PROMIS Utilization in Pediatric Orthopaedics: A Scoping Review
Related Experiment Video
Updated: Sep 2, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Matthew T Eisenberg1, Andrew M Block, Aravinda K Ganapathy
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
Insights
The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used in pediatric orthopaedics. While efficient, PROMIS measures show prominent ceiling and floor effects in certain domains like Pain Interference.
Area of Science:
- Orthopaedic Surgery
- Health Outcomes Research
- Pediatric Medicine
Background:
- A standardized patient-reported outcome metric is lacking in orthopaedics.
- The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the NIH for efficient health assessment.
- No prior study has summarized PROMIS use in pediatric orthopaedics.
Purpose of the Study:
- To conduct a scoping review of studies utilizing PROMIS in the pediatric orthopaedic population.
- To identify trends in PROMIS application and frequently used domains.
- To assess the presence of ceiling and floor effects in pediatric orthopaedic PROMIS studies.
Main Methods:
- A comprehensive literature search was conducted across major databases (Ovid Medline, Embase, Scopus, Cochrane) from 2010 to August 2021.
- 1961 unique citations were identified, with 51 studies ultimately included after full-text review.
- Studies were categorized by anatomical region or sub-specialty.
Main Results:
- The use of PROMIS in pediatric orthopaedics has significantly increased, with most studies published in 2020-2021.
- Hand and Upper Extremity (25.5%) and Sports (23.5%) were the most common sub-specialties studied.
- Pain Interference (76.5%), Mobility (60.8%), and Upper Extremity (54.9%) were the most frequently assessed PROMIS domains.
Conclusions:
- PROMIS utilization in pediatric orthopaedics has grown substantially, indicating increasing adoption by clinicians.
- Significant ceiling effects were noted for Upper Extremity and floor effects for Pain Interference.
- PROMIS measures are deemed efficient, reliable, and effective for assessing patient outcomes in pediatric orthopaedics.
Background:
The lack of a common patient-reported outcome metric used among the orthopaedic population is a problem that has been previously identified by the American Academy of Orthopaedic Surgeons. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health with the goal of creating a precise and efficient measurement tool for patient-reported symptoms, functioning, and health-related quality of life to be used in clinical research. A study summarizing its use in the pediatric orthopaedic population has not been previously performed.
Methods:
We performed a literature search of Ovid Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 2010 to August 2021. There were 1961 unique citations included after the removal of 1756 duplicates. After initial screening, 183 studies were screened under full-text review leaving a final number of 51 studies included in this scoping review.
Results:
Pediatric PROMIS studies were grouped by body part or sub-speciality: "Hand and Upper Extremity" (25.5%, n=13), "Sports" (23.5%, n=12), "Spine" (13.7%, n=7), "Trauma" (13.7%, n=7), "General Pediatric Orthopaedics" (11.8%, n=6), "Lower Extremity" (9.8%, n=5), and "Orthopaedic Oncology" (2%, n=1). An increase in studies utilizing PROMIS was seen throughout the study period with only 3 studies published from 2013 to 2016 to 39 in 2020 and 2021 alone. The 3 most frequently used pediatric PROMIS domains were Pain Interference (76.5%, n=39/51), Mobility (60.8%, n=31/51), and Upper Extremity (54.9%, n=28/51). 64.3% (n=9/14) of the included studies which reported on the floor effects of Pain Interference exhibited a significant floor effect. In all, 77.8% (n=7/9) of the included studies which reported on ceiling effects of Upper Extremity exhibited a significant ceiling effect.
Conclusion:
The use of PROMIS increased significantly since the first publication in 2013 suggesting orthopaedic providers have increasingly utilized PROMIS in their day-to-day practice as an outcome measure. Ceiling and floor effects were prominent in several of the included domains (Pain Interference and Upper Extremity). Overall, PROMIS measures are efficient, reliable, and effective to use.
Level Of Evidence:
IV.
