Wong Liam H, Meeker James E
School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, 3303 S. Bond Avenue, Portland, OR, 97239, USA.
J Patient Rep Outcomes. 2022 Jan 4;6(1):2. doi: 10.1186/s41687-021-00407-w.
A crucial component to improving patient care is better clinician understanding of patients' health-related quality of life (HRQoL). In orthopaedic surgery, HRQoL assessment instruments such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), provide surgeons with a framework to assess how a treatment or medical condition is affecting each patient's HRQoL. PROMIS has been demonstrated as a valuable instrument in many diseases; however, the extent to which orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research is unclear.
Systematic scoping methodology was used to investigate the characteristics of studies using PROMIS to assess HRQoL measures as orthopaedic surgical outcomes as well as studies validating computerized adaptive test (CAT) PROMIS physical health (PH) domains including: Physical Function (PF), Upper Extremity (UE), Lower Extremity (LE).
A systematic search of PubMed identified 391 publications utilizing PROMIS in orthopaedics; 153 (39%) were PROMIS PH CAT validation publications. One-hundred publications were in Hand and Upper Extremity, 69 in Spine, 44 in Adult Reconstruction, 43 in Foot and Ankle, 43 in Sports, 37 in Trauma, 31 in General orthopaedics, and 24 in Tumor. From 2011 through 2020 there was an upward trend in orthopaedic PROMIS publications each year (range, 1-153) and an increase in studies investigating or utilizing PROMIS PH CAT domains (range, 1-105). Eighty-five percent (n = 130) of orthopaedic surgery PROMIS PH CAT validation publications (n = 153) analyzed PF; 30% (n = 46) analyzed UE; 3% (n = 4) analyzed LE.
PROMIS utilization within orthopaedics as a whole has significantly increased within the past decade, particularly within PROMIS CAT domains. The existing literature reviewed in this scoping study demonstrates that PROMIS PH CAT domains (PF, UE, and LE) are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. The expanded use of PROMIS CATs in orthopaedic surgery highlights the potential for improved quality of patient care. While challenges of integrating PROMIS into electronic medical records exist, expanded use of PROMIS CAT measurement instruments throughout orthopaedic surgery should be performed. Plain english summary In orthopaedic surgery, health-related quality of life tools such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), offer patients an opportunity to better understand their medical condition and be involved in their own care. Additionally, PROMIS provides surgeons with a framework to assess how a treatment or medical condition is affecting each patient's functional status and quality of life. The efficacy of PROMIS has been demonstrated in many diseases; however, its application throughout orthopaedic care has yet to be depicted. This study sought to identify the extent to which all orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research in order to identify its potential as an applicable and valuable tool across specialties. We determined that PROMIS utilization has significantly increased within the past decade. The existing literature reviewed in this scoping study demonstrates that the PROMIS computerized adaptive test domains evaluating physical function status are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. Based on these results, this study recommends the expanded and more uniform use of PROMIS computerized adaptive test measurement instruments in the clinical care of orthopaedic patients.
改善患者护理的一个关键因素是临床医生更好地理解患者的健康相关生活质量（HRQoL）。在骨科手术中，诸如美国国立卫生研究院开发的患者报告结局测量信息系统（PROMIS）等HRQoL评估工具，为外科医生提供了一个框架，以评估一种治疗方法或疾病状况如何影响每位患者的HRQoL。PROMIS已被证明在许多疾病中是一种有价值的工具；然而，骨科手术亚专业在同行评审研究中使用和验证PROMIS测量方法的程度尚不清楚。
采用系统的范围界定方法，调查使用PROMIS评估HRQoL测量方法作为骨科手术结局的研究特点，以及验证计算机自适应测试（CAT）PROMIS身体健康（PH）领域的研究特点，包括：身体功能（PF）、上肢（UE）、下肢（LE）。
对PubMed进行系统检索，共识别出391篇在骨科中使用PROMIS的出版物；153篇（39%）是PROMIS PH CAT验证出版物。100篇发表于手和上肢领域，69篇发表于脊柱领域，44篇发表于成人重建领域，43篇发表于足踝领域，43篇发表于运动领域，37篇发表于创伤领域，31篇发表于普通骨科领域，24篇发表于肿瘤领域。从2011年到2020年，骨科PROMIS出版物数量逐年呈上升趋势（范围为1 - 153篇），并且研究调查或使用PROMIS PH CAT领域的研究数量也有所增加（范围为1 - 105篇）。85%（n = 130）的骨科手术PROMIS PH CAT验证出版物（n = 153）分析了PF；30%（n = 46）分析了UE；3%（n = 4）分析了LE。
在过去十年中，整个骨科领域对PROMIS的使用显著增加，特别是在PROMIS CAT领域。本范围界定研究中回顾的现有文献表明，PROMIS PH CAT领域（PF、UE和LE）在所有骨科手术亚专业的大多数患者护理背景下都是可靠、敏感且可解释的。PROMIS CAT在骨科手术中的广泛应用凸显了改善患者护理质量的潜力。虽然将PROMIS整合到电子病历中存在挑战，但应在整个骨科手术中更广泛地使用PROMIS CAT测量工具。
在骨科手术中，诸如美国国立卫生研究院开发的患者报告结局测量信息系统（PROMIS）等与健康相关的生活质量工具，为患者提供了一个更好地了解自身病情并参与自身护理的机会。此外，PROMIS为外科医生提供了一个框架，以评估一种治疗方法或疾病状况如何影响每位患者的功能状态和生活质量。PROMIS的有效性已在许多疾病中得到证明；然而，其在整个骨科护理中的应用情况尚未得到描述。本研究旨在确定所有骨科手术亚专业在同行评审研究中使用和验证PROMIS测量方法的程度，以确定其作为一种适用于各专业且有价值的工具的潜力。我们确定在过去十年中PROMIS的使用显著增加。本范围界定研究中回顾的现有文献表明，评估身体功能状态的PROMIS计算机自适应测试领域在所有骨科手术亚专业的大多数患者护理背景下都是可靠、敏感且可解释的。基于这些结果，本研究建议在骨科患者的临床护理中更广泛、更统一地使用PROMIS计算机自适应测试测量工具。
