From the Department of Rehabilitation Medicine (K.M., A.B., T.M., D.A.), University of Washington, Seattle, WA; Division of Surgery, Shriners Hospitals for Children-Boston (C.M.R.); Department of Surgery (C.M.R.), Massachusetts General Hospital, Harvard Medical School; Department of Physical Medicine and Rehabilitation (J.C.S.), Spaulding Rehabilitation Hospital, Spaulding Research Institute, Harvard Medical School, Boston, MA; Department of Surgery (N.G., B.T.S.), University of Washington Harborview, Seattle, WA; Harborview Injury Prevention and Research Center (B.T.S.), Seattle, WA; and Department of Surgery, University of Texas Medical Branch (S.W.), Galveston, TX.
J Trauma Acute Care Surg. 2022 Jan 1;92(1):213-222. doi: 10.1097/TA.0000000000003365.
Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. Patient-Reported Outcomes Measurement Information System (PROMIS)-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in this population.
The PROMIS-29 scores of physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference were evaluated for validity and reliability in adult burn survivors. Unidimensionality, floor and ceiling effects, internal consistency, and reliability were examined. Differential item functioning was used to examine bias with respect to demographic and injury characteristics. Correlations with measures of related constructs (Community Integration Questionnaire, Satisfaction with Life Scale, Post-Traumatic Stress Checklist-Civilian, and Veteran's Rand-12) and known-group differences were examined.
Eight hundred and seventy-six burn survivors with moderate to severe injury from 6 months to 20 years postburn provided responses on PROMIS-29 domains. Participants' ages ranged from 18 years to 93 years at time of assessment; mean years since injury was 3.4. All PROMIS domain scores showed high internal consistency (Cronbach's α = 0.87-0.97). There was a large ceiling effect on ability to participate in social roles (39.7%) and physical function (43.3%). One-factor confirmatory factor analyses supported unidimensionality (all comparative fit indices >0.95). We found no statistically significant bias (differential item functioning). Reliability was high (>0.9) across trait levels for all domains except sleep, which reached moderate reliability (>0.85). All known-group differences by demographic and clinical characteristics were in the hypothesized direction and magnitude except burn size categories.
The results provide strong evidence for reliability and validity of PROMIS-29 domain scores among adult burn survivors. Reliability of the extreme scores could be increased and the ceiling effects reduced by administering PROMIS-43, which includes six items per domain, or by administering by computerized adaptive testing.
Diagnostic Test or Criteria, level III.
患者报告的结果对于了解烧伤后的康复情况、基准服务提供情况以及衡量干预措施的影响非常重要。尽管在烧伤幸存者中没有使用，但患者报告结局测量信息系统（PROMIS）-29 域已被验证可用于不同人群。本研究的目的是检验 PROMIS-29 评分在该人群中的有效性和可靠性。
评估成年烧伤幸存者的身体功能、焦虑、抑郁、疲劳、睡眠障碍、参与社会角色的能力和疼痛干扰的 PROMIS-29 评分的有效性和可靠性。检验了单维性、地板和天花板效应、内部一致性和可靠性。使用差异项目功能来检验与人口统计学和损伤特征相关的偏差。检验了与相关结构（社区融合问卷、生活满意度量表、创伤后应激检查表-平民版和退伍军人的兰德 12）和已知组差异的相关性。
876 名烧伤程度为中度至重度的烧伤幸存者在烧伤后 6 个月至 20 年内提供了 PROMIS-29 域的回复。参与者的年龄在评估时从 18 岁到 93 岁不等；平均受伤年限为 3.4 年。所有 PROMIS 域评分均显示出较高的内部一致性（Cronbach's α=0.87-0.97）。在参与社会角色的能力（39.7%）和身体功能（43.3%）方面，天花板效应较大。单因素验证性因子分析支持单维性（所有比较拟合指数>0.95）。我们没有发现统计学上的偏差（差异项目功能）。除睡眠外，所有领域的特质水平的可靠性都很高（>0.9），睡眠的可靠性达到中等水平（>0.85）。除烧伤面积类别外，所有按人口统计学和临床特征划分的已知组差异均符合假设方向和程度。
结果为成年烧伤幸存者的 PROMIS-29 域评分的可靠性和有效性提供了有力证据。通过管理 PROMIS-43（每个域包含六个项目）或通过计算机自适应测试，可以提高极端分数的可靠性，并降低天花板效应。
诊断测试或标准，III 级。
