PROMIS Physical Function Computer-Adaptive Test Compared to Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Over 60 Years of Age

Session IX - Upper Extremity

Sat., 10/12/13 Upper Extremity, PAPER #103, 3:12 pm OTA 2013

PROMIS Physical Function Computer-Adaptive Test Compared to Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Over 60 Years of Age

Jordan H. Morgan, BS1; Kanu Okike, MD1; Michael Kallen, PhD, MPH2; Mark Vrahas, MD1;
1Brigham and Women’s Hospital and Massachusetts General Hospital,
Boston, Massachusetts, USA;
2Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Background/Purpose: In 2004 the National Institutes of Health funded PROMIS (Patient Reported Outcomes Measurement Information System) with the goal of creating highly reliable, precise measures of patient–reported health status. Key components of this effort were to use item response theory and computer-adaptive testing (CAT) to increase measure accuracy while decreasing patient burden. The effort has been very successful and several outcome measures have been created including ones for physical function. Although these measures have been studied in the general population and in some disease-specific populations, there has been little work evaluating them in orthopaedic trauma populations and they have not been compared to more commonly used, existing measures. The purpose of this study was to compare the PROMIS Physical Function (PF) CAT to commonly used traditional measures for the evaluation of patients with proximal humeral fractures. The traditional measures included the Disabilities of the Arm, Shoulder and Hand (DASH) measure, Short Musculoskeletal Functional Assessment (SMFA), and Constant shoulder score.

Methods: Patients over 60 years of age with displaced proximal humerus fractures treated either operatively or nonoperatively between 2006 and 2009 at two Level I trauma centers were identified and invited to participate in a study evaluating outcomes. 47 patients agreed to participate and returned for additional evaluation. Evaluation included completion of the DASH, SMFA, the PROMIS PF CAT, and the Constant shoulder score. All measures were administered electronically via an iPad accessing www.assessmentcenter.net, an online data management tool. Range of motion and strength measurement for the Constant shoulder score were collected by a research coordinator blinded to the treatment method. Descriptive statistics (eg, percentage, median, minimum, maximum) were obtained, and histograms were produced to review the distributional qualities of all continuous data. Pearson correlation analyses were then used to determine the observed correlations among the administered outcome measures.

Results: Of the 47 patients completing the study, 38.3% were male and 55.3% received surgical fixation. Median age at injury was 68.0 years (range, 60-88 years), while median time from injury to completion of outcome measures was 39.0 months (range, 17-77 months). On average, patients answered 86 outcome-related questions for this study: 4 for the PROMIS PF CAT (range, 4-8 questions), 6 for the Constant shoulder score, 30 for the DASH, and 46 for the SMFA. Time to complete the PROMIS PF CAT (median completion time = 98 seconds) was significantly less than that for the DASH (median completion time = 336 seconds, P <0.001) and the SMFA (median completion time = 482 seconds, P <0.001). Median completion time was not significantly different between the PROMIS PF CAT and the Constant shoulder score measures. PROMIS PF CAT scores correlated significantly with all other outcome measure scores. PROMIS PF CAT scores correlated highly with the DASH (r = –0.64, P <0.001), the SMFA Bother Index (r = –0.71, P <0.001), the SMFA Functional Index (r = –0.83, P <0.001) and the Constant-shoulder score (r = 0.50, P <0.001). The SMFA displayed ceiling effects with 35% of patients scoring within 10 points of the maximum on both function and bother indices. Similarly, 23% of patient scored within 10 points of the maximum on the DASH.

Conclusion: The median completion time for the PROMIS PF CAT was less than one-third of that for the DASH and one-fifth of that for the SMFA. At the same time, it strongly correlated with these more commonly used upper extremity outcome measures, suggesting that it is measuring the same concept. This study suggests using the PROMIS PF CAT alone yields an assessment of upper extremity function similar to those provided by more commonly used measures while substantially reducing patient testing time.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.