From the Harvard Orthopedic Trauma Initiative, Brigham & Women's Hospital, Boston, MA (Dr. Alvarez-Nebreda, Mr. McTague, Dr. Harris, and Dr. Weaver), the Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRICYS), Madrid, Spain (Dr. Alvarez-Nebreda), the Harvard Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA (Dr. Heng), the Brigham & Women's Hospital (Dr. Rosner), and the Division of Aging, Department of Medicine, Brigham & Women's Hospital, Boston, MA (Dr. Javedan).
J Am Acad Orthop Surg. 2019 Feb 15;27(4):e156-e165. doi: 10.5435/JAAOS-D-17-00644.
Patient-reported Outcomes Measurement Information System (PROMIS) instruments are useful to evaluate health status, but its use can be challenging for some vulnerable elderly patients, requiring aid from their proxies. Whether the proxies could be accurate informants is unknown. The goal of this study was to compare elderly patients' and their proxies' answers with PROMIS physical function (PF) and pain interference (PI) computer adaptive test for the evaluation of patients' outcomes after musculoskeletal injury. In addition, to correlate patients' reported PF with the Timed Up and Go (TUG) test.
This prospective cohort study, from February to September 2016, in the Orthopaedic trauma clinic of two level I Trauma centers, included 273 patients aged 65 years or older, ambulatory, cognitively intact, with a discernible proxy. PROMIS PF and PI, TUG, and the "FRAIL" Questionnaire screening tool were performed. The correlation of PROMIS scores between patients and proxies, and also with the TUG score, was assessed using Spearman rank correlation. The Bland-Altman analysis served to check agreement and bias. Subgroup comparison was tested using probit transformations.
The mean age of patients was 75.7 years, SD 7.5 (62.2 years; SD, 13.8 for proxies), 66.7% women, 57.1% married, and 34% with femoral fractures. A significant correlation and agreement of PROMIS PF and PI scores were found between patients and proxies (Spearman rho for both, PF and PI = 0.73), although proxies tended to overestimate the interference of pain on patient's performance (median difference, -1.7; P < 0.001). The correlation was markedly stronger in nonfrail patients and in those with faster TUG scores. There was also a correlation between patients' PROMIS PF and TUG test (Spearman rho = - 0.58).
Proxies are good informants of the PF of ambulatory, cognitively intact elderly patients, as evaluated by the PROMIS PF instrument, after musculoskeletal injury, although they tend to slightly overestimate PI. The use of proxy-reported PROs might better characterize functional impairment and pain in a vulnerable patient population, and it could decrease selection bias in outcomes research.
Diagnostic level II.
患者报告结局测量信息系统（PROMIS）工具可用于评估健康状况，但对于一些脆弱的老年患者来说，使用起来可能具有挑战性，需要其代理人的帮助。目前尚不清楚代理人是否可以作为准确的信息提供者。本研究的目的是比较老年人及其代理人在评估肌肉骨骼损伤后患者结局时，使用 PROMIS 身体机能（PF）和疼痛干扰（PI）计算机自适应测试的答案。此外，还将患者报告的 PF 与计时起立行走（TUG）测试相关联。
这是一项前瞻性队列研究，于 2016 年 2 月至 9 月在两个一级创伤中心的骨科创伤诊所进行，纳入了 273 名年龄在 65 岁或以上、能走动、认知功能正常、有明确代理人的患者。进行了 PROMIS PF 和 PI、TUG 和“脆弱性”问卷筛查工具。使用 Spearman 等级相关评估患者和代理人之间的 PROMIS 评分的相关性，以及与 TUG 评分的相关性。Bland-Altman 分析用于检查一致性和偏差。使用概率转换进行亚组比较测试。
患者的平均年龄为 75.7 岁，标准差为 7.5 岁（62.2 岁；SD，代理人 13.8 岁），66.7%为女性，57.1%已婚，34%为股骨骨折。患者和代理人之间的 PROMIS PF 和 PI 评分具有显著的相关性和一致性（Spearman rho 对于 PF 和 PI 均为 0.73），尽管代理人往往会高估疼痛对患者表现的干扰（中位数差异，-1.7；P < 0.001）。在非脆弱患者和 TUG 评分较快的患者中，相关性更强。患者的 PROMIS PF 和 TUG 测试之间也存在相关性（Spearman rho = -0.58）。
在肌肉骨骼损伤后，代理人可以很好地反映 PROMIS PF 仪器评估的活动能力正常、认知功能正常的老年患者的 PF，但他们往往会略微高估 PI。使用代理人报告的 PRO 可以更好地描述弱势患者群体的功能障碍和疼痛，并减少结局研究中的选择偏差。
诊断水平 II。
