Validation of Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests in cervical spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The Patient-Reported Outcomes Measurement Information System (PROMIS), which is funded by the National Institutes of Health, is a set of adaptive, responsive assessment tools that measures patient-reported health status. PROMIS measures have not been validated for surgical patients with cervical spine disorders. The objective of this project is to evaluate the validity (e.g., convergent validity, known-groups validity, responsiveness to change) of PROMIS computer adaptive tests (CATs) for pain behavior, pain interference, and physical function in patients undergoing cervical spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The legacy outcome measures Neck Disability Index (NDI) and SF-12 were used as comparisons with PROMIS measures. PROMIS CATs, NDI-10, and SF-12 measures were administered prospectively to 59 consecutive tertiary hospital patients who were treated surgically for degenerative cervical spine disorders. A subscore of NDI-5 was calculated from NDI-10 by eliminating the lifting, headaches, pain intensity, reading, and driving sections and multiplying the final score by 4. Assessments were administered preoperatively (baseline) and postoperatively at 6 weeks and 3 months. Patients presenting for revision surgery, tumor, infection, or trauma were excluded. Participants completed the measures in Assessment Center, an online data collection tool accessed by using a secure login and password on a tablet computer. Subgroup analysis was also performed based on a primary diagnosis of either cervical radiculopathy or cervical myelopathy.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Convergent validity for PROMIS CATs was supported with multiple statistically significant correlations with the existing legacy measures, NDI and SF-12, at baseline. Furthermore, PROMIS CATs demonstrated known-group validity and identified clinically significant improvements in all measures after surgical intervention. In the cervical radiculopathy and myelopathic cohorts, the PROMIS measures demonstrated similar responsiveness to the SF-12 and NDI scores in the patients who self-identified as having postoperative clinical improvement. PROMIS CATs required a mean total of 3.2 minutes for PROMIS pain behavior (mean ± SD 0.9 ± 0.5 minutes), pain interference (1.2 ± 1.9 minutes), and physical function (1.1 ± 1.4 minutes) and compared favorably with 3.4 minutes for NDI and 4.1 minutes for SF-12.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study verifies that PROMIS CATs demonstrate convergent and known-groups validity and comparable responsiveness to change as existing legacy measures. The PROMIS measures required less time for completion than legacy measures. The validity and efficiency of the PROMIS measures in surgical patients with cervical spine disorders suggest an improvement over legacy measures and an opportunity for incorporation into clinical practice.</jats:p></jats:sec>

Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion

“…The survey's unique algorithm has allowed for a timely collection of clinical data compared to legacy outcome measures. [1][2][3] Since the introduction of PROMIS, multiple domains have been created to assess physical, mental, or social health. In relation to spine surgery, the PROMIS Physical Function (PF) domain has been particularly valuable due to its ability to accurately evaluate strength, mobility, and coordination.…”

The Influence of Preoperative Psychological States on Postoperative Outcomes Following Percutaneous Kyphoplasty(PKP)

“…PROMIS has proven to be effective in rapid evaluation of outcomes and reduce the burden of patients who complete the questionnaires due to its unique computer adaptive testing algorithm [12,28]. PROMIS have been increasingly adopted in orthopedic and spine conditions to capture patient-centered indicators of health status for use in clinical care, research, and cost-effectiveness analysis [5][6][7][8][9][10][11].…”

“…PROMIS have been increasingly adopted in orthopedic and spine conditions to capture patient-centered indicators of health status for use in clinical care, research, and cost-effectiveness analysis [5][6][7][8][9][10][11]. When compared to traditional surveys, PROMIS provides a more e cient and accurate way reporting patient symptoms, function, and healthrelated quality of life [5,6,12]. Among these, the PROMIS Physical Function (PF) domain can particularly re ect the strength, range of motion and coordination of patients, so it provides utility in evaluation of postoperative function of patients with spine conditions.…”

Preoperative Performance of Patient-Reported Outcomes Measurement Information System in Patients with Meniscal Root Tears

“…19 Several studies have also investigated floor effects of PROMIS PF-CT for patients with high disability. 22,28,30 Dowdle et al analyzed floor and ceiling effects in 61 patients undergoing primary total shoulder arthroplasty for end-stage glenohumeral arthritis and reported no floor effect for the PROMIS PF-CT. 22 Therefore, PROMIS PF-CT may be a better instrument due to its ability to capture, both highly functional and markedly disabled patients while strongly correlating with legacy PROMs.…”