Tracking quality of life-related outcomes in the U.S. population with monthly PROMIS computerized adaptive testing

This study evaluated the feasibility, reliability, and sensitivity of repeatedly administering brief PROMIS® computerized adaptive tests (CATs) monthly in a large, nationally representative internet panel.

PROMIS CATs for anger, meaning in life, and positive affect were administered monthly for 13 consecutive months to the same 12,231 U.S. adults in the Understanding America Study (UAS). Each CAT was limited to three items per domain to minimize respondent burden. We assessed measurement precision, rank-order stability, and predictors of overall levels and month-to-month variability in each PROMIS measure. Time-series analyses also tested whether PROMIS scores were sensitive to acute health events reported each month.

Three-item CATs achieved strong measurement precision (reliability ≥ 0.80) across wide score ranges and showed moderate rank-order stability (ICCs = 0.67-0.79). In between-subjects analyses, a greater number of chronic conditions was associated with both poorer average PROMIS scores and higher month-to-month variability. In within-subjects analyses, PROMIS scores were responsive to acute health events: anger and positive affect showed significant same-month changes in response to most health events, while meaning in life was less reactive. Event-related changes typically dissipated within 1-2 months.

Brief PROMIS CATs can be administered monthly while maintaining psychometric rigor. This high-frequency approach enables the assessment of both average levels and temporal dynamics of health, revealing new insights into the effects of chronic disease and acute health events. These findings support the use of PROMIS measures in longitudinal population health research.