Editorial Commentary: We PROMIS…One More Patient-Reported Outcome Questionnaire!

Fabricant, Peter D.

doi:10.1016/j.arthro.2017.11.013

Arthroscopy: The Journal of Arthroscopic & Related Surgery

2018

DOI: 10.1016/j.arthro.2017.11.013

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Editorial Commentary: We PROMIS…One More Patient-Reported Outcome Questionnaire!

Peter D. Fabricant

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Cited by 3 publications

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“…Orthopaedic surgeons have cited a lack of time as a primary barrier to screening for, and addressing, mental health impairment as part of standard musculoskeletal care 12 . For orthopaedic clinicians who do incorporate mental health screening into their practices, the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety measures have become popular tools because they are short questionnaires that can harness computer adaptive testing (CAT) technology to efficiently provide precise scores [15][16][17][18][19][20][21][22][23][24] . Yet, appropriate use of PROMIS measures requires that clinicians understand how to interpret patient scores clinically.…”

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confidence: 99%

Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients

et al. 2023

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Background:There is growing awareness among orthopaedic clinicians that mental health directly impacts clinical musculoskeletal outcomes. The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used for mental health screening in this context, but proper interpretation of patient scores remains unclear. The purpose of the present study was to compare musculoskeletal patients’ PROMIS Depression and Anxiety scores with a board-certified clinical psychologist’s assessment of their depression and/or anxiety diagnoses, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.Methods:In this cross-sectional analysis, existing medical records were reviewed for 50 patients who presented to an interdisciplinary program within a tertiary care orthopaedic department for the treatment of ≥1 musculoskeletal condition. All patients completed PROMIS Depression and Anxiety measures and were evaluated by a board-certified clinical psychologist. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of PROMIS Depression and Anxiety scores as compared with the psychologist’s diagnosis of a DSM-5 depressive or anxiety disorder.Results:Twenty-eight patients (56%) were diagnosed by the psychologist with a DSM-5 depressive disorder, and 15 (30%) were diagnosed with a DSM-5 anxiety disorder. The ROC analysis for PROMIS Depression had an area under the curve (AUC) of 0.82. The optimal score cutoff to predict a diagnosis of a DSM-5 depressive disorder was ≥53 (sensitivity, 79% [95% CI, 63% to 94%]; specificity, 86% [72% to 100%]; positive predictive value [PPV], 88% [75% to 100%]; negative predictive value [NPV], 76% [59% to 93%]). The ROC analysis for PROMIS Anxiety had an AUC of 0.67. The optimal score cutoff to predict a diagnosis of a DSM-5 anxiety disorder was ≥59 (sensitivity, 60% [95% CI, 35% to 85%]; specificity, 74% [60% to 89%]; PPV, 50% [27% to 73%]; and NPV, 81% [68% to 95%]).Conclusions:Modestly elevated PROMIS Depression scores were suggestive of the presence of a DSM-5 depressive disorder, whereas elevations in PROMIS Anxiety scores seemed to have less association with DSM-5 anxiety disorders. Nevertheless, neither PROMIS measure demonstrated adequate discriminant ability to definitively identify patients who met DSM-5 criteria.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 99%

Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients

et al. 2023

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“…We admire such studies that have been published in Arthroscopy. [5][6][7][8][9][10][11][12] In the future, developing and adding a utility score to PROMIS to assess the "value" of a health state could allow simultaneous assessment of health outcome and utility using a single measure. This could allow researchers to efficiently perform decision analyses and ultimately costeffectiveness analyses for diverse health interventions.…”

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The Patient-Reported Outcomes Measurement Information System (PROMIS): Can We Finally Compare Apples to Oranges?

Rossi¹,

Sheean²,

Cote³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Legacy patient-reported outcome mea`sures lack standardization, resulting in difficulty comparing the results of diverse clinical outcome studies: "You can't compare apples to oranges." To address this concern, the National Institutes of Health initiated the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess common dimensions of a wide range of diseases. PROMIS uses computer adaptive testing: A fluid questionnaire chooses subsequent questions based on the responses to previous questions to efficiently characterize outcomes using only 4 to 6 questions. This greatly reduces survey fatigue. Research correlating PROMIS to legacy measures is of value. For now, some questions may require more information than PROMIS can provide, in which case legacy measures could be preferred. In the future, developing and adding a utility score to PROMIS could assess "value" and allow decision analyses and cost-effectiveness analyses for diverse health interventions. In the end, PROMIS may allow us to compare apples to oranges.

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Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments Correlate Better With Legacy Measures in Knee Cartilage Patients at Postoperative Than at Preoperative Assessment

Nwachukwu

Beletsky

Naveen

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Editorial Commentary: We PROMIS…One More Patient-Reported Outcome Questionnaire!

Cited by 3 publications

References 20 publications

Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients

Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients

The Patient-Reported Outcomes Measurement Information System (PROMIS): Can We Finally Compare Apples to Oranges?

Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments Correlate Better With Legacy Measures in Knee Cartilage Patients at Postoperative Than at Preoperative Assessment

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