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Evaluation of Test-Retest Reliability for the Patient-Reported Outcomes Measurement Information System Upper

Hernan Roca1, Gretchen Maughan-Egbert1, Brittany N Garcia1

  • 1Department of Orthopaedics, University of Utah, Salt Lake City, UT.

The Journal of Hand Surgery
|April 30, 2025
PubMed
Summary

Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI) computer adaptive tests (CAT) show good reliability in hand surgery patients at the population level. However, individual patient results may exceed minimal clinical differences, limiting their use for personal treatment decisions.

Keywords:
PROMIS upper extremity CAT and pain interference CATPatient-reported outcome measuresreliabilitytest retest

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Rehabilitation Medicine

Background:

  • Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, including upper extremity (UE) and pain interference (PI) computer adaptive tests (CAT), are increasingly used in hand surgery research.
  • These PROMIS CATs were developed using general population data, raising questions about their applicability to specific patient cohorts with upper extremity pathology.

Purpose of the Study:

  • To assess the test-retest reliability of the PROMIS UE and PI CATs within a cohort of hand surgery patients.
  • To determine if the observed score variations exceed minimally clinically important differences at the individual patient level.

Main Methods:

  • Adult hand surgery patients (n=88) completed the PROMIS UE and PI CATs twice, 1-7 days apart, with stable symptoms between assessments.
  • Intraclass correlation coefficients (ICCs) evaluated test-retest reliability.
  • Bland-Altman plots visualized score differences relative to minimally clinically important difference thresholds.

Main Results:

  • The PROMIS UE CAT demonstrated good to excellent reliability (ICC=0.87), and the PI CAT showed good reliability (ICC=0.84).
  • However, score differences exceeding the minimally clinically important difference were found in 34% of patients for the UE CAT and 23% for the PI CAT.

Conclusions:

  • The PROMIS UE and PI CATs exhibit reliable performance at the population level for hand surgery patients.
  • Clinically significant score changes occurred in a substantial proportion of individual patients, suggesting caution when interpreting results for personal clinical decision-making.