Skip to main content
Journal cover image

Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release.

Publication ,  Journal Article
Bernstein, DN; Houck, JR; Mahmood, B; Hammert, WC
Published in: Clin Orthop Relat Res
November 2019

BACKGROUND: The Patient-reported Outcome Measurement Information System (PROMIS) continues to be an important universal patient-reported outcomes measure (PROM) in orthopaedic surgery. However, there is concern about the performance of the PROMIS as a general health questionnaire in hand surgery compared with the performance of region- and condition-specific PROMs such as the Michigan Hand Questionnaire (MHQ) and the Boston Carpal Tunnel Questionnaire (BCTQ), respectively. To ensure that PROMIS domains capture patient-reported outcomes to the same degree as region- and condition-specific PROMs do, comparing PROM performance is necessary. QUESTIONS/PURPOSES: (1) Which PROMs demonstrate high responsiveness among patients undergoing carpal tunnel release (CTR)? (2) Which of the PROMIS domains (Physical Function [PF], Upper Extremity [UE], and Pain Interference [PI]) demonstrate concurrent validity with the HHQ and BCTQ domains? METHODS: In this prospective study, between November 2014 and October 2016, patients with carpal tunnel syndrome visiting a single surgeon who elected to undergo CTR completed the BCTQ, MHQ, and PROMIS UE, PF, and PI domains at each visit. A total of 101 patients agreed to participate. Of these, 31 patients (31%) did not return for a followup visit at least 6 weeks after CTR and were excluded, leaving a final sample of 70 patients (69%). We compared the PROMIS against region- and condition-specific PROMs in terms of responsiveness and concurrent validity. Responsiveness was determined using Cohen's d or the effect-size index (ESI). The larger the absolute value of the ESI, the greater the effect size. Using the ESI allows surgeons to better quantify the impact of CTR, with a medium ESI (that is, 0.5) representing a visible clinical change to a careful observer. Concurrent validity was determined using Spearman's correlation coefficient with correlation strengths categorized as excellent (> 0.7), excellent-good (0.61-0.70), good (0.4-0.6), and poor (< 0.4). Significance was set a priori at p < 0.05. RESULTS: Among PROMIS domains, the PI demonstrated the best responsiveness (ESI = 0.74; 95% CI, 0.39-1.08), followed by the UE (ESI = -0.66; 95% CI, -1.00 to -0.31). For the MHQ, the Satisfaction domain had the largest effect size (ESI = -1.48; 95% CI, -1.85 to -1.09), while for the BCTQ, the Symptom Severity domain had the best responsiveness (ESI = 1.54; 95% CI, 1.14-1.91). The PROMIS UE and PI domains demonstrated excellent-good to excellent correlations to the total MHQ and BCTQ-Functional Status scores (preoperative UE to MHQ: ρ = 0.68; PI to MHQ: ρ = 0.74; UE to BCTQ-Functional Status: ρ = 0.74; PI to BCTQ-Functional Status: ρ = 0.67; all p < 0.001), while the PROMIS PF demonstrated poor correlations with the same domains (preoperative PF to MHQ; ρ = 0.33; UE to BCTQ-Functional Status: ρ = 0.39; both p < 0.01). CONCLUSIONS: The PROMIS UE and PI domains demonstrated slightly worse responsiveness than the MHQ and BCTQ domains that was nonetheless acceptable. The PROMIS PF domain was unresponsive. All three PROMIS domains correlated with the MHQ and BCTQ, but the PROMIS UE and PI domains had notably stronger correlations to the MHQ and BCTQ domains than the PF domain did. We feel that the PROMIS UE and PI can be used to evaluate the clinical outcomes of patients undergoing CTR, while also providing more robust insight into overall health status because they are general PROMs. However, we do not recommend the PROMIS PF for evaluating patients undergoing CTR. LEVEL OF EVIDENCE: Level II, diagnostic study.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

November 2019

Volume

477

Issue

11

Start / End Page

2544 / 2551

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Recovery of Function
  • Prospective Studies
  • Patient Satisfaction
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Hand
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bernstein, D. N., Houck, J. R., Mahmood, B., & Hammert, W. C. (2019). Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release. Clin Orthop Relat Res, 477(11), 2544–2551. https://doi.org/10.1097/CORR.0000000000000773
Bernstein, David N., Jeff R. Houck, Bilal Mahmood, and Warren C. Hammert. “Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release.Clin Orthop Relat Res 477, no. 11 (November 2019): 2544–51. https://doi.org/10.1097/CORR.0000000000000773.
Bernstein, David N., et al. “Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release.Clin Orthop Relat Res, vol. 477, no. 11, Nov. 2019, pp. 2544–51. Pubmed, doi:10.1097/CORR.0000000000000773.
Bernstein DN, Houck JR, Mahmood B, Hammert WC. Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release. Clin Orthop Relat Res. 2019 Nov;477(11):2544–2551.
Journal cover image

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

November 2019

Volume

477

Issue

11

Start / End Page

2544 / 2551

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Recovery of Function
  • Prospective Studies
  • Patient Satisfaction
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Hand