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

Abstract

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).

There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review

“…We think the likelihood of this is very low because we strictly adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our comprehensive three-database search. After the current study was accepted for publication, but before final publication, Karhade et al [28] published a retrospective study examining MCID thresholds and attainment for PROMIS scores. Because that study was published after our search dates, it was not included in this analysis.…”

Patient‐reported outcome tools in musculoskeletal oncology

“…Although the SF‐36 has not been specifically validated in orthopedic oncology patients, an MCID has been reported for this tool 72,73 . PROMIS has been validated in several solid malignancies, 74 benign orthopedic conditions, 75 in addition to metastatic spine tumors 76 and bone and soft tissue tumors 77 . Two studies have reported MCID for PROMIS following surgical management in patients with benign and malignant soft tissue tumors 52 and lower extremity metastases 78 .…”

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

“…Most would agree that anchor-based scores are preferable, but the lack of these scores for commonly performed orthopaedic procedures has driven the need for distribution-based approaches. The article by Karhade et al [1] clearly indicates the complexity of the issue. PROMIS, PROMs, MCID, anchor-based, distribution-based, one-third to one-half standard deviation, minimal detectable change (MDC) 50, MDC 95, and MDC 99 are just some of the terms and abbreviations used in the paper.…”

“…An article in this month's Clinical Orthopaedics and Related Research ® by Karhade et al [1] describes this issue-or maybe "confusion" is a better word-exceedingly well. They compared the achievement of the minimum clinically important difference (MCID) for common orthopaedic procedures using the Patient-Reported Outcomes Measurement Information System (PROMIS) compared with other patient-reported outcome measures (PROMs), called legacy PROMs because they have been used for many years.…”