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Nagaraja V, Mara C, Khanna PP, Namas R, Young A, Fox DA, Laing T, McCune WJ, Dodge C, Rizzo D, Almackenzie M, Khanna D. Establishing clinical severity for PROMIS ® measures in adult patients with rheumatic diseases. Qual Life Res 2017; 27:755-764. [PMID: 28983738 DOI: 10.1007/s11136-017-1709-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Different patient-reported outcome (PRO) measures are used for rheumatic diseases (RD). The aims of this study are-(1) Identify PROMIS® domains most relevant to care of patients with RD, (2) Collect T-Score metrics in patients with RD, and (3) Identify clinically meaningful cut-points for these domains. METHODS A convenience sample of RD patients was recruited consecutively during clinic visits, and asked to complete computer-adaptive tests on thirteen Patient-Reported Outcomes Measurement Information System (PROMIS®) instruments. Based on discussion with clinical providers, four measures were chosen to be relevant and actionable (from rheumatologists' perspective) in RD patients. Data from RD patients were used to develop clinical vignettes across a range of symptom severity. Vignettes were created based on most likely item responses at different levels on the T-score metric (mean = 50; SD = 10) and anchored at 5-point intervals (0.5 SDs). Patients with RD (N = 9) and clinical providers (N = 10) participated as expert panelists in separate one-day meetings using a modified educational standard setting method. RESULTS Four domains (physical function, pain interferences, sleep disturbance, depression) that are actionable at the point-of-care were selected. For all domains, patients endorsed cut-points at lower levels of impairment than providers by 0.5 to 1 SD (e.g., severe impairment in physical function was defined as a T-score of 35 by patients and 25 by providers). CONCLUSIONS We used a modified educational method to estimate clinically relevant cut-points to classify severity for PROMIS measures This allows for meaningful interpretation of PROMIS® measures in a clinical setting of RD population.
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Affiliation(s)
- Vivek Nagaraja
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA.,University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Constance Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7039, Cincinnati, OH, 45229, USA
| | - Puja P Khanna
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA.,Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Rajaie Namas
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - Amber Young
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA.,University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - David A Fox
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - Timothy Laing
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - William J McCune
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - Carol Dodge
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - Debra Rizzo
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA
| | - Maha Almackenzie
- Department of Medicine, University of Toledo, Toledo, OH, USA.,Divison of Rheumatology, University of Toledo, 3000 Arlington Ave, mailstop 1186, Toledo, OH, 43614, USA
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI, 48109-5422, USA. .,University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA.
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