Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts.
Midwestern University, Downers Grove, Illinois.
J Bone Joint Surg Am. 2022 Apr 20;104(8):709-715. doi: 10.2106/JBJS.20.02197. Epub 2022 Feb 22.
Patient-reported outcome (PRO) measures are integral to clinical practice. While new instruments bring updated methodology and delivery methods, they must be compared with existing measures to ensure that they are comparable with currently used instruments and allow ongoing comparison. In this study, we evaluated 2 PRO measures for patients with brachial plexus birth injury (BPBI): the legacy Pediatric Outcomes Data Collection Instrument (PODCI) and the newer Patient-Reported Outcomes Measurement Information System (PROMIS). We hypothesized that the PROMIS and PODCI would be correlated, with high convergent validity, and that PROMIS assessment would have higher discriminant validity and take less time to complete than the PODCI.
A cross-sectional prospective study was undertaken at a tertiary referral center. Subjects (n = 50) completed the PODCI and PROMIS, both as short form (SF) and computer-adaptive testing (CAT) measures, in randomized order. Patient and parent questionnaires were completed according to subject age. Physicians completed upper-extremity (UE) physical function tests. Correlations between PODCI and PROMIS scores were analyzed to determine convergent validity, UE subscores were analyzed relative to physical function scores to assess discriminant validity, and completion times were calculated to determine survey time to completion.
High convergent validity was found between the parent-reported PODCI, PROMIS SF, and PROMIS CAT measures. A ceiling effect was found for the PODCI but not for the PROMIS. The PROMIS CAT had better discriminant validity than either the PROMIS SF or PODCI. Patient and parent outcome scores did not highly correlate. Survey time to completion varied by PRO measure and method of delivery.
There was high convergent validity between the UE domains of the PROMIS and PODCI, with a lower time to completion for the PROMIS SF. Although results show that the PROMIS CAT may take longer to complete, there are notable benefits to its adoption, including high convergent validity with the PODCI and better discriminant validity than the PODCI and PROMIS SF measures.
患者报告的结局（PRO）测量是临床实践不可或缺的一部分。虽然新的工具带来了更新的方法和传递方法，但必须将其与现有的测量方法进行比较，以确保与当前使用的仪器具有可比性，并允许进行持续的比较。在这项研究中，我们评估了两种用于臂丛神经出生损伤（BPBI）患者的 PRO 测量方法：传统的儿科结局数据收集工具（PODCI）和较新的患者报告结局测量信息系统（PROMIS）。我们假设 PROMIS 和 PODCI 之间存在相关性，具有较高的收敛有效性，并且 PROMIS 评估具有更高的判别有效性，并且完成时间比 PODCI 短。
在三级转诊中心进行了一项横断面前瞻性研究。受试者（n=50）按随机顺序完成了 PODCI 和 PROMIS，均为短式（SF）和计算机自适应测试（CAT）测量。根据受试者年龄，患者和家长完成了调查问卷。医生完成了上肢（UE）功能测试。分析 PODCI 和 PROMIS 评分之间的相关性以确定收敛有效性，分析 UE 子评分与身体功能评分的相关性以评估判别有效性，并计算完成时间以确定完成调查所需的时间。
发现家长报告的 PODCI、PROMIS SF 和 PROMIS CAT 测量之间具有高度的收敛有效性。PODCI 存在上限效应，但 PROMIS 没有。PROMIS CAT 的判别有效性优于 PROMIS SF 或 PODCI。患者和家长的结局评分相关性不高。完成调查所需的时间因 PRO 测量方法和传递方法而异。
PROMIS 和 PODCI 的 UE 域之间具有高度的收敛有效性，PROMIS SF 的完成时间更短。尽管结果表明 PROMIS CAT 可能需要更长的时间才能完成，但它具有许多采用的好处，包括与 PODCI 具有高度的收敛有效性以及比 PODCI 和 PROMIS SF 测量具有更好的判别有效性。
