Tishelman Jared C, Vasquez-Montes Dennis, Jevotovsky David S, Stekas Nicholas, Moses Michael J, Karia Raj J, Errico Thomas, Buckland Aaron J, Protopsaltis Themistocles S
J Neurosurg Spine. 2019 Feb 1;30(4):545-550. doi: 10.3171/2018.10.SPINE18571. Print 2019 Apr 1.
The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular due to computer adaptive testing methodology. This study aims to validate the association between PROMIS and legacy outcome metrics and compare PROMIS to legacy metrics in terms of ceiling and floor effects and questionnaire burden.
A retrospective review of an outcomes database was performed at a single institution from December 2016 to April 2017. Inclusion criteria were age > 18 years and a chief complaint of back pain or neck pain. The PROMIS computer adaptive testing Pain Interference, Physical Function (PF), and Pain Intensity domains; Oswestry Disability Index (ODI); Neck Disability Index (NDI); and visual analog scale (VAS) back, VAS leg, VAS neck, and VAS arm were completed in random order. PROMIS was compared to legacy metrics in terms of the average number of questions needed to complete each questionnaire and the score distributions in the lower and higher bounds of scores.
A total of 494 patients with back pain and 130 patients with neck pain were included. For back pain, ODI showed a strong correlation with PROMIS-PF (R = -0.749, p < 0.001), Pain Intensity (R = 0.709, p < 0.001), and Pain Interference (R = 0.790, p < 0.001) domains. Additionally, the PROMIS Pain Intensity domain correlated to both VAS back and neck pain (R = 0.642, p < 0.001 for both). PROMIS-PF took significantly fewer questions to complete compared to the ODI (4.123 vs 9.906, p < 0.001). When assessing for instrument sensitivity, neither survey presented a significant ceiling and floor effect in the back pain population (ODI: 0.40% and 2.63%; PROMIS-PF: 0.60% and 1.41%). In the neck pain cohort, NDI showed a strong correlation with PROMIS-PF (R = 0.771, p < 0.001). Additionally, PROMIS Pain Intensity correlated to VAS neck (R = 0.642, p < 0.001). The mean number of questions required to complete the questionnaire was much lower for PROMIS-PF compared to NDI (4.417 vs 10, p < 0.001). There were no significant differences found in terms of ceiling and floor effects for neck complaints (NDI: 2.3% and 6.92%; PROMIS-PF: 0.00% and 5.38%) or back complaints (ODI: 0.40% and 2.63%; PROMIS-PF: 1.41% and 0.60%).
PROMIS correlates strongly with traditional disability measures in patients with back pain and neck pain. For both back and neck pain, the PROMIS-PF required patients to answer significantly fewer questions to achieve similar granularity. There were no significant differences in ceiling and floor effects for NDI or ODI when compared with the PROMIS-PF instrument.
患者报告结局测量信息系统（PROMIS）因计算机自适应测试方法而越来越受欢迎。本研究旨在验证PROMIS与传统结局指标之间的关联，并在天花板效应、地板效应和问卷负担方面将PROMIS与传统指标进行比较。
于2016年12月至2017年4月在一家机构对结局数据库进行回顾性研究。纳入标准为年龄>18岁且主诉背痛或颈痛。PROMIS计算机自适应测试疼痛干扰、身体功能（PF）和疼痛强度领域；奥斯维斯特里残疾指数（ODI）；颈部残疾指数（NDI）；以及视觉模拟量表（VAS）背部、VAS腿部、VAS颈部和VAS手臂，以随机顺序完成。在完成每份问卷所需的平均问题数量以及分数分布的下限和上限方面，将PROMIS与传统指标进行比较。
共纳入494例背痛患者和130例颈痛患者。对于背痛，ODI与PROMIS-PF（R = -0.749，p < 0.001）、疼痛强度（R = 0.709，p < 0.001）和疼痛干扰（R = 0.790，p < 0.001）领域显示出强烈相关性。此外，PROMIS疼痛强度领域与VAS背部和颈部疼痛均相关（两者R = 0.642，p < 0.001）。与ODI相比，完成PROMIS-PF所需的问题显著更少（4.123对9.906，p < 0.001）。在评估工具敏感性时，两种调查在背痛人群中均未呈现显著的天花板效应和地板效应（ODI：0.40%和2.63%；PROMIS-PF：0.60%和1.41%）。在颈痛队列中，NDI与PROMIS-PF显示出强烈相关性（R = 0.771，p < 0.001）。此外，PROMIS疼痛强度与VAS颈部相关（R = 0.642，p < 0.001）。与NDI相比，完成问卷所需的平均问题数量对于PROMIS-PF要低得多（4.417对10，p < 0.001）。在颈痛主诉（NDI：2.3%和6.92%；PROMIS-PF：0.00%和5.38%）或背痛主诉（ODI：0.40%和2.63%；PROMIS-PF：1.41%和0.60%）的天花板效应和地板效应方面未发现显著差异。
PROMIS与背痛和颈痛患者的传统残疾测量指标密切相关。对于背痛和颈痛，PROMIS-PF要求患者回答的问题显著更少就能达到相似的精细程度。与PROMIS-PF工具相比，NDI或ODI在天花板效应和地板效应方面没有显著差异。
