Anthony Chris A, Glass Natalie A, Hancock Kyle, Bollier Matt, Wolf Brian R, Hettrich Carolyn M
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Am J Sports Med. 2017 Feb;45(2):449-453. doi: 10.1177/0363546516668304. Epub 2016 Oct 21.
Shoulder instability is a relatively common condition occurring in 2% of the population. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains.
To compare PROMIS instruments to current PRO instruments in patients who would be undergoing operative intervention for recurrent shoulder instability.
Cohort study (diagnosis); Level of evidence, 2.
A total of 74 patients with a primary diagnosis of shoulder instability who would be undergoing surgery were asked to fill out the American Shoulder and Elbow Surgeons shoulder assessment form (ASES), Marx shoulder activity scale (Marx), Short Form-36 Health Survey Physical Function subscale (SF-36 PF), Western Ontario Shoulder Instability Index (WOSI), PROMIS physical function computer adaptive test (PF CAT), and PROMIS upper extremity item bank (UE). Correlation between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3).
Utilization of the PROMIS UE demonstrated excellent correlation with the SF-36 PF ( r = 0.78, P < .01) and ASES ( r = 0.71, P < .01); there was excellent-good correlation with the EQ-5D ( r = 0.66, P < .01), WOSI ( r = 0.63, P < .01), and PROMIS PF CAT ( r = 0.63, P < .01). Utilization of the PROMIS PF CAT demonstrated excellent correlation with the SF-36 PF ( r = 0.72, P < .01); there was excellent-good correlation with the ASES ( r = 0.67, P < .01) and PROMIS UE ( r = 0.63, P < .01). When utilizing the PROMIS UE, ceiling effects were present in 28.6% of patients aged 18 to 21 years. Patients, on average, answered 4.6 ± 1.8 questions utilizing the PROMIS PF CAT.
The PROMIS UE and PROMIS PF CAT demonstrated good to excellent correlation with common shoulder and upper extremity PRO instruments as well as the SF-36 PF in patients with shoulder instability. In patients aged ≤21 years, there were significant ceiling effects utilizing the PROMIS UE. While the PROMIS PF CAT appears appropriate for use in adults of any age, our findings demonstrate that the PROMIS UE has significant ceiling effects in patients with shoulder instability who are ≤21 years old, and we do not recommend use of the PROMIS UE in this population.
肩关节不稳定是一种相对常见的病症，在2%的人群中出现。患者报告结果测量信息系统（PROMIS）由美国国立卫生研究院开发，旨在通过为主要健康领域开发题库来推进患者报告结果（PRO）工具。
比较PROMIS工具与当前PRO工具在因复发性肩关节不稳定而接受手术干预的患者中的情况。
队列研究（诊断）；证据等级，2级。
总共74例初步诊断为肩关节不稳定且即将接受手术的患者被要求填写美国肩肘外科医师协会肩关节评估表（ASES）、马克思肩关节活动量表（马克思）、简明健康调查身体功能分量表（SF - 36 PF）、西安大略肩关节不稳定指数（WOSI）、PROMIS身体功能计算机自适应测试（PF CAT）和PROMIS上肢题库（UE）。PRO工具之间的相关性被定义为极佳（>0.7）、优 - 良（0.61 - 0.7）、良好（0.4 - 0.6）和差（0.2 - 0.3）。
使用PROMIS UE显示与SF - 36 PF（r = 0.78，P <.01）和ASES（r = 0.71，P <.01）具有极佳相关性；与EQ - 5D（r = 0.66，P <.01）、WOSI（r = 0.63，P <.01）和PROMIS PF CAT（r = 0.63，P <.01）具有优 - 良相关性。使用PROMIS PF CAT显示与SF - 36 PF（r = 0.72，P <.01）具有极佳相关性；与ASES（r = 0.67，P <.01）和PROMIS UE（r = 0.63，P <.01）具有优 - 良相关性。当使用PROMIS UE时，18至21岁的患者中有28.6%出现天花板效应。患者平均使用PROMIS PF CAT回答了4.6 ± 1.8个问题。
PROMIS UE和PROMIS PF CAT在肩关节不稳定患者中与常见的肩部和上肢PRO工具以及SF - 36 PF显示出良好至极佳的相关性。在年龄≤21岁的患者中，使用PROMIS UE存在显著的天花板效应。虽然PROMIS PF CAT似乎适用于任何年龄的成年人，但我们的研究结果表明，PROMIS UE在年龄≤21岁的肩关节不稳定患者中存在显著的天花板效应，我们不建议在该人群中使用PROMIS UE。
