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Hennekes ME, Li S, Bennie J, Makhni EC. What does routine depression screening in the ambulatory orthopedic clinic teach us? Results from nearly 60,000 patient encounters. J Orthop 2024; 51:81-86. [PMID: 38333047 PMCID: PMC10847749 DOI: 10.1016/j.jor.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
Background It remains unclear what role depression screening plays in routine ambulatory orthopedic care. The purpose of this study was to determine (1) the floor and ceiling effects of the Patient-Reported Outcomes Measurement Information System Depression (PROMIS-D) form, (2) the prevalence of positive PROMIS-D screening forms across an orthopedic service line, and (3) the prevalence of previously diagnosed depression and interventions among a representative sample of patients. Methods This retrospective study analyzed 58,227 patients who presented to ambulatory orthopedic clinics across an orthopedic service line between January 1, 2019 to December 31, 2021. All patients completed a self-administered PROMIS-D form as part of the ambulatory encounter. Scores were analyzed with respect to patient characteristics including age, gender, and presenting orthopedic complaint. A sample of 1000 patients was evaluated for prevalence of depressive symptoms and formal psychiatric diagnosis and interventions in the 5 years preceding the clinic visit. Results PROMIS-D displayed a negligible ceiling effect (<0.001 %) but a large floor effect (19.0 %). PROMIS-D scores indicating depressive symptoms were highest among patients presenting with spine complaints (42.8 %) and lowest among patients presenting to orthopedic pediatric clinics (28.6 %). Women and those in the lowest quartile median household income (MHI) were more likely to report depressive symptoms. Among the 1000 patient sample, 31.3 % exhibited depressive symptoms. Of these, 39 % had previously received some form of mental health treatment, including 33.2 % who were prescribed antidepressants. Conclusions PROMIS-D is a useful screening questionnaire for patients in the orthopedic clinic, although there is a consistent floor effect. There are a number of patients who present to the orthopedic clinic who have depressive symptoms but have had no interaction with behavioral health. Given the impact depression can have on outcomes, screening for depressive symptoms should be considered as part of routine orthopedic practice.
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Affiliation(s)
| | - Stanley Li
- Michigan State University College of Human Medicine, 15 E Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Justin Bennie
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Eric C. Makhni
- Henry Ford Health, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
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Huddleston HP, Mehta N, Lavoie-Gagne OZ, Maheshwer B, Fu MC, Cole BJ, Verma NN, Forsythe B, Yanke AB. Patient-reported outcomes measurement information system depression psychometrically underperforms compared to legacy measures and is poorly associated with postoperative functional outcomes in shoulder arthroplasty patients. Shoulder Elbow 2023; 15:626-633. [PMID: 37981972 PMCID: PMC10656966 DOI: 10.1177/17585732221137555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2023]
Abstract
Background The purpose of this study was to investigate the associations between each mental health patient-reported outcome measure with postoperative functional outcomes following shoulder arthroplasty, and to compare psychometric properties of patient-reported outcomes measurement information system depression to the legacy (VR-12 Mental) patient-reported outcome measure. Methods Patients who underwent primary shoulder arthroplasty from July 2018 to February 2019 were retrospectively reviewed. Patient-reported outcomes measurement information system depression and VR-12 Mental were administered preoperatively; American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation were administered at 6-month and 1-year postoperatively. Rasch partial credit modeling analysis was used to compare psychometric properties of legacy versus patient-reported outcomes measurement information system instruments in assessing mental health. Results Ninety-three patients who underwent total shoulder arthroplasty (n = 52), reverse total shoulder arthroplasty (n = 39), or hemiarthroplasty (n = 2) were included. Preoperative VR-12 Mental scores were moderately associated with American Shoulder and Elbow Surgeons at 6-months (coefficient: 0.52, P = 0.026) and 1-year (coefficient: 0.65, P = 0.002), while preoperative patient-reported outcomes measurement information system depression scores were not. Patient-reported outcomes measurement information system depression demonstrated significant floor effects (16%); VR-12 Mental demonstrated minimal floor and ceiling effects (1.1% for both). VR-12 Mental demonstrated broader coverage of mental outlook on Rasch modeling than patient-reported outcomes measurement information system depression and had adequate model fit after one round of reiterative item elimination. Discussion Patient-reported outcomes measurement information system depression was poorly associated with postoperative American Shoulder and Elbow Surgeons scores, demonstrated significant floor effects, and had limited coverage of mental health on Rasch modeling with reiterative elimination. Level of Evidence IV.
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Affiliation(s)
| | - Nabil Mehta
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | | | - Bhargavi Maheshwer
- Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Brian J Cole
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
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Kunze KN, Madjarova S, Jayakumar P, Nwachukwu BU. Challenges and Opportunities for the Use of Patient-Reported Outcome Measures in Orthopaedic Pediatric and Sports Medicine Surgery. J Am Acad Orthop Surg 2023; 31:e898-e905. [PMID: 37279168 DOI: 10.5435/jaaos-d-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 06/08/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are essential tools in assessing treatment response, informing clinical decision making, driving healthcare policy, and providing important prognostic data regarding patient health status change. These tools become essential in orthopaedic disciplines, such as pediatrics and sports medicine, given the diversity of patient populations and procedures. However, the creation and routine administration of standard PROMs alone do not suffice to appropriately facilitate the aforementioned functions. Indeed, both the interpretation and optimal application of PROMs are essential to provide to achieve greatest clinical benefit. Contemporary developments and technologies surrounding PROMs may help augment this benefit, including the application of artificial intelligence, novel PROM structure with improved interpretability and validity, and PROM delivery methods that provide increased access to patients resulting in greater compliance and data acquisition yields. Despite these exciting innovations, several challenges remain in this realm that must be addressed to continue to advance the clinical usefulness and subsequent benefit of PROMs. This review will highlight the opportunities and challenges surrounding contemporary PROM use in the orthopaedic subspecialties of pediatrics and sports medicine.
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Affiliation(s)
- Kyle N Kunze
- From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Kunze, Madjarova, and Nwachukwu), Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX (Dr. Jayakumar)
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Wilson CD, Welling BD, Hammonds KAP, Robin BN. Impact of patient resilience on early recovery from rotator cuff repair. Shoulder Elbow 2022; 14:222-229. [PMID: 35265189 PMCID: PMC8899317 DOI: 10.1177/17585732211003556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
AIMS We sought to evaluate early recovery from rotator cuff repair by assessing the correlation between patient resilience and postoperative shoulder pain and function, and physical and mental health. METHODS Patients scheduled to undergo arthroscopic rotator cuff repair were prospectively enrolled. Resilience was assessed using the Brief Resilience Scale (BRS), pain and function was measured by American Society of Shoulder and Elbow Surgeons (ASES) shoulder scores, and physical and mental health was measured by the Patient-Reported Outcome Measurement Information System Global Health-10 (PROMIS-10). All scores were obtained preoperatively and postoperatively at three- and six months. Spearman correlation coefficient (r) was used to assess the relationship between variables. RESULTS Ninety-eight patients ultimately underwent rotator cuff repair; 76 and 68 patients provided three- and six-month follow-up, respectively. There was no statistically significant correlation between preoperative BRS and three- and six-month ASES. However, there was a statistically significant correlation between preoperative BRS and three-month PROMIS-10 (r = 0.3763, p = 0.009) and concurrent BRS and PROMIS-10 at three months (r = 0.5657, p = 0.0025) and six months (r = 0.5308, p = 0.0025). DISCUSSION Resilience appears to be more predictive of global physical and mental health than shoulder pain and function in early recovery from rotator cuff repair.
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Affiliation(s)
- Charlie D Wilson
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA,Charlie D Wilson, Department of Orthopaedic Surgery, Baylor Scott & White Health, 5612 Drury Ln., Temple, TX 76502, USA.
| | - Benjamin D Welling
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
| | | | - Brett N Robin
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
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Joyce CD, Gutman MJ, Hill BW, Singh AM, Sherman M, Abboud JA, Namdari S. Radiographic Severity May Not be Associated with Pain and Function in Glenohumeral Arthritis. Clin Orthop Relat Res 2022; 480:354-363. [PMID: 34435980 PMCID: PMC8747494 DOI: 10.1097/corr.0000000000001950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the routine use of plain radiographs to stratify the severity of glenohumeral osteoarthritis, little is known about the relationship between radiographic measures and patient-perceived pain and function. QUESTIONS/PURPOSES (1) What radiographic findings are associated with worse pain and function in patients with glenohumeral osteoarthritis? (2) What demographic factors are associated with worse pain and function in patients with glenohumeral osteoarthritis? METHODS This retrospective study included patients presenting for an initial office visit for primary glenohumeral osteoarthritis. Patients with other concurrent shoulder pathologic findings, prior surgery, lack of pain and functional scores, recent injection, or inadequate radiographs were excluded. Between January 2017 and January 2019, 3133 patients were eligible based on these inclusion criteria; 59% (1860) had outcome assessments and 48% (893) of those had radiographs. An additional 42% (378) of those with radiographs were excluded because of other shoulder findings, recent injection, prior surgery, or inadequate radiographs, leaving 16% (515 of 3133) who were fully analyzed in this study. A radiographic review included the joint space width, posterior humeral head subluxation, inferior humeral head osteophyte size, cystic change, and head asphericity. Additionally, radiographic arthritis was classified according to the Walch, Samilson-Prieto, and Kellgren-Lawrence classifications by two separate reviewers. Radiographic and demographic criteria as well as the presence of psychologic or mental illness were correlated with VAS Pain (range 1-10; minimal clinically important difference [MCID] 1.6), American Shoulder and Elbow Surgeons (ASES; range 0-100; MCID 13.6), Single Assessment Numeric Evaluation (SANE; range 0-100; MCID 14), and Simple Shoulder Test (SST; range 0-12; MCID 1.5) scores using univariate and multivariable regression analyses. RESULTS After accounting for age, gender, and psychologic illness in the multivariable analysis, we found that patients with Samilson-Prieto Grade 4 arthrosis had lower VAS Pain scores (β = -1.9; p = 0.02) than those with Grade 0 or 1 did; however, no clinically important associations were found between Samilson-Prieto Grade 4 and ASES (β = 7; p = 0.25), SANE (β = 4; p = 0.63), or SST (β = 0.5; p = 0.62) scores. No clinically important associations were found between Kellgren-Lawrence Grade 3 and VAS Pain (β = 1.4; p = 0.10), ASES (β = -8; p = 0.22), SANE (β = -13; p = 0.11), or SST scores (β = 0.4; p = 0.66). Radiographic joint space and posterior subluxation also did not have any clinically important associations with VAS Pain or functional scores. In assessing Walch glenoid type, there was no clinically important association between glenoid type and VAS Pain (F = 3.1; p < 0.01), ASES (F = 1.9; p = 0.15), SANE (F = 0.45; p = 0.66), or SST scores (F = 0.76; p = 0.71). Men had higher SST scores than women did (β = 2.0; p < 0.01), but there were no clinically important differences in VAS Pain (β = -0.4; p = 0.04), ASES (β = 6; p < 0.01), or SANE (β = 4; p = 0.07) scores. No clinically important association was found between age or the presence of any psychologic illness and VAS Pain or functional scores. CONCLUSION In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered with respect to radiographic or demographic factors. Surgeons should understand that the pain levels of patients with glenohumeral arthritis may not parallel radiographic severity. Future studies can build on these findings by examining other non-radiographic or demographic factors that affect pain in patients with shoulder arthritis, such as psychological factors. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
| | - Michael J. Gutman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian W. Hill
- Palm Beach Orthopaedic Institute, West Palm Beach, FL, USA
| | - Arjun M. Singh
- University of Illinois College of Medicine, Chicago, IL, USA
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Baumgarten KM. The American Shoulder and Elbow Surgeons score has excellent correlation with the Western Ontario Osteoarthritis score. J Shoulder Elbow Surg 2021; 30:2604-2610. [PMID: 33895303 DOI: 10.1016/j.jse.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/04/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND/HYPOTHESIS The purpose of this study was to compare the correlation, responsiveness, and responder and administrator burden of the American Shoulder and Elbow Surgeons (ASES) score with the Western Ontario Osteoarthritis of the Shoulder (WOOS) score for patients undergoing total shoulder arthroplasty. The goal was to determine whether one score was superior to the other to limit the use of multiple scoring measures when tracking patient outcomes. The hypothesis of this study was that for patients undergoing total shoulder arthroplasty, the WOOS score would have (1) a high level of correlation with the ASES score, (2) comparable responsiveness to the ASES score, and (3) a higher responder and administrator burden than the ASES score. METHODS We performed a retrospective review of a database of patients undergoing total shoulder arthroplasty in which the ASES score was recorded with the WOOS score. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine whether correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations and by type of arthroplasty (anatomic vs. reverse). Responsiveness was determined by calculating the standardized response mean and the effect size of both scores. Responder and administrator burden was examined using 50 consecutive preoperative patients to determine the number of incorrectly completed WOOS and ASES scores. RESULTS The correlation of the ASES and WOOS scores for all patients was excellent (n = 1218, r = 0.88, P < .0001). The correlation of the ASES and WOOS scores was excellent for patients undergoing anatomic total shoulder arthroplasty (n = 695, r = 0.71, P < .0001) and reverse total shoulder arthroplasty (n = 523, r = 0.88, P < .0001). The correlation of preoperative scores was strong-moderate (n = 606, r = 0.62, P < .0001), and that of postoperative scores was strong-moderate (n = 612, r = 0.69, P < .0001). The standardized response mean (WOOS score, 2.1; ASES score, 2.1) and the effect size (WOOS score, 3.0; ASES score, 3.0) demonstrated comparable responsiveness. Twenty-six percent of the WOOS scores were completed incorrectly and were invalid compared with 0% of the ASES scores (P < .0001). CONCLUSION There is excellent correlation and comparable responsiveness between the ASES score and WOOS score. Including these scores simultaneously when tracking patient-determined outcomes appears to be redundant and therefore unnecessary. Because there is higher responder and administrative burden for the WOOS score, we recommend use of the ASES score over the WOOS score in patients undergoing total shoulder arthroplasty.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, Montgomery JR, Uhl TL. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clin Orthop Relat Res 2021; 479:1982-1992. [PMID: 33835100 PMCID: PMC8373537 DOI: 10.1097/corr.0000000000001750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported measures guide physicians in clinical decision making and therefore it is critical to determine what clinical factors are associated with these scores. Psychological and physical factors are commonly studied separately in patients with rotator cuff tears to determine their influence on outcomes. It is well established that psychological distress and scapular motion change in the presence of a symptomatic rotator cuff tear. However, these factors have not been studied simultaneously in a clinical setting to determine their association with shoulder outcome scores. QUESTION/PURPOSE After controlling for relevant confounding variables, what physical and psychological factors are associated with better (1) American Shoulder and Elbow Surgeons (ASES) scores for function, (2) ASES pain scores, and (3) total ASES scores? METHODS Fifty-nine patients with a potential symptomatic rotator cuff tear were recruited and agreed to participate in this cross-sectional study. Of those, 85% (50 of 59) met eligibility criteria for a primary diagnosis of an MRI-confirmed symptomatic partial-thickness or full-thickness rotator cuff tear without a history of shoulder surgery. Demographics, rotator cuff tear size, arm flexion, and clinical scapular motion during active arm flexion were evaluated by experienced examiners using standardized procedures. Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment form, which measures 11 different pain-related psychological distress symptoms. Three separate stepwise multiple linear regression analyses were performed for ASES pain, function, and total scores, with significance set at p < 0.05. RESULTS This model found that ASES function scores were associated with four factors: older age, increased arm flexion, increased percentage of scapular external rotation during arm flexion, and increased scores for acceptance of chronic pain (adjusted r2 = 0.67; p = 0.01). Those four factors appear to explain 67% of the observed variance in ASES function scores in patients with rotator cuff tears. Furthermore, increased percentage of scapular external rotation during arm flexion and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.36; p < 0.01) were associated with better ASES pain scores. And finally, better ASES total scores were associated with four factors: increased arm flexion, increased percentage of scapular upward rotation, increased scapular external rotation during arm flexion, and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.65; p < 0.001). CONCLUSION Our results favor adopting a comprehensive biopsychological clinical assessment for patients with rotator cuff tears that specifically includes humeral and scapular motion, fear-avoidance behaviors, and pain coping behaviors along with demographics. These particular physical and psychological variables were found to be associated with the ASES and, therefore, should be clinically examined simultaneously and targeted as part of a tailored treatment plan. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Nicole G. Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Nick Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Scott Mair
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Tim L. Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Gonzalez AI, Kortlever JTP, Crijns TJ, Ring D, Reichel LM, Vagner GA. Pain during physical examination of a healing upper extremity fracture. J Hand Surg Eur Vol 2021; 46:476-481. [PMID: 32903126 DOI: 10.1177/1753193420952010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The evidence that symptom intensity and magnitude of limitations correlate with thoughts and emotions means that subjective signs, such as pain with physical examination, reflect both physical and mental health. During a 1-month evaluation of a rapidly healing upper extremity fracture with no risk of nonunion, 117 people completed measures of adaptiveness to pain and pain during the physical examination. Greater pain during examination correlated with less adaptive responses to pain and older age. This finding raises questions about using tenderness to assess fracture union.Level of evidence: II.
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Affiliation(s)
- Amanda I Gonzalez
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - Joost T P Kortlever
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - Lee M Reichel
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - Gregg A Vagner
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
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Matar RN, Shah NS, Grawe BM. Patient-Reported Outcomes Measurement Information System Scores Are Inconsistently Correlated With Legacy Patient-Reported Outcome Measures in Shoulder Pathology: A Systematic Review. Arthroscopy 2021; 37:1301-1309.e1. [PMID: 33253797 DOI: 10.1016/j.arthro.2020.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the current literature regarding Patient-Reported Outcomes Measurement Information System (PROMIS) and its correlation to legacy patient-reported outcomes measures (PROMs) in 5 domains: (1) rotator cuff disease, (2) shoulder instability, (3) shoulder arthroplasty, (4) proximal humerus fractures, and (5) glenohumeral arthritis. The secondary purpose is to evaluate the floor and ceiling effects, the number of questions, and time needed to complete PROMIS and legacy PROMs in shoulder care. METHODS A systematic review of the available literature on PROMIS scores in shoulder care was performed. This review was accomplished per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. RESULTS A total of 11 studies that reported data on 1485 patients met inclusion criteria. There was a strong correlation between general function PROMs and the PROMIS PF for patients with rotator cuff disease, shoulder instability, shoulder arthroplasty, and proximal humerus fractures. In addition, there was a strong correlation between PROMIS UE and legacy PROMs in patients with rotator cuff injury and shoulder instability. PROMIS instruments asked fewer questions than legacy PROMs (9.46 vs 12.99, respectively), took less time to complete (88.21 vs 96.53 seconds, respectively), had less floor effects in both PROMIS PF and UE (0.17% and 0.62% vs 2.89%, respectively), and had lower ceiling effects for PROMIS PF but not PROMIS UE assessments (0.17% and 6.37% vs 1.89%, respectively). CONCLUSIONS This systematic review demonstrated PROMIS instruments have varying correlations with legacy PROMs measures for patients with rotator cuff disease, shoulder instability, shoulder arthroplasty, and glenohumeral arthritis. PROMIS instruments do measure clinical outcomes faster and with fewer questions. Other than PROMIS UE v1.2 ceiling effects, PROMIS instruments have lower rates of floor and ceiling effects. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Robert N Matar
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A..
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
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Nayfe R, Chansard M, Hynan LS, Mortensen EM, Annaswamy T, Fraenkel L, Makris UE. Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain. BMC Musculoskelet Disord 2020; 21:598. [PMID: 32900386 PMCID: PMC7487821 DOI: 10.1186/s12891-020-03587-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH's Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated "legacy" instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments. METHODS We enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC. RESULTS Of the 71 Veterans recruited, the median (IQR) age was 67 (63-71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4-1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001. CONCLUSIONS Given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
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Affiliation(s)
- Rabih Nayfe
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA
| | | | - Linda S Hynan
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Psychiatry, UTSW, Dallas, TX, USA
| | - Eric M Mortensen
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA
| | - Thiru Annaswamy
- Department of Physical Medicine & Rehabilitation, VA North Texas Health Care System, Dallas, TX, USA
| | - Liana Fraenkel
- Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA.
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA.
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, 4500 S Lancaster Rd., Dallas, TX, 75216, USA.
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Marks R. Anxiety and Osteoarthritis Disability: Updated Overview and Commentary. Open Orthop J 2020. [DOI: 10.2174/1874325002014010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
Osteoarthritis, a widespread highly painful often incapacitating joint disease continues to impose immense personal and societal challenges among adults of all ages, especially among older adults. In the absence of any effective cure or treatment, it has become essential to explore all correlates of this chronic disabling disease, especially those that might be preventable or modifiable. Anxiety, a potentially remediable state of mental distress - found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.
Objective:
In line with previous promising work, this narrative review elected to explore the extent to which current researchers in the field are pursuing this topic, and if so, the degree to which prevailing peer-reviewed data sources support an important role for continued research in this realm, and in what regard.
Methods:
Primarily explored were the key databases housing relevant publications that emerged over Aug 1, 2018-Feb 26, 2020 using the keywords Osteoarthritis and Anxiety. Using a descriptive approach, the relative progress made over the past five previous years in this regard was assessed, in addition to what joints have been studied and with what frequency, and how the degree of interest compares to other currently researched osteoarthritis themes. The potential for intervening in the osteoarthritis pain cycle by addressing anxiety was also examined.
Results:
Findings show a high level of current interest in this topic, and that despite the paucity of prospective studies, studies on joints other than the knee and hip joints, some equivocal conclusions, small numbers of anxiety-related studies compared to other topics, and substantive design limitations, it appears that future research in this realm is strongly indicated.
Conclusion:
This topic if examined further is likely to produce highly advantageous results at all stages of the osteoarthritic disease process and in the context of primary, secondary, as well as tertiary measures to ameliorate osteoarthritis pain and disability.
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Nwachukwu BU, Beletsky A, Naveen N, Southworth TM, Okoroha KR, Forsythe B, Verma N, Yanke A, Cole BJ. Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments Correlate Better With Legacy Measures in Knee Cartilage Patients at Postoperative Than at Preoperative Assessment. Arthroscopy 2020; 36:1419-1428. [PMID: 32035174 DOI: 10.1016/j.arthro.2020.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/13/2019] [Accepted: 01/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To define the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression computer adaptive tests (CATs) in patients undergoing knee cartilage surgical procedures. METHODS The PROMIS PF, PI, and Depression CATs were administered preoperatively and at 6 months alongside legacy knee patient-reported outcome measures (PROMs) in patients undergoing knee cartilage surgical procedures. Statistical analysis consisted of the time to completion, psychometric analysis for correlative strengths, absolute and relative floor and ceiling effects, and Cohen effect size. RESULTS Our study included 250 patients (57.2% male patients), averaging 1.87, 1.53, and 1.91 minutes for completion of the PF, PI, and Depression CATs, respectively. Preoperatively, the PROMIS PF and PI CATs showed wide ranges of correlation coefficients with respect to function (r = 0.14-0.72 and r = 0.29-0.77, respectively) and health-related quality-of-life PROMs (r = 0.64-0.70). At 6 months, the PROMIS PF CAT (r = 0.82-0.93) and PI CAT (r = 0.77-0.93) both exhibited excellent correlations with respect to legacy function and health-related quality-of-life PROMs except for the Marx Activity Rating Scale (r = 0.36-0.44). None of the PROMIS instruments exhibited any significant floor or ceiling effects. CONCLUSIONS The PROMIS PF, PI, and Depression CATs performed better with respect to legacy PROMs in the postoperative period than the preoperative period. In addition, the PROMIS PF and PI measures performed best with respect to the International Knee Documentation Committee questionnaire, and no floor or ceiling effects were identified for the PROMIS instruments. The PROMIS instruments may be more suited to track outcomes postoperatively than to establish preoperative baselines in cartilage surgery patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Neal Naveen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Taylor M Southworth
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kelechi R Okoroha
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Adam Yanke
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Gulledge CM, Lizzio VA, Smith DG, Guo E, Makhni EC. What Are the Floor and Ceiling Effects of Patient-Reported Outcomes Measurement Information System Computer Adaptive Test Domains in Orthopaedic Patients? A Systematic Review. Arthroscopy 2020; 36:901-912.e7. [PMID: 31919023 DOI: 10.1016/j.arthro.2019.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review to answer the following: (1) What are the floor and ceiling (F/C) effects of the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) domains of physical function (PF), upper extremity physical function (UE), pain interference (PI), and depression (D) in adult orthopaedic patients? (2) Do the PROMIS-PF and PROMIS-PI domains have differing F/C effects depending on use in upper extremity, lower extremity, spine, neck, and back, or trauma patients?. METHODS (Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed, the review was registered on PROSPERO, and the methodological index for non-randomized studies was used for this systematic review. Studies reporting the F/C effects of at least 1 of 4 PROMIS CAT domains in orthopaedic patient cohorts accessed through PubMed and Embase on October 30, 2018, were included. F/C effects for each study were reported within forest plots. RESULTS Forty-three studies were included. Generally, varying cohorts demonstrated no F/C effects for PROMIS-PF (0%-9.0%), variable ceiling effects for PROMIS-UE (lower in v2.0; 0%-28.2%), variable floor effects for PROMIS-PI (0%-19.0%), and significant floor effects for PROMIS-D (0.4%-23.4%). CONCLUSIONS The orthopaedic literature demonstrated generally favorable floor and ceiling effects for PROMIS CAT domains, with the exception of variable ceiling effects for PROMIS-UE (the newer version exhibits only minor effects), variable floor effects for PROMIS-PI, and significant floor effects for PROMIS-D. In addition, the F/C effects of PROMIS-PF did not vary based on patient population. Although the floor effects of PROMIS-PI did vary based on patient population, the variability does not appear to be based solely on anatomic location. The PROMIS-PF and PROMIS-UE v2.0 demonstrate consistently low floor and ceiling effects. However, the PROMIS-PI and PROMIS-D may need modification before widespread adoption for clinical and research purposes. LEVEL OF EVIDENCE III; systematic review of Level I-III studies.
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Affiliation(s)
- Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Vincent A Lizzio
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - D Grace Smith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Eric Guo
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
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Kohan EM, Hill JR, Lamplot JD, Aleem AW, Keener JD, Chamberlain AM. Severity of Glenohumeral Osteoarthritis Does Not Correlate With Patient-Reported Outcomes. J Shoulder Elb Arthroplast 2020; 4:2471549220901873. [PMID: 34497959 PMCID: PMC8282148 DOI: 10.1177/2471549220901873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022] Open
Abstract
Background Patient pain and clinical function are important factors in decision-making
for patients with glenohumeral osteoarthritis (GHOA). The correlation
between radiographic severity of arthritis and demographic factors with
modern patient-reported outcome measures has not yet been well defined. Methods This cross-sectional study included 256 shoulders in 246 patients presenting
with isolated GHOA. All patients obtained standard radiographs and completed
the American Shoulder and Elbow Surgeons score, Simple Shoulder Test (SST),
Shoulder Activity Scale, Visual Analog Scale, and Patient-Reported Outcome
Measurement Information System (PROMIS) computer adaptive tests at the time
of presentation. Radiographs were graded according to the Samilson–Prieto
classification. Mean pain and functional scores were compared between the
radiographic grades of osteoarthritis (OA) and demographic factors. Results There were 6 shoulders rated as grade 1 OA, 41 shoulders as grade 2, 149
shoulders as grade 3a, and 65 shoulders as grade 3b. There was excellent
interobserver reliability in grade of OA (κ = 0.77). There were no
significant differences in patient-reported pain or any validated measure of
clinical function between radiographic grades of OA
(P > .05). Males reported higher
function and lower pain scores than females
(P = .001–.066), although only the
values for the SST and PROMIS physical function test were clinically
relevant. Discussion While gender correlated with pain and function, the clinical relevance is
limited. Radiographic severity of GHOA does not correlate with
patient-reported pain and function, and symptoms should remain the primary
determinants of surgical decision-making. Further investigation is necessary
to examine whether radiographic severity of OA influences improvement
following operative intervention in this population.
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Affiliation(s)
- Eitan M Kohan
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Jeffrey Ryan Hill
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
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Gulledge CM, Smith DG, Ziedas A, Muh SJ, Moutzouros V, Makhni EC. Floor and Ceiling Effects, Time to Completion, and Question Burden of PROMIS CAT Domains Among Shoulder and Knee Patients Undergoing Nonoperative and Operative Treatment. JB JS Open Access 2019; 4:JBJSOA-D-19-00015. [PMID: 32043052 PMCID: PMC6959920 DOI: 10.2106/jbjs.oa.19.00015] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) have emerged as an efficient technique for measuring patient-reported outcomes among orthopaedic patients. The purpose of this study was to investigate the floor and ceiling (F/C) effects, time to completion (TTC), and question burden of PROMIS CATs administered to patients presenting to a shoulder and sports medicine orthopaedic clinic.
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Affiliation(s)
- Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - D Grace Smith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Alexander Ziedas
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
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