PROMIS: a valid and efficient outcomes instrument for patients with ACL tears

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Health Outcomes Research

Background:

• Patient-reported outcomes (PROs) are crucial for assessing physical function after anterior cruciate ligament (ACL) reconstruction.
• Traditional PRO instruments can be lengthy, potentially impacting patient compliance and data quality.
• The Patient Reported Outcomes Information System Physical Function Computer Adaptive Test (PROMIS PF CAT) offers a potentially more efficient alternative.

Purpose of the Study:

• To compare the PROMIS PF CAT with established knee-specific PROs in a healthy population undergoing ACL surgery.
• To evaluate the correlation strength between PROMIS PF CAT scores and traditional physical function measures.
• To assess the test burden and identify any floor or ceiling effects of the PROMIS PF CAT in this cohort.

Main Methods:

• 100 patients undergoing ACL surgery completed the PROMIS PF CAT, SF-36 PF, KOOS, Marx Scale, and EQ-5D.
• Correlations were categorized as high (≥0.7), high-moderate (0.61-0.69), moderate (0.4-0.6), moderate-weak (0.31-0.39), and weak (≤0.3).
• Floor or ceiling effects were defined as ≥15% of patients reporting the lowest or highest possible score.

Main Results:

• The PROMIS PF CAT demonstrated high correlations with SF-36 PF (r=0.82), EQ-5D (r=-0.70), KOOS ADL (r=0.74), and KOOS Sport (r=0.70).
• No significant floor or ceiling effects were observed for the PROMIS PF CAT (0% of patients).
• The average number of items administered by the PROMIS PF CAT was low (mean 4.2 items).

Conclusions:

• The PROMIS PF CAT is a valid and reliable measure of physical function in patients undergoing ACL surgery.
• It exhibits strong correlations with commonly used PROs, indicating good convergent validity.
• The PROMIS PF CAT presents a low test burden and lacks floor or ceiling effects, making it suitable for this population.