Validation of GAITRite and PROMIS as high‐throughput physical function outcome measures following ACL reconstruction

Abstract

New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high through-put outcomes for high volume clinics. To this end we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-op and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (p < 0.0001). Additional advantages were that PROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-op, and a significant improvement at 10 weeks post-op, versus pre-op (p<0.001), which were not detected with IKDC. GAITRite was limited by a low ceiling that could not detect improvement of physical function beyond 20 weeks, while both PROMIS and IKDC detected significant improvement out to 52 weeks postop (p<0.001). Linear regressions demonstrated a significant relationship between IKDC and PROMIS, with a combined correlation value of 0.8954 (p<.001) for all time points. Finally, ROC curve analysis demonstrated that PROMIS is a diagnostic test for poor outcomes.

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

“…Reliable patient-reported outcome data can inform surgeons and permit realistic discussions and patient decisions about high risks of not only of cure, morbidity, and mortality but also about quality of life 1, 2 .In the ACL study the patients had pre and post-operative PROMIS evaluation. The preoperative scores effectively identified patients at risk for poor outcome25 . For the orthopedic trauma study investigators obtained on the first post trauma follow up visit recall PROMIS data from the patient and a proxy to establish the patient's pre injury quality of life status 26 .…”

“…study demonstrated that orthopedic surgeons are leading users of PROMIS measures. Orthopedic surgery contributed 9 publications on topics including fractures21 , chronic foot and ankle disorders[22][23][24] , sacral tumors 1,2 , ACL injury25 , and orthopedic trauma26 . One fracture study evaluated a percutaneous approach to acetabular fractures27 and the other evaluated the use of routine arthroscopy in the management of ankle fractures 21 .…”

Establishing a Common Metric for Physical Function: Linking the HAQ-DI and SF-36 PF Subscale to PROMIS® Physical Function

“…Measures of physical function can quantify the impact of chronic health conditions, and in so doing, they can help evaluate whether and how well patients are recovering from disease, trauma or restorative surgery. [2][3][4] Across these applications, people use different measures of PF. Three of the more common choices include the Health Assessment Questionnaire (HAQ), the SF-36® ten-item PF scale derived from the Medical Outcomes Study, and the Patient Reported Outcomes Measurement System (PROMIS®) PF item bank, including its various short form and computerized adaptive testing (CAT) options.…”

Correlation of PROMIS Physical Function and Pain CAT Instruments with Oswestry Disability Index and Neck Disability Index in Spine Patients

“…8 Several clinical studies have been published recently using PROMIS CAT as the primary outcome measure. [9][10][11] The Oswestry Disability Index has emerged as one of the most widely used spine specific outcome measures. [12][13][14][15] It was originally introduced in 1976 by Obrien et al and was published in 1980.…”