The Effects of Lower Extremity Rotational Malalignment on Pediatric Patient-reported Outcomes Measurement and Information System (PROMIS) Scores

Abstract

Background: There is sparse literature demonstrating the relationship between lower limb pediatric idiopathic rotational malalignment (IRM) and patient-reported outcomes measurement information system (PROMIS) scores. Our goal is to determine and quantify the amount that IRM deformities, as measured with the 3D gait analysis, affect childrens’ pain interference, mobility, and peer relationship PROMIS domains. Secondary outcomes include investigating the potential relationships between IRM and various subgroups (Pediatric Outcomes Data Collection Instrument (PODCI), gender, Body Mass Index (BMI), femur Versus tibia). We also examine whether the PROMIS domains correlate with PODCI in this population. Methods: This study was a retrospective cohort, single institution, and consecutively recruited cases series. We identified 47 children over a 3-year period who were evaluated at the motion analysis center at our tertiary care hospital, with increased torsion of the femur or tibia. After exclusions, 25 children with IRM, documented PROMIS data and gait analysis were considered. Results: Femoral malrotation had a significant relationship with female gender ( P =0.001) and increased BMI ( P <0.001). Femoral malrotation had a correlation with PROMIS pain interference ( P =0.016), whereas tibial rotation did not achieve significance ( P =0.084). In the ANOVA regression analysis, there was a strong prediction of the PROMIS mobility domain when both malrotation and pain interference were present ( P =0.007). There were Pearson Correlations of PROMIS and PODCI domains for Mobility Versus Sports ( P =0.007) and Pain Interference Versus Comfort/Pain ( P =0.004), respectively. Conclusion: The evident relationship between lower limb rotational malalignment and PROMIS scores signifies the likelihood for gait and pain disturbance. This in turn could show us that children are likely to be more debilitated and thus may benefit from timely correction. We aim to conduct this as a multicentre trial to confirm our findings. Level of Evidence: Level IV.

Drop landing analysis of rotational osteotomies

“…MacWilliams et al showed correction of idiopathic TT normalized frontal plane knee moments and restored ankle power [8]. Other studies have demonstrated the detrimental effect on patient pain, function and mentality from malalignment [6,7]. The improvement in PODCI and GAS scores post-operatively from corrective osteotomy in this series echo the results of Stambough et al reporting improved IKDC-9 scores with femoral derotational osteotomy [39].…”

“…Associations of malrotation with patellofemoral pathology, anterior knee pain, abnormal gait, FAI, and potential predisposition for injury and osteoarthritis have all been reported [4,5]. More recently, the effect of these deformities on patient-reported outcomes has been highlighted, demonstrating lower PODCI and PROMIS scores [6,7]. Traditionally, and currently, at most centers, the clinical examination is the principal diagnostic tool available.…”

Concurrent Validity of PROMIS and LD-SRS Scores in Pediatric Patients With Lower Limb Differences

“…[5][6][7] A number of studies have validated select PROMIS domains against specific legacy measures in patients across a wide spectrum of upper and lower limb conditions, including idiopathic lower limb rotational malalignment, congenital anomalies, and posttraumatic amputations. [8][9][10][11] Furthermore, multiple comparisons of PROMIS and SRS scores have sought to validate the novel generic instrument against the legacy disease-specific measures in patients with spinal deformity, 6,[12][13][14][15][16][17][18][19] but none have yet to validate PROMIS against the LD-SRS for pediatric patients with lower limb differences. We sought to assess the concurrent validity of select Patient-reported Outcomes Measurement Information System (PROMIS) domains and Limb Deformity-Scoliosis Research Society (LD-SRS) scores in pediatric patients with lower limb differences.…”

“…As a generic HRQoL measure, PROMIS confers a number of benefits—including reduced administrative burden, faster time to completion, and diminished floor and ceiling effects when compared with legacy measures—to researchers, clinicians, and patients alike 5–7 . A number of studies have validated select PROMIS domains against specific legacy measures in patients across a wide spectrum of upper and lower limb conditions, including idiopathic lower limb rotational malalignment, congenital anomalies, and posttraumatic amputations 8–11 …”