Departments of Orthopaedic Surgery.
Department of Orthopaedic Surgery, University of North Carolina, NC.
J Pediatr Orthop. 2022 Aug 1;42(7):e720-e726. doi: 10.1097/BPO.0000000000002190. Epub 2022 Jun 15.
The use of patient-reported outcome measures, especially Patient-Reported Outcomes Measurement Information System (PROMIS) measures, has increased in recent years. Given this growth, it is imperative to ensure that the measures being used are validated for the intended population(s)/disease(s). Our objective was to assess the construct validity of 8 PROMIS computer adaptive testing (CAT) measures among children with adolescent idiopathic scoliosis (AIS).
We prospectively enrolled 200 children (aged 10 to 17 y) with AIS, who completed 8 PROMIS CATs (Anxiety, Depressive Symptoms, Mobility, Pain Behavior, Pain Interference, Peer Relationships, Physical Activity, Physical Stress Experiences) and the Scoliosis Research Society-22r questionnaire (SRS-22r) electronically. Treatment categories were observation, bracing, indicated for surgery, or postoperative from posterior spinal fusion. Construct validity was evaluated using known group analysis and convergent and discriminant validity analyses. Analysis of variance was used to identify differences in PROMIS T -scores by treatment category (known groups). The Spearman rank correlation coefficient ( rs ) was calculated between corresponding PROMIS and SRS-22r domains (convergent) and between unrelated PROMIS domains (discriminant). Floor/ceiling effects were calculated.
Among treatment categories, significant differences were found in PROMIS Mobility, Pain Behavior, Pain Interference, and Physical Stress Experiences and in all SRS-22r domains ( P <0.05) except Mental Health ( P =0.15). SRS-22r Pain was strongly correlated with PROMIS Pain Interference ( rs =-0.72) and Pain Behavior ( rs =-0.71) and moderately correlated with Physical Stress Experiences ( rs =-0.57). SRS-22r Mental Health was strongly correlated with PROMIS Depressive Symptoms ( rs =-0.72) and moderately correlated with Anxiety ( rs =-0.62). SRS-22r Function was moderately correlated with PROMIS Mobility ( rs =0.64) and weakly correlated with Physical Activity ( rs =0.34). SRS-22r Self-Image was weakly correlated with PROMIS Peer Relationships ( rs =0.33). All unrelated PROMIS CATs were weakly correlated (| rs |<0.40). PROMIS Anxiety, Mobility, Pain Behavior, and Pain Interference and SRS-22r Function, Pain, and Satisfaction displayed ceiling effects.
Evidence supports the construct validity of 6 PROMIS CATs in evaluating AIS patients. Ceiling effects should be considered when using specific PROMIS CATs.
Level II, prognostic.
近年来，患者报告的结果测量，尤其是患者报告结局测量信息系统（PROMIS）测量的使用有所增加。鉴于这种增长，必须确保所使用的测量方法经过了预期人群/疾病的验证。我们的目的是评估 8 种 PROMIS 计算机自适应测试（CAT）测量方法在青少年特发性脊柱侧凸（AIS）患儿中的结构效度。
我们前瞻性地招募了 200 名患有 AIS 的儿童（年龄 10 至 17 岁），他们通过电子方式完成了 8 项 PROMIS CAT（焦虑、抑郁症状、移动性、疼痛行为、疼痛干扰、同伴关系、身体活动、身体应激体验）和脊柱侧凸研究协会 22r 问卷（SRS-22r）。治疗类别为观察、支具、有手术指征或后路脊柱融合术后。使用已知组分析和收敛性和判别有效性分析评估结构有效性。方差分析用于根据治疗类别（已知组）识别 PROMIS T 评分的差异。计算相应的 PROMIS 和 SRS-22r 域之间的 Spearman 秩相关系数（ rs ）（收敛性）和不相关的 PROMIS 域之间的 Spearman 秩相关系数（ rs ）（判别性）。计算地板/天花板效应。
在治疗类别中，在 PROMIS 移动性、疼痛行为、疼痛干扰和身体应激体验以及所有 SRS-22r 域（ P <0.05）中发现了显著差异，除了心理健康（ P =0.15）。SRS-22r 疼痛与 PROMIS 疼痛干扰（ rs =-0.72）和疼痛行为（ rs =-0.71）呈强相关，与身体应激体验（ rs =-0.57）呈中度相关。SRS-22r 心理健康与 PROMIS 抑郁症状（ rs =-0.72）呈强相关，与焦虑（ rs =-0.62）呈中度相关。SRS-22r 功能与 PROMIS 移动性（ rs =0.64）中度相关，与身体活动（ rs =0.34）弱相关。SRS-22r 自我形象与 PROMIS 同伴关系（ rs =0.33）弱相关。所有不相关的 PROMIS CAT 均呈弱相关（| rs |<0.40）。PROMIS 焦虑、移动性、疼痛行为和疼痛干扰以及 SRS-22r 功能、疼痛和满意度显示出天花板效应。
有证据支持 6 种 PROMIS CAT 在评估 AIS 患者方面的结构有效性。在使用特定的 PROMIS CAT 时，应考虑天花板效应。
二级，预后。
