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

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.