Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Versus Physical Function (PF) Computer Adaptive Tests (CATs) in Upper Extremity Clinics

Abstract

Purpose To examine the performance of the PROMIS Upper Extremity Function CAT relative to the PROMIS Physical Function CAT in patients seeking specialty care for upper extremity conditions. Methods This observational trial analyzed prospectively collected PROMIS Upper Extremity and Physical Function CAT scores from 5202 adult patients with 10344 outpatient clinic visits presenting to a tertiary orthopaedic clinic. Pearson’s correlation coefficient was utilized to evaluate the association between initial Physical Function and Upper Extremity scores, as well as the association between changes in Physical Function and Upper Extremity scores between visits. Differences in scores between populations presenting with hand conditions versus shoulder and elbow conditions were evaluated via Student’s t test, as were differences in scores between new and return patient visits. Results PROMIS Upper Extremity CAT scores were strongly correlated with PROMIS Physical Function CAT scores. However, patients averaged 8 points lower scoring on Upper Extremity CAT testing compared to Physical Function CAT scores. The Upper Extremity CAT demonstrated a ceiling effect at a score of 56 that impacted 7% of patients with a secondary ceiling at 50. Change in Physical Function and Upper Extremity scores between visits were moderately correlated with a mean difference of less than 1 point. Patients presenting for hand conditions achieved better Physical Function and Upper Extremity scores than patients presenting for shoulder and elbow conditions. Conclusions The PROMIS Upper Extremity module appears responsive to changes over time. However, the current Upper Extremity CAT has a ceiling score of 56 which does not allow for improvement of scores 0.6 SD higher than the presumptive normative population mean of 50. Although a specific assessment of upper extremity function is desirable, continued refinement of the PROMIS Upper Extremity CAT is required to better assess patients with higher levels of function.

Patient-Reported Outcomes Measurement Information System physical function correlates with Toronto Extremity Salvage Score in an orthopaedic oncology population

“…The more recently developed PROMIS UE CAT, which was designed to specifically assess UE function, may have increased sensitivity to capture UE impairment. However, similar to the UE TESS, the PROMIS UE CAT has demonstrated a ceiling effect [7], [8].…”

“…CAT is completed when the consistency of the answers is sufficient for scoring. PROMIS CAT has been studied in several orthopaedic populations [20], specifically including hand and shoulder [1], [2], [8], [13], [24], [25], [32], foot and ankle [18], sports [16], [28], adult reconstruction [20], spine [30] and trauma [19], [18], [21], [33], [29], [1], [2], [8], [13], [16], [20], [25], [31], as well as various oncologic subspecialities [15], [34], [5], [9]. There is currently a widespread initiative for adoption and inclusion of PROMIS domains in all Federal Drug Administration–funded and industry-funded clinical oncology outcome research.…”

Measures of Adult Shoulder Function

“…In a subgroup aged 21 years or younger, ceiling effects were 71.1% at 6 months and 81% at 2 years. Ceiling effects were found for 3% of patients (T score of 56 or higher) undergoing arthroscopic rotator cuff repair (285) and 7.2% (T score of 56 or higher) of patients with hand or shoulder conditions (286). The latter study also reported 1.2% floor effects.…”

“…PROMIS PF Short Form 8a: r = 0.73 to 0.77 in upper extremity trauma (289). PROMIS PF CAT: r = 0.63 in shoulder instability (287), r = 0.70 in rotator cuff pathology (282), r = 0.69 (baseline) and r = 0.53 (change) in upper extremity conditions (286), and r = 0.48 in hand and upper extremity conditions (276). PROMIS Pain Interference CAT: r = −0.60 in hand and upper extremity conditions (276).…”

Psychometrics of the Patient-Reported Outcomes Measurement Information System Physical Function instrument administered by computerized adaptive testing and the Disabilities of Arm, Shoulder and Hand in the orthopedic elbow patient population

“…25 The PROMIS UE shows a strong correlation with the PROMIS PF and a similar ceiling effect (7%) in an orthopedic sample, though patients with elbow conditions evidenced lower scores on the PROMIS UE than for patients with hand conditions. 3 Until this work is completed on PROMIS refinements, the DASH may be selected as a better fit for assessing elbow orthopedic outcomes in high functioning patients.…”