Establishing Minimal Clinically Important Difference for PROMIS Physical Function Improvement After Revascularization...

Area of Science:

• Vascular Surgery
• Patient-Reported Outcomes
• Health Services Research

Background:

• Peripheral arterial disease (PAD) affects physical function, with revascularization aiming to improve it.
• Defining a meaningful threshold for physical function improvement post-revascularization is crucial for patient care.
• Current understanding lacks a clear definition of clinically significant functional gains after lower extremity revascularization.

Purpose of the Study:

• To define a minimal clinically important difference (MCID) for patient-reported physical function (PROMIS-PF) after lower extremity revascularization in PAD patients.
• To identify factors that predict achieving this defined functional improvement threshold.
• To assess the relationship between technical revascularization success and functional outcomes.

Main Methods:

• Retrospective cohort analysis of adult PAD patients undergoing elective revascularization (2016-2023) with PROMIS-PF scores.
• Utilized anchor- and distribution-based methods to determine the PROMIS-PF MCID.
• Employed LASSO regression and generalized linear mixed models to identify predictors of reaching the MCID.

Main Results:

• A 5-point change in PROMIS-PF was identified as the MCID, with 40% of patients achieving this improvement.
• Higher baseline PROMIS-PF scores and older age were associated with a lower likelihood of meeting the MCID.
• Improvement in ankle-brachial index (ABI) did not consistently predict achieving the functional MCID.

Conclusions:

• A 5-point improvement in PROMIS-PF is a meaningful outcome post-revascularization for PAD.
• Functional improvement is influenced by patient's baseline function and age, not solely by technical surgical success.
• An improved ABI does not guarantee a corresponding meaningful improvement in patient-reported physical function.