Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state of PROMIS upper extremity after total shoulder arthroplasty

Gordon, Dan; Pines, Yaniv; Ben-Ari, Erel; As, Rokito; Kwon, Young Woo; Zuckerman, Joseph D.

doi:10.1016/j.jseint.2021.05.003

Cited by 29 publications

(26 citation statements)

References 44 publications

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“…22,23 Previous crosssectional studies 11,12,[24][25][26][27][28][29][30][31] have shown a strong correlation between PROMIS UE CAT and legacy instruments across a spectrum of common orthopedic conditions and procedures. However, there are fewer longitudinal correlation studies 19,21,[32][33][34][35][36] in the literature and none in patients undergoing TSA. We showed that PROMIS UE CAT is sensitive to functional improvements in patients undergoing shoulder Fourth, we did not include all the available patient-reported outcome (PRO) instruments described for shoulder arthroplasty due to logistic issues with conducting the study and maintaining patient participation.…”

Section: Discussionmentioning

confidence: 99%

“…Previous cross‐sectional studies 11,12,24–31 have shown a strong correlation between PROMIS UE CAT and legacy instruments across a spectrum of common orthopedic conditions and procedures. However, there are fewer longitudinal correlation studies 19,21,32–36 in the literature and none in patients undergoing TSA. We showed that PROMIS UE CAT is sensitive to functional improvements in patients undergoing shoulder arthroplasty as early as 6 weeks after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Performance and responsiveness to change of PROMIS UE in patients undergoing total shoulder arthroplasty

Pines

Gordon

Alben

et al. 2022

Journal Orthopaedic Research

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The Patient‐Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT) is a newer patient‐reported outcome measure for upper extremity physical function. To date, no longitudinal study exists assessing PROMIS UE CAT responsiveness in patients undergoing shoulder arthroplasty. The purpose of this prospective longitudinal study is to report PROMIS UE CAT responsiveness to change and correlation to legacy instruments in patients undergoing total shoulder arthroplasty (TSA). Ninety‐six patients (97 shoulders) undergoing TSA completed the PROMIS UE, Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) preoperatively and postoperatively at 6 weeks, 12 weeks, and after 6 months. Spearman's correlation coefficients (r) were calculated between PROMIS UE and other scores at each time‐point. Responsiveness to change was assessed using the effect size (Cohen's d) and standardized response mean compared with the preoperative time‐point. Floor and ceiling effects were also assessed. PROMIS UE CAT demonstrated positive responsiveness at all time‐points after TSA. It demonstrated excellent correlation (range: 0.68–0.84) with ASES, SST, and OSS at all postoperative time‐points, but the correlation was weaker (r < 0.6, except OSS) preoperatively. Only OSS and SST showed ceiling effects at the 6–12‐month time‐point (16.8% and 18.2%, respectively). PROMIS UE CAT responsiveness to change and strength of correlation with legacy instruments improves with time elapsed after TSA. Further quantification of meaningful responsiveness to change will require estimation of the minimal clinically important difference and substantial clinical benefit for PROMIS UE CAT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Performance and responsiveness to change of PROMIS UE in patients undergoing total shoulder arthroplasty

Pines

Gordon

Alben

et al. 2022

Journal Orthopaedic Research

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“…A systematic search of the PubMed/MEDLINE databases was used to identify studies examining PROMIS assessments in orthopaedic surgery patients. Studies were included in the anchor-based analyses if they calculated anchor-based thresholds for PROMIS Physical Function for THA, TKA, PLF, ACLR, and APM or the PROMIS Upper Extremity for TSA and RCR [3, 10-12, 16, 18, 23, 24, 29, 34, 37].…”

Section: Methodsmentioning

confidence: 99%

What Is the Clinical Benefit of Common Orthopaedic Procedures as Assessed by the PROMIS Versus Other Validated Outcomes Tools?

Karhade

Bernstein

Desai

et al. 2022

Clin Orthop Relat Res

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Background Patient-reported outcome measures (PROMs), including the Patient-reported Outcomes Measurement Information System (PROMIS), are increasingly used to measure healthcare value. The minimum clinically important difference (MCID) is a metric that helps clinicians determine whether a statistically detectable improvement in a PROM after surgical care is likely to be large enough to be important to a patient or to justify an intervention that carries risk and cost. There are two major categories of MCID calculation methods, anchor-based and distribution-based. This variability, coupled with heterogeneous surgical cohorts used for existing MCID values, limits their application to clinical care. Questions/purposes In our study, we sought (1) to determine MCID thresholds and attainment percentages for PROMIS after common orthopaedic procedures using distribution-based methods, (2) to use anchor-based MCID values from published studies as a comparison, and (3) to compare MCID attainment percentages using PROMIS scores to other validated outcomes tools such as the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Knee Disability and Osteoarthritis Outcome Score (KOOS). Methods This was a retrospective study at two academic medical centers and three community hospitals. The inclusion criteria for this study were patients who were age 18 years or older and who underwent elective THA for osteoarthritis, TKA for osteoarthritis, one-level posterior lumbar fusion for lumbar spinal stenosis or spondylolisthesis, anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty for glenohumeral arthritis or rotator cuff arthropathy, arthroscopic anterior cruciate ligament reconstruction, arthroscopic partial meniscectomy, or arthroscopic rotator cuff repair. This yielded 14,003 patients. Patients undergoing revision operations or surgery for nondegenerative pathologies and patients without preoperative PROMs assessments were excluded, leaving 9925 patients who completed preoperative PROMIS assessments and 9478 who completed other preoperative validated outcomes tools (HOOS, KOOS, numerical rating scale for leg pain, numerical rating scale for back pain, and QuickDASH). Approximately 66% (6529 of 9925) of patients had postoperative PROMIS scores (Physical Function, Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from Partners HealthCare, Somerville, MA, USA (number 2019P003521).

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“…For example, the Patient Acceptable Symptom State (PASS) ( 63 , 64 , 66 ) gathers patient perspective about the satisfaction a patient has with their current health state, considering an acceptable level of symptoms, activities of daily living, and function that results in a satisfactory assessment of health. There are various version of the PASS, but most use a dichotomous response scale of “yes” or “no.” Describing the level of satisfaction a patient has with their state of health at the end of care or at the end of participation in a research study warrants consideration as a clinically meaningful research outcome ( 65 , 67 ).…”

Section: Prom Analysis and Interpretationmentioning

confidence: 99%

Patient-reported outcome measures as an outcome variable in sports medicine research

Valier

Bliven²,

Lam³

et al. 2022

Front. Sports Act. Living

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Injury prevention and rehabilitation research often address variables that would be considered clinician-oriented outcomes, such as strength, range of motion, laxity, and return-to-sport. While clinician-oriented variables are helpful in describing the physiological recovery from injury, they neglect the patient perspective and aspects of patient-centered care. Variables that capture patient perspective are essential when considering the impact of injury and recovery on the lives of patients. The inclusion of patient-reported outcome measures (PROMs) as dependent variables in sports medicine research, including injury prevention and rehabilitation research, provides a unique perspective regarding the patient's perception of their health status, the effectiveness of treatments, and other information that the patient deems important to their care. Over the last 20 years, there has been a significant increase in the use of PROMs in sports medicine research. The growing body of work gives opportunity to reflect on what has been done and to provide some ideas of how to strengthen the evidence moving forward. This mini-review will discuss ideas for the inclusion of PROMs in sports medicine research, with a focus on critical factors, gaps, and future directions in this area of research. Important elements of research with PROMs, including instrument selection, administration, and interpretation, will be discussed and areas for improvement, consideration, and standardization will be provided.

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Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state of PROMIS upper extremity after total shoulder arthroplasty

Cited by 29 publications

References 44 publications

Performance and responsiveness to change of PROMIS UE in patients undergoing total shoulder arthroplasty

Performance and responsiveness to change of PROMIS UE in patients undergoing total shoulder arthroplasty

What Is the Clinical Benefit of Common Orthopaedic Procedures as Assessed by the PROMIS Versus Other Validated Outcomes Tools?

Patient-reported outcome measures as an outcome variable in sports medicine research

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