Crosswalking the Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Pain Intensity Scores to the Roland-Morris Disability Questionnaire and the Oswestry Disability Index

Crosswalking 4 Pain Impact Measures in a Nationally Representative Sample of Adults With Back Pain

OBJECTIVE

To generate crosswalk equations and tables for 4 pain impact measures: the Impact Stratification Score (ISS), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and the Pain, Enjoyment of Life and General Activity Scale (PEG).

DESIGN

Cross-sectional survey assessing demographics and pain impact. Crosswalks were developed using item-response theory (IRT) cocalibrations and linear regressions between the ISS, ODI, RMDQ, and PEG.

SETTING

Online panel.

PARTICIPANTS

Population-based sample of United States adults aged 18 and older. Eligibility criteria were reporting current back pain, not reporting 2 fake health conditions, and having data for 2 or more pain measures (N=1530; 37% of sample). Crosswalks were developed (n=1030) and cross-validated in a subsample of 500 participants (n=125 randomly sampled from each ISS quartile).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

ISS, ODI, RMDQ, and the PEG.

RESULTS

Associations of the ISS with the PEG and ODI met the criteria for IRT cocalibration. Other measure pairs were crosswalked using regression. Associations were strongest between the PEG and the ISS (r=0.87, normalized mean absolute error [NMAE]=0.38) and between the ODI and the ISS (r=0.85, NMAE=0.39). Associations were weakest between the PEG and the RMDQ (r=0.69, R2=0.48, NMAE: 0.55-0.58). Regression equations and IRT accounted for 48%-64% of the variance (NMAE: 0.38-0.58) in corresponding pain measures in the cross-validation sample.

CONCLUSIONS

The crosswalks between the ISS and common legacy pain measures created in this study of a nationally representative sample of United States adults with back pain can be used to estimate 1 pain impact measure from another. Further evaluation in clinical samples is recommended.

Effects of dynamic neuromuscular stabilization training on the core muscle contractility and standing postural control in patients with chronic low back pain: a randomized controlled trial

BACKGROUND

Patients with chronic low back pain (CLBP) usually demonstrate poor postural control due to impaired core muscle function. Dynamic neuromuscular stabilization (DNS) is based on developmental kinesiology principles, utilizing infant motor patterns to treat motor disorders. DNS has been shown to improve postural control in cerebral palsy patients by activating core muscle. However, whether the DNS approach is superior for enhancing core muscle contractility and postural control in CLBP patients still remains unclear.

OBJECTIVES

This study aimed to compare the effects of DNS training and conventional core exercises on core muscle contractility and standing postural control in CLBP patients.

METHODS

Sixty CLBP patients were randomly assigned to a DNS group or a control group. Participants in the DNS group received DNS training, while those in the control group completed conventional core exercises. Both groups completed 12 sessions over 4 weeks (3 sessions/week, 50 min/session). Pre- and post-intervention evaluations included diagnostic musculoskeletal ultrasound to assess the change rate of core muscles (transversus abdominis (TrA), lumbar multifidus, and diaphragm), a balance assessment system to evaluate postural control performance (center of pressure displacement (COP)), and clinical questionnaires (Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RDQ)) for pain intensity and disability.

RESULTS

After 4 weeks, comparisons between both groups revealed significant statistical differences in the interaction effects of time*group. These differences were observed in the change rates of the left and right TrA (F1,58=4.820 and 3.964, p = 0.032 and 0.041), diaphragm change rate (F1,58=11.945, p = 0.001), as well as COP velocity (F1,58=5.283, p = 0.025), variability (F1,58=13.189, p = 0.001) in the anterior-posterior (AP) direction, COP path length (F1,58=6.395, p = 0.014), and COP area (F1,58=5.038, p = 0.029) in the eye-closed condition. DNS participants showed significantly greater muscle change rates and reduced COP (p < 0.05). The scores of VAS (F1,58=173.929, p = 0.001), ODI (F1,58=60.871, p = 0.001), and RDQ (F1,58=60.015, p = 0.001) decreased significantly over time, although no group differences were found between both groups (p > 0.05).

CONCLUSIONS

DNS is superior to conventional core exercises in enhancing core muscle contractility and standing postural control in CLBP patients, showing potential to reduce pain and improve disability. Its mechanism may involve the enhancement of proprioceptive feedback, particularly when visual feedback is blocked.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300074595 on 10 August 2023.

Longitudinal validation of the PROMIS-16 in a sample of adults in the United States with back pain

PURPOSE

This longitudinal study evaluates whether the Patient-Reported Outcomes Measurement and Information System (PROMIS)-16 domains capture average change over time comparable to the PROMIS-29 + 2 and have similar associations with change in overall health rating and two disability indices.

METHODS

Data were collected using Amazon's Mechanical Turk at baseline, 3 months, and 6 months among individuals reporting chronic low back pain. The analytic sample includes respondents who completed baseline and at least one follow-up assessment (N = 1137). We estimated latent growth models for eight PROMIS domains and compared growth parameters between the PROMIS-16 and PROMIS 29 + 2 with a z-test. Additionally, for each domain, random intercept and slope scores for individuals were computed for the PROMIS-29 + 2 and PROMIS-16 and correlated to estimate concordance. Using growth parameters for physical function and pain interference, we predicted average change in the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), the overall health rating, and compared regression coefficients between the PROMIS-16 and PROMIS 29 + 2.

RESULTS

All growth models fit the data well. Intercept and slope parameters were statistically comparable (p's > 0.05) in magnitude across all domains between the PROMIS-16 and PROMIS-29 + 2. Correlations between random intercept and slope scores for individuals across domains were high. Additionally, the regression coefficients between slopes for pain interference and physical function and ODI, RMDQ, and overall health rating were statistically comparable (p's > 0.05) between the PROMIS-16 and PROMIS 29 + 2.

CONCLUSION

Results provide between-level support for the longitudinal and predictive validity of the PROMIS-16. Similar average baseline scores and changes over time were observed between PROMIS-16 and PROMIS-29 + 2. Further, average change estimates comparably predicted average change in distal outcomes. This work provides evidence supporting the utility of the PROMIS-16 as a viable, short-profile option for use in clinical and research settings.

The Reha-Toolbox Project: Linking Item Subsets of 3 Established Rehabilitation PROMs to 9 Domains of the Patient-Reported Outcomes Measurement Information System (PROMIS)

OBJECTIVE

The overarching goal of the patient-reported outcomes measurement information system (PROMIS) is to standardize patient-reported outcomes across settings and health conditions globally. Following this purpose, the Reha-Toolbox study aimed to link item subsets of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the Indicators of Rehabilitation Status (IRES-3), and the Hamburg Modules for the Assessment of Psychosocial Health (HEALTH-49) to the standardized metrics provided by PROMIS.

DESIGN

Cross-sectional, single-group linking study.

SETTING

Online survey.

PARTICIPANTS

Experts (N=5) mapped items from the 3 rehabilitation measures to PROMIS scales. Data were collected online from a general population sample (N=1000). Items from the rehabilitation measures and their corresponding PROMIS short forms were administered to facilitate item linkage.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

WHODAS 2.0, IRES-3, HEALTH-49, and PROMIS scales.

RESULTS

Overall, 96 of 171 outcome items (56%) from the legacy measures and 1 additional IRES-3 item were mapped to 9 PROMIS domains, including pain interference, physical function, dyspnea, fatigue, depression, anxiety, cognitive function, ability to participate in social roles and activities, and satisfaction with participation in social roles and activities. Ninety-five items fulfilled the linking assumptions of construct similarity, unidimensionality, and measurement invariance. The legacy items were successfully calibrated on the corresponding PROMIS metrics using graded-response models. The range and precision of the measures varied, depending on the number of items in each domain. Domains that were assessed with 4 or more items achieved sufficient reliability for group-based analyses. Crosswalk tables were created for each measure and domain. We discussed the reasons for and implications of the fact that the rehabilitation measures were only partially linked to the PROMIS metrics.

CONCLUSIONS

The study achieved robust linking between subsets of WHODAS 2.0, IRES-3, HEALTH-49 items, and 9 PROMIS scales.

Towards Standardized Assessment of Outcomes in Back Pain-Validation of Linking Studies Between Disease-Specific and Generic Patient-Reported Outcome Measures

Background: Comparing outcomes across different health measurement tools is essential where various patient-reported outcome measures (PROMs) are used. In spinal surgery, where recent studies show that over 30 different PROMs are applied, this need becomes even more pressing. Although several statistical transformations between the Oswestry Disability Index (ODI) and the PROMIS Profile 29 have been proposed, validation studies on conversion equations and cross-walk tables remain limited. In this study, we examined the agreement between observed ODI scores and those predicted from the PROMIS Profile 29 in a large sample of patients with low back pain, collected from routine clinical care. Methods: We compared the performance of regression and linking models at both the individual and group levels. Using Bland-Altman plots, we assessed the mean difference, 95% limits of agreement, root mean squared error (RMSE), and standardized mean differences (Cohen's d) between predicted and observed ODI scores. Results: While group-level agreement was satisfactory, with negligible effect sizes, individual prediction accuracy was relatively poor. Additionally, regression models showed inconsistent performance across the ODI score range, though incorporating more domains marginally improved predictions. Conclusions: The equipercentile linking approach demonstrated stable agreement across all ODI scores, making it the preferred method. Future regression models should account for nonlinear relationships between PROMs to enhance prediction accuracy.

Optimizing Oxford Shoulder Scores with computerized adaptive testing reduces redundancy while maintaining precision

AIMS

The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy.

METHODS

A total of 16,238 preoperative OSS were available in the National Joint Registry (NJR) for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey dataset (April 2012 to April 2022). Prior to CAT, the foundational item response theory (IRT) assumptions of unidimensionality, monotonicity, and local independence were established. CAT compared sequential item selection with stopping criteria set at standard error (SE) < 0.32 and SE < 0.45 (equivalent to reliability coefficients of 0.90 and 0.80) to full-length patient-reported outcome measure (PROM) precision.

RESULTS

Confirmatory factor analysis (CFA) for unidimensionality exhibited satisfactory fit with root mean square standardized residual (RSMSR) of 0.06 (cut-off ≤ 0.08) but not with comparative fit index (CFI) of 0.85 or Tucker-Lewis index (TLI) of 0.82 (cut-off > 0.90). Monotonicity, measured by H value, yielded 0.482, signifying good monotonic trends. Local independence was generally met, with Yen's Q3 statistic > 0.2 for most items. The median item count for completing the CAT simulation with a SE of 0.32 was 3 (IQR 3 to 12), while for a SE of 0.45 it was 2 (IQR 2 to 6). This constituted only 25% and 16%, respectively, when compared to the 12-item full-length questionnaire.

CONCLUSION

Calibrating IRT for the OSS has resulted in the development of an efficient and shortened CAT while maintaining accuracy and reliability. Through the reduction of redundant items and implementation of a standardized measurement scale, our study highlights a promising approach to alleviate time burden and potentially enhance compliance with these widely used outcome measures.

Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery

BACKGROUND

National campaigns in the United States, such as Choosing Wisely, emphasize that decreasing low-value office visits maximizes health care value. Although patient-reported outcomes (PROs) are frequently used to quantify postoperative outcomes, they have not been assessed as a tool to help guide clinicians consider alternatives or discontinue in-person follow-up visits. The purpose of this study is to assess the frequency and cost of in-person follow-up visits after patients report substantial improvement defined as 2 consecutive improvements above preoperative Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores.

METHODS

Retrospective PROMIS PI data were obtained between 2015 and 2020 for common elective foot (n = 759) and ankle (n = 578) surgical procedures. Patients were divided into quartiles according to their preoperative PI score. Multivariable Cox proportional hazards models were used to investigate time to substantial improvement. Substantial improvement was defined as having 2 consecutive postoperative minimal clinically important differences (MCIDs) above preoperative PROMIS PI scores. MCID was measured using the distribution-based method. Multivariable negative binomial models were used to determine the number of visits and direct associated costs after substantial improvement. The cost to payors was estimated using reimbursement rates.

RESULTS

Within 3 months, 12% to 46% of foot and 16% to 61% of ankle patients achieved substantial improvement. Results vary by preoperative pain quartile, with patients who report higher preoperative pain scores achieving earlier improvement. After achieving substantial improvement, foot and ankle patients averaged 3.60 and 4.01 follow-up visits during the remaining 9 months of the year. Visit costs averaged $266 and $322 per foot and ankle patient respectively.

CONCLUSION

Postoperative follow-up visits are time-consuming and costly. Physicians might consider objective measures, such as PROMIS PI, to determine the need, timing, and alternatives for in-person follow-up visits for elective foot and ankle surgeries after patients demonstrate reliable clinical improvement.

LEVEL OF EVIDENCE

Level III, retrospective cohort study at a single institution.

How Well Do Seven Self-Report Measures Represent Underlying Back Pain Impact?

BACKGROUND

The extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others.

AIMS

To determine if different self-report back pain impact measures represent an underlying pain latent variable and estimate associations with it.

METHOD

Seven pain impact measures completed by Amazon Mechanical Turk adults are used to estimate internal consistency reliability and associations: Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), short form of the Örebro Musculoskeletal Pain Questionnaire (OMPQ), Subgroups for Targeted Treatment (STarT) Back Tool, the Graded Chronic Pain Scale (GCPS) disability score, PEG (Pain intensity, interference with Enjoyment of life, interference with General activity), and Impact Stratification Score (ISS).

RESULTS

The sample of 1,874 adults with back pain had an average age of 41 and 52% were female. Sixteen percent were Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White. Internal consistency reliability estimates ranged from 0.710 (OMPQ) to 0.923 (GCPS). Correlations among the measures ranged from 0.609 (RMDQ with OMPQ) to 0.812 (PEG with GCPS). Standardized factor loadings on the pain latent variable ranged from 0.782 (RMDQ) to 0.870 (ISS).

CONCLUSIONS

Scores of each measure can be estimated from the others for use in research.

Persistence of Low Back Pain and Predictive Ability of Pain Intensity and Disability in Daily Life among Nursery School Workers in Japan: A Five-Year Panel Study

Nursery school workers are known for having a high prevalence of low back pain (LBP). The natural history of LBP and the determinants of persistent LBP remain unclear. We examined the prevalence of persistent LBP and whether pain intensity and disability in daily life due to LBP affected the persistence of LBP among these workers. A five-year panel study was conducted for 446 nursery school workers in Japan. LBP, pain intensity, and disability in daily life due to LBP were assessed with a self-administered questionnaire survey. Pain intensity was assessed using the numerical rating scale (NRS). The Roland-Morris Disability Questionnaire (RDQ) was used to assess disability in daily life due to LBP. At baseline, 270 nursery school workers (60.5%) suffered from LBP. The estimated prevalence of persistent LBP was 84.6% (80.3-88.9%), 82.2% (77.7-86.8%), and 82.0% (77.4-86.5%) at 1, 3, and 5 years after the initial study, respectively. NRS scores of 5 or greater predicted the persistence of LBP at 1 and 3 years after the initial survey (adjusted odds ratios: 4.01 (1.27-12.6) and 8.51 (1.87-38.7), respectively), while RDQ scores did not. In conclusion, LBP highly persisted for a long time and pain intensity predicted persistent LBP among nursery school workers in Japan.

Equipercentile equating of scores from common patient-reported outcome measures of physical function in patients with cancer

OBJECTIVE

To provide equipercentile equating of physical function (PF) scores from frequently used patient-reported outcome measures (PROMs) in cancer patients to facilitate data pooling and comparisons.

STUDY DESIGN AND SETTING

Adult cancer patients from five European countries completed the European Organization for Research and Treatment of Cancer (EORTC) computer adaptive test (CAT) Core, EORTC Quality of Life Questionnaire Version 3.0 (QLQ-C30), Functional Assessment of Cancer Therapy - General (FACT-G), 36-item Short Form Health Survey (SF-36), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 20a short form. The R package "equate" was used to establish conversion tables of PF scores on those measures with a bivariate rank correlation of at least 0.75.

RESULTS

In total, 953 patients with cancer (mean age 58.9 years, 54.7% men) participated. Bivariate rank correlations between PF scores from the EORTC CAT Core, EORTC QLQ-C30, SF-36, and PROMIS were all above 0.85, but below 0.69 for the FACT-G. Conversion tables were established for all measures but the FACT-G. These tables indicate which score from one PROM best matches the score from another PROM and provide standard errors of converted scores.

CONCLUSION

Our analysis indicates that linking of PF scores from both EORTC measures (CAT and QLQ-C30) with PROMIS and SF-36 is possible, whereas the physical domain of the FACT-G seems to be different. The established conversion tables may be used for comparing results or pooling data from clinical studies using different PROMs.

What Affects the Quality of Score Transformations? Potential Issues in True-Score Equating Using the Partial Credit Model

This simulation study investigated to what extent departures from construct similarity as well as differences in the difficulty and targeting of scales impact the score transformation when scales are equated by means of concurrent calibration using the partial credit model with a common person design. Practical implications of the simulation results are discussed with a focus on scale equating in health-related research settings. The study simulated data for two scales, varying the number of items and the sample sizes. The factor correlation between scales was used to operationalize construct similarity. Targeting of the scales was operationalized through increasing departure from equal difficulty and by varying the dispersion of the item and person parameters in each scale. The results show that low similarity between scales goes along with lower transformation precision. In cases with equal levels of similarity, precision improves in settings where the range of the item parameters is encompassing the person parameters range. With decreasing similarity, score transformation precision benefits more from good targeting. Difficulty shifts up to two logits somewhat increased the estimation bias but without affecting the transformation precision. The observed robustness against difficulty shifts supports the advantage of applying a true-score equating methods over identity equating, which was used as a naive baseline method for comparison. Finally, larger sample size did not improve the transformation precision in this study, longer scales improved only marginally the quality of the equating. The insights from the simulation study are used in a real-data example.

Crosswalking the National Institutes of Health Impact Stratification Score to the PEG

OBJECTIVE

To crosswalk the National Institutes of Health (NIH) Pain Consortium's Research Task Force proposed Impact Stratification Score (ISS) to the PEG (Pain Intensity, Interference With Enjoyment of Life, Interference With General Activity) Scale.

DESIGN

Cross-sectional data collected in 2021. Ordinary least squares regression analyses of ISS and PEG.

SETTING

Amazon Mechanical Turk workers.

PARTICIPANTS

1931 adults with back pain with an average age of 41 (range, 19-77); 48% were female, 16% Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White (N=1931).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Patient-Reported Outcomes Measurement Information System (PROMIS)-29+2 v2.1 survey that includes the ISS, and the 3-item PEG.

RESULTS

The ISS and PEG had a correlation coefficient of 0.74. The ISS accounted for 55% of the adjusted variance in the PEG and the standardized average deviation between observed and predicted scores (normalized mean absolute error) was 0.53. Likewise, the PEG explained 55% of the variance in the ISS with a normalized mean absolute error of 0.52.

CONCLUSIONS

This study provides a crosswalk between the ISS and PEG that can be used to predict one from the other. The regression equations can facilitate comparisons in studies that use different measures.

Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain

BACKGROUND

Inclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move.

OBJECTIVE

To characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures.

DESIGN

Cross-sectional study of 328 adults with chronic low back pain (CLBP).

METHOD

Spearman correlations assessed the relationship between pairs of measures. Multiple linear regression models assessed the association between self-reported measures of physical function and the grouping of physical capacity measures. Self-reported measures included Roland Morris Disability Questionnaire (RMDQ), PROMIS Physical Function, Pain Behavior, and Pain Interference; Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and Chronic Pain Acceptance Questionnaire (CPAQ). Capacity measures included walking speed and endurance, lower extremity functional strength, lumbopelvic range of motion, and trunk endurance.

RESULTS

PROMIS Physical Function was directly and weakly correlated with walking speed (ρ = 0.26, 2-min walk) and inversely and weakly correlated with lower extremity strength (ρ = -0.29, 5x sit-to-stand). RMDQ was not correlated with any of the capacity-based measures. PROMIS Physical Function was inversely and moderately correlated with Pain Interference (ρ = -0.48) and Pain Behavior (ρ = -0.43), PCS (ρ = -0.36), and FABQ (ρ = -0.31). The RMDQ was strongly correlated with PROMIS Physical Function (ρ = -0.56), Pain Behavior (ρ = 0.51) and Pain Interference (ρ = 0.49); and moderately correlated with PCS (ρ = 0.37) and FABQ (ρ = 0.33). PROMIS Physical Function and RMDQ were not correlated with CPAQ. Lower scores on PROMIS Physical Function were weakly associated with lower measures of lower extremity strength (-0.30, 95% CI: -0.51 to -0.09, p = 0.005). Higher scores on RMDQ were also weakly associated with lower measures of lower extremity strength (0.26, 95% CI: 0.11 to 0.41, p = 0.001).

CONCLUSIONS

A strong association emerged between self-reported limitations in physical function, pain behavior, and pain interference. A weak association emerged between self-reported physical function and lower extremity strength.

Linking Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form and PROMIS Physical Function

INTRODUCTION

Linking scores on patient-reported outcome measures can enable data aggregation for research, clinical care, and quality. We aimed to link scores on the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) and the Patient-reported Outcomes Measurement Information System Physical Function (PROMIS PF).

METHODS

A retrospective study was conducted from 2017 to 2020 evaluating patients with hip osteoarthritis who received routine clinical care from an orthopaedic surgeon. Our sample included 3,382 unique patients with 7,369 pairs of HOOS-PS and PROMIS PF measures completed at a single nonsurgical, preoperative, or postoperative time point. We included one randomly selected time point of scores for each patient in our linking analysis sample. We compared the accuracy of linking using four methods, including equipercentile and item response theory-based approaches.

RESULTS

PROMIS PF and HOOS-PS scores were strongly correlated ( r = -0.827 for raw HOOS-PS scores and r = 0.820 for summary HOOS-PS scores). The assumptions were met for equipercentile and item response theory approaches to linking. We selected the item response theory-based Stocking-Lord approach as the optimal crosswalk and estimated item parameters for the HOOS-PS items on the PROMIS metric. A sensitivity analysis demonstrated overall robustness of the crosswalk estimates in nonsurgical, preoperative, and postoperative patients.

CONCLUSION

These crosswalks can be used to convert scores between HOOS-PS and PROMIS PF metric at the group level, which can be valuable for data aggregation. Conversion of individual patient-level data is not recommended secondary to increased risk of error.