Related Experiment Video
Updated: May 23, 2025
Home-Based Monitor for Gait and Activity Analysis
Published on: August 8, 2019
Utility of PROMIS computerized adaptive testing for assessing mobility in lower extremity fracture patients
Michiel A J Luijten1, Lotte Haverman2, Caroline B Terwee3
1Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC location AMC, Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Methodology, Amsterdam, the Netherlands.
Introduction:
Assessment of mobility in orthopaedic trauma patients is commonly performed using the Lower Extremity Functional Assessment (LEFS). Computerized adaptive testing (CAT) utilizing the Patient-Reported Outcomes Measurement Information System (PROMIS) is an advanced method for assessing multiple aspects of patient-reported health and may provide an effective alternative for this purpose. The objective of this study was to correlate and psychometrically compare PROMIS (Mobility (MOB) and Physical Function (PF)) CATs to legacy mobility PROMs (Lower Extremity Functional Scale (LEFS)/ Short Musculoskeletal Function Assessment (SMFA)), and to evaluate factors associated with worse mobility.
Patients And Methods:
In this Cross-sectional study performed in a single Level-I trauma center, 123 patients were recruited who were treated for a lower-extremity fracture (October 1, 2021-July 1, 2023). Correlations (Pearson), known-group validity (Two-sample T test), reliability (Standard error (SE) and Cronbach's alpha), items and completion time, and floor/ceiling effects were assessed. Factors associated with PROMIS-MOB scores were also identified based on multivariable regression analysis.
Results:
PROMIS-MOB and LEFS/SMFA (0.75/0.86), PROMIS-PF and LEFS/SMFA (0.76/0.84), and both PROMIS-CATs (0.88) were highly correlated. Regarding know-group validity, all PROM scores were worse among patients with moderate-extreme pain. Only PROMIS-CATs scores were worse among older (≥65 years) and short-term follow-up (3≤months) patients. Reliability was very high for PROMIS-MOB (SE2.1), PROMIS-PF (SE2.0), LEFS (alpha0.97) and SMFA (apha0.97). Fewer items were needed for PROMIS-MOB (6) and PROMIS-PF (5) compared to LEFS (20) and SMFA (34). Completion time (mean seconds) of PROMIS-MOB (65) and PROMIS-PF (70) was less compared to LEFS (338) and SMFA (367) (p<0.001). Neither PROMIS-CATs nor LEFS/SMFA exhibited floor/ceiling effects. Advancing age, depression, pain intensity, shorter follow-up were associated with worse PROMIS-MOB scores.
Conclusion:
PROMIS-MOB and PROMIS-PF CATs exhibited a strong correlation with the LEFS and SMFA, indicating that they offer the same information regarding mobility and general physical functioning. Nonetheless, CATs took less time to complete and were better able to detect (subtle) differences between certain groups than traditionally used PROMs. Given that both PROMIS-MOB and PROMIS-PF CATs were also highly correlated, it is questionable whether the more specific mobility CAT provides distinct information in lower extremity fracture patients.
Levels Of Evidence:
Diagnostic study, Level II.
