Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands.
Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
J Orthop Trauma. 2024 Jul 1;38(7):390-396. doi: 10.1097/BOT.0000000000002814. Epub 2024 May 31.
OBJECTIVES: To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (physical function [PF] and pain interference [PI]) computerized adaptive testing to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index [DI] and bother index [BI]). To explore factors associated with PROMIS scores. DESIGN: Cross-sectional study. SETTING: Level I Trauma Center. PATIENT SELECTION CRITERIA: Isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023). OUTCOME MEASURES: Correlations (Pearson), reliability (standard error [SE] [T score]), efficiency (amount of information per item [1 - SE2/Nitems]), and floor/ceiling effects were assessed. An r > 0.7 represented high correlation, and SE ≤ 2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified. RESULTS: In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0 [PROMIS-PF], SE 2.1 [PROMIS-PI], and SE 1.2 [SMFA-DI], SE 1.8 [SMFA-BI]). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8 (SD 2.5) and 4.1 (SD 1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores. CONCLUSIONS: PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As computerized adaptive tests are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的：比较患者报告的结局测量信息系统（PROMIS）（身体机能[PF]和疼痛干扰[PI]）计算机化自适应测试与传统的短肌肉骨骼功能评估（SMFA）（功能障碍指数[DI]和困扰指数[BI]）的测量特性。探讨与 PROMIS 评分相关的因素。 设计：横断面研究。 地点：一级创伤中心。 患者选择标准：从矫形创伤门诊招募了上肢/下肢骨折的孤立性患者（2021 年 10 月 1 日至 2023 年 1 月 1 日）。 结果测量：评估相关性（Pearson）、可靠性（标准误差[SE] [T 评分]）、效率（每个项目的信息量[1 - SE2/Nitems]）和地板/天花板效应。r>0.7 代表高度相关，SE≤2.2 代表足够的可靠性。还确定了与 PROMIS 评分较差相关的因素。 结论：共 202 例患者在中位随访 98 天完成了 PROMs。PROMIS-PF 与 SMFA-DI 之间，以及 PROMIS-PI 与 SMFA-BI 之间的相关性分别为-0.84 和 0.65。两种仪器的可靠性均非常高（平均 SE 2.0[PROMIS-PF]、SE 2.1[PROMIS-PI]、SE 1.2[SMFA-DI]、SE 1.8[SMFA-BI]）。与 SMFA-DI 相比，PROMIS-PF 的相对效率为 7.8（SD 2.5），与 SMFA-BI 相比，PROMIS-PI 的相对效率为 4.1（SD 1.7）。PROMIS 和 SMFA 均未出现地板/天花板效应。在多变量回归分析中，除其他因素外，抑郁水平升高与 PROMIS-PF 和 PROMIS-PI 评分较差呈（独立）相关。 结论：PROMIS-PF 和 PROMIS-PI CAT 与 SMFA 呈（高度和中度）相关，因此测量身体机能和不适的可比结构。由于计算机化自适应测试的管理效率更高，因此它们是评估骨折治疗效果的 SMFA 的极具吸引力的替代方法。抑郁症状与 PROMIS 评分之间的关系强调了在矫形创伤患者中关注心理健康的社会方面的重要性。 证据水平：预后 III 级。请参阅作者说明，以获取完整的证据水平描述。
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