Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized...

Area of Science:

• Orthopaedic Surgery
• Health Outcomes Research
• Biomedical Engineering

Background:

• Assessing patient-reported outcomes is crucial for evaluating musculoskeletal injury treatment effectiveness.
• Traditional questionnaires can be lengthy and less efficient for data collection.
• The Patient-Reported Outcomes Measurement Information System (PROMIS) offers computerized adaptive testing (CAT) as a potentially more efficient alternative.

Purpose of the Study:

• To compare the measurement properties of PROMIS physical function (PF) and pain interference (PI) CATs with the Short Musculoskeletal Function Assessment (SMFA) dysfunction index (DI) and bother index (BI).
• To identify factors associated with PROMIS scores in orthopaedic trauma patients.

Main Methods:

• A cross-sectional study was conducted at a Level I Trauma Center.
• 202 isolated upper/lower extremity fracture patients completed PROMIS and SMFA questionnaires.
• Measurement properties assessed included correlation (Pearson), reliability (standard error), efficiency, and floor/ceiling effects.

Main Results:

• PROMIS-PF and SMFA-DI showed high negative correlation (-0.84); PROMIS-PI and SMFA-BI showed moderate positive correlation (0.65).
• Both instruments demonstrated high reliability and no significant floor/ceiling effects.
• PROMIS CATs were significantly more efficient than SMFA (7.8x for PF/DI, 4.1x for PI/BI).
• Depression was independently associated with worse PROMIS-PF and PROMIS-PI scores.

Conclusions:

• PROMIS PF and PI CATs measure comparable constructs to SMFA DI and BI, offering a highly efficient alternative for fracture treatment evaluation.
• The efficiency of PROMIS CATs makes them a compelling option for routine clinical use.
• Psychosocial factors, such as depression, significantly impact patient-reported outcomes in orthopaedic trauma, highlighting the need for holistic assessment.