable area under the curve (0.57) for PROMIS-PI reported by Kuhns et al It is important to be mindful of this observation and interpret the CIOV results in our study, particularly those relating to PASS for PROMIS-PI, with appropriate caution.…”

“…We also used PROMIS-PF and PROMIS-PI CT scores, which assess for global functioning and patient quality of life while correlating well with the hip legacy scales and providing benefits such as decreased survey burden as well as mitigation of floor and ceiling effects. 33,[53][54][55][56] The most notable limitations of this study are the small sample size (63 patients) and significant loss to follow-up (34.4%). Our numbers are slightly lower yet still comparable to other published works in the field of isolated acetabuloplasty.…”

“…32 Achieving any of these CIOV values was interpreted as a clinically favorable outcome. 32,33,43 Secondary outcomes included complications and revision surgeries, which were extracted from the EMR.…”

The Current Utilization of Patient-reported Outcome Measurement Information System in Shoulder, Elbow, and Sports Medicine

“…They found that patients with younger age and lower BMI preoperatively were more likely to attain these thresholds. 39 Patients with symptomatic acetabular dysplasia were evaluated by Li et al in a prospective study. 40 A total of 57 patients underwent periacetabular osteotomy and were assessed preoperatively and at a mean of 1.5 years postoperatively with the PROMIS PF and PI CATs along with several legacy PROMs (including HOS-Pain, HOS-ADL, and mHHS).…”

“…They found that patients with younger age and lower BMI preoperatively were more likely to attain these thresholds. 39…”