Use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures to characterise health status for patients seeking care from an orthopaedic provider: a retrospective cohort study.
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2021-09-02
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Abstract
Objectives
Characterise the health status of patients newly consulting an orthopaedic specialist across eight clinical subspecialties.Design
Retrospective cohort.Setting
18 orthopaedic clinics, including 8 subspecialties (14 ambulatory and 4 hospital based) within an academic health system.Participants
14 910 patients consulting an orthopaedic specialist for a new patient consultation who completed baseline Patient-Reported Outcomes Measurement Information System (PROMIS) measures associated with their appointment from 17 November 2017 to 13 May 2019. Patients were aged 55.72±5.8 years old, and 61.3% were female and 79.3% were Caucasian and 13.4% were black or African American. Patients who did not complete PROMIS measures or cancelled their appointment were excluded from the study.Primary outcome
PROMIS domains of physical function, pain interference, pain intensity, depression, anxiety, fatigue, sleep disturbance and the ability to participate in social roles.Results
Mean PROMIS scores for physical function were (38.1±9.2), pain interference (58.9±8.1), pain intensity (4.6±2.5), depression (47.9±8.9), anxiety (49.9±9.5), fatigue (50.5±10.3), sleep disturbance (51.1±9.8) and ability to participate in social roles (49.1±10.3) for the entire cohort. Across the clinical subspecialties, neurosurgery, spine and trauma patients were most profoundly affected across almost all domains and patients consulting with a hand specialist reported the least limitations or symptoms across domains. There was a moderate, negative correlation between pain interference and physical functioning (r=-0.59) and low correlations between pain interference with anxiety (r=0.36), depression (r=0.39) as well as physical function and anxiety (r=-0.32) and depression(r=-0.30) and sleep (r=-0.31).Conclusions
We directly compared clinically meaningful PROMIS domains across eight orthopaedic subspecialties, which would not have been possible with legacy measures alone. These results support PROMIS's utility as a common metric to assess and compare patient health status across multiple orthopaedic subspecialties.Type
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Publication Info
Horn, Maggie E, Emily K Reinke, Xiaofang Yan, Sheng Luo, Michael Bolognesi, Bryce B Reeve, Steven Z George, undefined Comprehensive Outcomes in Orthopaedics and Rehabilitation Data System (COORDS) group, et al. (2021). Use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures to characterise health status for patients seeking care from an orthopaedic provider: a retrospective cohort study. BMJ open, 11(9). p. e047156. 10.1136/bmjopen-2020-047156 Retrieved from https://hdl.handle.net/10161/23863.
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Scholars@Duke
![Horn](https://scholars.duke.edu/profile-images/thumbnail200/0724263.jpg)
Maggie Elizabeth Horn
![Reinke](https://scholars.duke.edu/profile-images/thumbnail200/0802597.jpg)
Emily Reinke
Dr. Reinke is the Senior Research Program Leader in Sports Medicine. She manages the divisional portfolio and research staff. While supporting the industry sponsored studies, her focus is on PI-initiated research of all areas of interest where she assists as needed with study design, protocol logistics, database design, EMR data extraction, analysis, project presentation, and grant preparation. Her personal expertise is in ACL research, as she has been a member of the Multicenter Orthopaedic Outcomes Network (MOON) knee group since 2007.
![Luo](https://scholars.duke.edu/profile-images/thumbnail200/0796693.jpg)
Sheng Luo
![Bolognesi](https://scholars.duke.edu/profile-images/thumbnail200/0119360.jpg)
Michael Paul Bolognesi
As chief of the adult reconstruction service, the majority of my research effort has been directed toward clinical outcomes, implant survivorship, functional recovery, the biology of hip and knee arthritis and cost effectiveness.
![Reeve](https://scholars.duke.edu/profile-images/thumbnail200/0805164.jpg)
Bryce B. Reeve
Dr. Bryce Reeve is a Professor of Population Health Sciences and Professor of Pediatrics at Duke University School of Medicine. He also serves as Director of the Center for Health Measurement since 2017. Trained in psychometric methods, Dr. Reeve’s work focuses on assessing the impact of disease and treatments on the lives of patients and their caregivers. This includes the development of clinical outcome assessments using both qualitative and quantitative methods, and the integration of patient-centered data in research and healthcare delivery settings to inform decision-making. From 2000 to 2010, Dr. Reeve served as Program Director for the U.S. National Cancer Institute and oversaw a portfolio of health-related quality of life research in cancer patients. From 2010 to 2017, he served as Professor of Health Policy and Management at the University of North Carolina. From 2011-2013, Dr. Reeve served as President of the International Society for Quality of Life Research (ISOQOL). In 2015, he received the John Ware and Alvin Tarlov Career Achievement Prize in Patient-Reported Outcomes Measures. In 2017, 2018, 2019 and 2021, he was ranked in the top 1% most-cited in his respective field over the past 11-year period.
![George](https://scholars.duke.edu/profile-images/thumbnail200/0718420.jpg)
Steven Zachary George
Dr. George’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders. His long term goals are to 1) improve accuracy for predicting who is going to develop chronic pain; and 2) identify non-pharmacological treatment options that limit the development of chronic pain conditions. Dr. George is an active member of the American Physical Therapy Association, United States Association of the Study of Pain, and International Association for the Study of Pain.
Dr. George’s research projects have been supported by the National Institutes of Health, Department of Defense, and Orthopaedic Academy of the American Physical Therapy Association. Dr. George and his collaborators have authored over 330 peer-reviewed publications in leading medical, orthopaedic surgery, physical therapy, rehabilitation, and pain research journals. He currently serves as Editor-in-Chief for the Physical Therapy & Rehabilitation Journal. Dr. George has also been involved with clinical practice guideline development for the Academy of Orthopaedic Physical Therapy and the American Psychological Association.
Dr. George has been recognized with prestigious research awards from the American Physical Therapy Association, American Pain Society, and International Association for the Study of Pain. For example from the American Physical Therapy Association: he was named the 21st John H.P. Maley Lecturer, recognized as a Catherine Worthingham Fellow in 2017, and selected for the Marian Williams Award for Research in Physical Therapy in 2022.
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