Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA.
J Clin Epidemiol. 2019 Nov;115:116-124. doi: 10.1016/j.jclinepi.2019.06.018. Epub 2019 Jul 19.
The 5 SPADE (sleep, pain, anxiety, depression, and low energy/fatigue) symptoms are among the most prevalent and disabling symptoms in clinical practice. This study evaluates the minimally important difference (MID) of Patient-Reported Outcomes Measurement Information System (PROMIS) measures and their correspondence with other brief measures to assess SPADE symptoms.
Three hundred primary care patients completed a 4-item PROMIS scale, a numeric rating scale (NRS), and a non-PROMIS legacy scale for each of the 5 SPADE symptoms. Optimal NRS cutpoints were examined, and cross-walk units for converting legacy measure scores to PROMIS scores were determined. PROMIS scores corresponding to standard deviation (SD) and standard error of measurement (SEM) changes in legacy scores were used to estimate MID.
At an NRS ≥5, the mean PROMIS T-score exceeded 55 (the operational threshold for a clinically meaningful symptom) for each SPADE symptom. Correlations were high (0.70-0.86) between each PROMIS scale and its corresponding non-PROMIS legacy scale. Changes in non-PROMIS legacy scale scores of 0.35 SD and 1 SEM corresponded to mean PROMIS T-scores of 2.92 and 3.05 across the 5 SPADE symptoms, with changes in 0.2 and 0.5 SD corresponding to mean PROMIS T-scores of 1.67 and 4.16.
A 2-step screening process for SPADE symptoms might use single-item NRS scores, proceeding to PROMIS scales for NRS scores ≥5. A PROMIS T-score change of three points represents a reasonable MID estimate, with two to four points approximating lower and upper bounds.
5 项 SPADE（睡眠、疼痛、焦虑、抑郁和低能量/疲劳）症状是临床实践中最常见和最具致残性的症状之一。本研究评估了患者报告的结局测量信息系统（PROMIS）测量的最小临床重要差异（MID）及其与其他简短测量方法评估 SPADE 症状的相关性。
300 名初级保健患者完成了 4 项 PROMIS 量表、数字评分量表（NRS）和 5 项 SPADE 症状的非 PROMIS 传统量表。研究考察了最佳 NRS 切点，并确定了将传统测量得分转换为 PROMIS 得分的换算单位。用于估计 MID 的 PROMIS 得分对应于传统得分的标准差（SD）和测量误差标准差（SEM）变化。
在 NRS≥5 时，每个 SPADE 症状的 PROMIS T 评分均超过 55（具有临床意义的症状的操作阈值）。每个 PROMIS 量表与其相应的非 PROMIS 传统量表之间的相关性均较高（0.70-0.86）。非 PROMIS 传统量表得分的 0.35 SD 和 1 SEM 变化对应于 5 项 SPADE 症状的 PROMIS T 评分均值分别为 2.92 和 3.05，0.2 和 0.5 SD 的变化对应于 PROMIS T 评分均值分别为 1.67 和 4.16。
SPADE 症状的两步筛选过程可能使用单项 NRS 评分，对于 NRS 评分≥5 的患者，使用 PROMIS 量表。PROMIS T 评分变化 3 分代表合理的 MID 估计值，2 分至 4 分接近下限和上限。
