Development and evaluation of the patient-reported outcomes measurement information system (PROMIS) pediatric pain quality item bank and short form

The quality of life assessment in children with juvenile idiopathic arthritis- comparison of PROMIS® generic and disease-specific cut-off points: a pilot study

OBJECTIVES

Decreased quality of life (QoL) is a significant complication of most rheumatic conditions in adults, whereas data on health-related quality of life (HRQoL) in children with juvenile idiopathic arthritis (JIA) are limited. Patient-Reported Outcomes Measurement Information System® (PROMIS® ) instruments assessing quality of life (QoL) components can be scored using disease-specific severity thresholds. Our study aimed to compare the results of generic and one of the JIA-specific scorings regarding PROMIS® Pediatric Mobility, Pain Interference, and Fatigue questionnaires, introduce PROMIS® Pediatric Global Health 7 questionnaire as a valuable method to assess QoL specifically in patients with JIA and determine differences in self-reported QoL in juvenile idiopathic arthritis (JIA) patients and their healthy peers in the Polish population.

METHODS

In this single-center cross-sectional study, four self-reported questionnaires derived from the PROMIS® Pediatric Item Bank (Global Health, Pain Interference, Fatigue, Mobility) were administered to 52 patients with JIA (8-17 years; mean 13.2 ± 2.9; girls 59.6%) and 101 age-matched healthy controls. Questionnaires were scored based on generic or JIA-specific cut-off points.

RESULTS

Regardless of the domain (PROMIS® Pain Interference, Fatigue, or Mobility), JIA patients assigned by generic cut-off points to a more severe outcome were classified into milder outcomes when cut-off points for JIA were used. The usefulness of the PROMIS® Pediatric Global Health 7 questionnaire was evidenced in children with JIA. No significant differences were found in QoL assessment between children with JIA and healthy children; however, self-reported impaired mobility was more prevalent in patients with JIA. A negative correlation was found between overall QoL and the assessment of three domains: pain, fatigue, and mobility impairment.

CONCLUSIONS

Our study underscores the importance of JIA-specific scoring in clinical practice. While more research is needed to establish a single disease-specific scoring, our findings provide valuable insights into the negative influence of pain, fatigue, and mobility impairment on QoL in JIA. These results have the potential to significantly impact patient care and improve the health-related quality of life in children with JIA.

Systematic Review of Pain Assessment Measures Used in Pediatric Acute Lymphoblastic Leukemia

BACKGROUND

Pain is a prevalent, frequent, and often persistent symptom among children with acute lymphoblastic leukemia (ALL). Despite its high prevalence, pain has remained understudied, and no evidence-based recommendations exist for how best to assess and treat pain in this population. Without proper assessment, clinical efforts to improve pain management in pediatric ALL will be ineffective.

AIMS

Therefore, the purpose of this systematic review is to describe and identify gaps in measurement approaches that have been used to assess pain in pediatric ALL, evaluate the psychometric properties of available pediatric pain measures, and provide recommendations for clinical research and practice.

METHODS

Literature searches were performed following Cochrane and PRISMA guidelines for systematic reviews. Domains of pain assessed, measures used to assess pain, measure format, respondent, and timing of pain assessment were extracted from studies that met inclusion criteria. The psychometric properties of included measures were then evaluated. A total of 238 full-text articles were screened and 123 met inclusion criteria.

RESULTS

Most studies assessed pain using generic health-related quality of life instruments rather than pain-specific measures. A total of 39 measures were used across the 123 included studies, and the psychometric properties of the measures varied considerably.

CONCLUSIONS

Recommendations include a selection of well-validated pain assessment measures that are currently available and can be used to facilitate best practices in ALL pain assessment. Clinicians and investigators are encouraged to utilize a multidimensional pain assessment approach to inform and enhance pain care in pediatric ALL.

Recommendations for Patient-Reported Outcomes Measurement Information System pediatric measures in youth with chronic pain: a COnsensus-based Standards for the selection of health Measurement INstruments systematic review of measurement properties

ABSTRACT

The Patient-Reported Outcome Measurement Information System (PROMIS) pediatric measures assess physical, emotional, and social health among children and adolescents. However, their measurement properties have not been systematically examined in youth with chronic pain. A systematic review applying the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) methodology was conducted to evaluate self-reported PROMIS pediatric measures in youth with chronic pain, assessing 8 measurement properties across all versions (item bank, short form, and computer adaptive testing) from 63 studies covering 25 measures. Moderate or high-quality evidence was most available for content validity, structural validity, internal consistency (measurement precision), and construct validity. Four short-form PROMIS pediatric measures-mobility, anxiety, depressive symptoms, and physical stress experiences-achieved recommendation for the use in chronic pain clinical trials; 7 approached recommendation and 14, including the commonly used PROMIS Pediatric Pain Interference Scale, would be recommended with further evidence. Recommendations were also provided for the use of each measure in observational studies. Overall, based on the existing evidence, a total of 11 self-reported PROMIS pediatric short-form measures, including pain intensity, pain behavior, mobility, sleep disturbance, sleep-related impairment, anxiety, depressive symptoms, psychological stress experiences, physical stress experiences, family relationships, and positive effect, are recommended or approaching recommendation for use in youth ages 8 to 19 years with chronic pain. Research is needed to further establish test-retest reliability, measurement errors, cross-cultural validity, and responsiveness. Future work should expand the evaluation of PROMIS pediatric measures in subpopulations of youth with chronic pain, particularly young children and those with neurodevelopmental disabilities.