Computerized Adaptive Testing for Patient Reported Outcomes in Ankle Fracture Surgery

Area of Science:

• Orthopedics
• Medical Informatics
• Health Outcomes Research

Background:

• Patient-reported outcome measures (PROMs) are crucial for evaluating surgical outcomes.
• Traditional PROMs can have limitations like floor/ceiling effects and reduced sensitivity to change.
• Computerized adaptive testing (CAT) offers potential advantages in patient assessment.

Purpose of the Study:

• To compare the efficacy of legacy PROMs versus PROMIS CAT in detecting clinically significant changes in patients post-ankle fracture surgery.
• To evaluate floor and ceiling effects of both legacy and PROMIS measures.
• To determine the minimal clinically significant difference (MCID) detectability of each instrument.

Main Methods:

• Retrospective comparative study of 132 patients undergoing osteosynthesis for unstable ankle fractures.
• Collected legacy scores (FAOS, OMAS, Weber) and PROMIS Physical Function (PF) and Lower Extremity (LE) CAT scores.
• Analyzed score correlations, floor/ceiling effects, and MCIDs at 3-month, 6-month, and 1-year intervals.

Main Results:

• PROMIS PF and LE scores showed no floor or ceiling effects.
• PROMIS LE detected significant changes between 6-month and 12-month postoperative visits (P = .0006).
• Legacy OMAS and Weber scores failed to identify significant differences between these time points.

Conclusions:

• PROMIS LE CAT is superior to legacy measures for evaluating patients after ankle fracture surgery.
• PROMIS LE demonstrates reduced floor/ceiling effects and enhanced sensitivity to clinically meaningful changes.
• PROMIS CAT offers improved assessment capabilities in orthopedic outcomes research.