Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Am Med Dir Assoc. 2018 Oct;19(10):846-851.e2. doi: 10.1016/j.jamda.2018.03.005. Epub 2018 May 24.
To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference items for use in a quality measure and to compare the resulting quality score, along with internal reliability and validity, to a similar item set in the Minimum Data Set Version 3.0 (MDS).
Cross-sectional, observational study.
One freestanding inpatient rehabilitation facility (IRF) and one large hospital-based IRF.
Patients with neurologic disorders. Of 1055 consecutive admissions, 26% were excluded based on clinician-determined cognitive impairment or emotional distress. Of the remainder, 50% consented and completed the survey near the end of their IRF stay (N = 391). Of these, more than half (57%) reported pain over the last day (n = 224).
Psychometric statistics and quality scores were computed from a 55-question survey, including the MDS and PROMIS pain interference items.
Estimates for internal reliability were higher for the PROMIS 2-item scale compared to the MDS: Cronbach α (0.86 vs 0.48) and interitem correlations (0.75 vs 0.31). The PROMIS-2 items were better able to detect differences in patients with mild and severe pain intensity (Cohen d = 1.57) relative to the corresponding MDS items (Cohen d = 0.81). Two quality scores based on the PROMIS-2 items, reflecting low and high levels of pain interference, showed 46% or 12% of patients meeting these thresholds. This compared to a 30% rate when patients were classified by the MDS as experiencing pain interference.
PROMIS pain interference items appear to be more internally consistent than similar MDS items. The graded PROMIS items permit the creation of multiple quality scores, showing predictable overlap with corresponding MDS quality scores. Because PROMIS items provide finer distinctions, they allow greater latitude in reporting quality scores. We recommend further study of pain interference scores across IRFs to improve their reliability and validity.
评估患者报告结局测量信息系统（PROMIS）疼痛干扰项目在质量测量中的应用，并比较由此产生的质量评分以及内部可靠性和有效性与最小数据集中的类似项目集 3.0（MDS）。
横断面观察性研究。
一家独立的住院康复机构（IRF）和一家大型医院基础的 IRF。
患有神经障碍的患者。在连续 1055 次入院中，根据临床医生确定的认知障碍或情绪困扰，26%的患者被排除在外。在其余的患者中，50%同意并在 IRF 住院结束时完成了调查（N=391）。在这些患者中，超过一半（57%）报告过去一天有疼痛（n=224）。
从 55 个问题的调查中计算出心理测量统计数据和质量评分，包括 MDS 和 PROMIS 疼痛干扰项目。
与 MDS 相比，PROMIS 2 项量表的内部可靠性估计更高：Cronbach α（0.86 与 0.48）和项目间相关性（0.75 与 0.31）。与相应的 MDS 项目相比，PROMIS-2 项目能够更好地检测出轻度和重度疼痛强度患者之间的差异（Cohen d=1.57）。基于 PROMIS-2 项的两个质量评分，反映了低和高水平的疼痛干扰，有 46%或 12%的患者达到这些阈值。相比之下，当患者根据 MDS 分类为经历疼痛干扰时，这一比例为 30%。
PROMIS 疼痛干扰项目似乎比类似的 MDS 项目更具一致性。分级 PROMIS 项目允许创建多个质量评分，与相应的 MDS 质量评分具有可预测的重叠。由于 PROMIS 项目提供了更精细的区分，它们允许在报告质量评分方面有更大的灵活性。我们建议在 IRF 中进一步研究疼痛干扰评分，以提高其可靠性和有效性。
