Clarifying thresholds for defining levels of physical function and pain interference using bookmarking in...

Area of Science:

• Orthopaedic Surgery
• Health Outcomes Research
• Psychometrics

Background:

• Patient-Reported Outcome (PROM) scores require interpretation to assess patient status.
• Bookmarking is a qualitative method to define score ranges and severity categories.
• Previous studies showed variability in expert opinion for PROM score interpretation.

Purpose of the Study:

• To evaluate variability in bookmarking thresholds across different patient and clinician groups.
• To test score ranges with existing variability in expert opinion.
• To establish consensus-based severity thresholds for specific PROMIS measures.

Main Methods:

• Two bookmarking sessions were conducted with orthopaedic fracture patients (n=11) and one with clinicians (n=10).
• Participants reviewed vignettes representing various severity levels for PROMIS Upper Extremity, Physical Function, and Pain Interference.
• Thresholds were determined by the midpoint between vignettes where participants shifted severity categories.

Main Results:

• Consensus thresholds were established for PROMIS Upper Extremity, Physical Function, and Pain Interference.
• For PROMIS Upper Extremity: ≥40 (normal), 30-39 (mild), 23-29 (moderate), <23 (severe).
• For PROMIS Physical Function: ≥46 (normal), 38-45 (mild), 26-37 (moderate), <26 (severe).
• For PROMIS Pain Interference: ≤50 (normal), 51-60 (mild), 61-68 (moderate), >68 (severe).

Conclusions:

• Testing vignette scores within patient populations refines severity category thresholds.
• These established thresholds provide evidence for interpreting PROMIS scores in orthopaedic care.
• The findings support the use of bookmarking for developing clinically meaningful interpretation guidelines for PROMs.