Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic
Susmita Kashikar-Zuck1, Adam Carle, Kimberly Barnett
1Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Pain Management Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Division of Rheumatology, Children's Hospital Of Philadelphia, Philadelphia, PA, USA Department of Psychology, University of North Texas, Denton, TX, USA Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Medical Center, Cincinnati, OH, USA.
Insights
This study validates Patient-Reported Outcomes Measurement Information System (PROMIS) measures for pediatric chronic pain. The findings support PROMIS tools for assessing pain interference, fatigue, and function in children.
Area of Science:
- Pediatric Health Outcomes Research
- Clinical Measurement Science
Background:
- The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to develop validated health outcome measures.
- A need exists for validated PROMIS measures specifically for pediatric chronic pain populations.
Purpose of the Study:
- To investigate the construct validity and responsiveness to change of seven PROMIS domains in children (ages 8-18) with chronic pain.
- To assess PROMIS measures for Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function, and Peer Relationships.
Main Methods:
- PROMIS measures were administered to pediatric chronic pain patients (N=82) and amplified musculoskeletal pain patients (N=63) at baseline and follow-up.
- Construct validity was examined by comparing PROMIS measures with legacy instruments.
- Responsiveness to change was assessed using longitudinal growth models.
Main Results:
- PROMIS measures for Pain Interference, Anxiety, Depression, Mobility, Upper Extremity, and Peer Relationships showed similar performance to legacy instruments.
- All seven PROMIS domains demonstrated responsiveness to change in pediatric chronic pain samples.
- Longitudinal models indicated slightly steeper improvement slopes for legacy measures.
Conclusions:
- Initial findings support the validity and responsiveness of PROMIS measures for assessing pediatric chronic pain.
- Further validation in larger, diverse pediatric pain cohorts is recommended to expand PROMIS utility in clinical research.
Abstract:
The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative is a comprehensive strategy by the National Institutes of Health to support the development and validation of precise instruments to assess self-reported health domains across healthy and disease-specific populations. Much progress has been made in instrument development, but there remains a gap in the validation of PROMIS measures for pediatric chronic pain. The purpose of this study was to investigate the construct validity and responsiveness to change of 7 PROMIS domains for the assessment of children (ages: 8-18) with chronic pain--Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function, and Peer Relationships. The PROMIS measures were administered at the initial visit and 2 follow-up visits at an outpatient chronic pain clinic (CPC; N = 82) and at an intensive amplified musculoskeletal pain day-treatment program (N = 63). Aim 1 examined construct validity of PROMIS measures by comparing them with corresponding "legacy" measures administered as part of usual care in the CPC sample. Aim 2 examined sensitivity to change in both CPC and amplified musculoskeletal pain samples. Longitudinal growth models showed that PROMIS' Pain Interference, Anxiety, Depression, Mobility, Upper Extremity, and Peer Relationship measures and legacy instruments generally performed similarly with slightly steeper slopes of improvement in legacy measures. All 7 PROMIS domains showed responsiveness to change. Results offered initial support for the validity of PROMIS measures in pediatric chronic pain. Further validation with larger and more diverse pediatric pain samples and additional legacy measures would broaden the scope of use of PROMIS in clinical research.
