Romeo Paul V, Alben Matthew G, Papalia Aidan G, Chowdhury Tas, Cecora Andrew J, Ragland Dashaun, Kwon Young W, Zuckerman Joseph D, Virk Mandeep S
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
J Shoulder Elbow Surg. 2025 Aug;34(8):e702-e712. doi: 10.1016/j.jse.2024.11.012. Epub 2025 Jan 3.
Patient-Reported Outcome Measurement Information Systems (PROMIS) is increasingly being utilized across the United States as a patient-reported outcome evaluation tool for a wide variety of musculoskeletal conditions. However, PROMIS Upper Extremity (P-UE) physical function has demonstrated limited responsiveness in the early postoperative period after total shoulder arthroplasty (TSA). The aim of this study is to determine if addition of PROMIS Pain Interference (P-Interference) or Pain Intensity (P-Intensity) scores improve the ability to detect postoperative changes in the 1-year postoperative period following TSA.
Patients who were indicated for and elected to undergo TSA between 2020 and 2022 were prospectively enrolled. Prospective data were collected for patient surveys (American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, P-UE, P-Interference and P-Intensity) at the 2-week, 6-week, 3-month, 6-month, and 12-month timepoints. Instrument responsiveness for each PROM was evaluated using the effect size (ES; Cohen d). Responsiveness was defined by the absolute values of each measurement, previously reported as small (0.2), medium (0.5), or large (0.8). Statistical analysis (2 sample t-tests and Fisher's tests) was performed using R studio version 4.2.3 (Boston, MA, USA).
A total of 127 subjects were enrolled in this study. All survey instruments demonstrated large responsiveness (>0.8) at 3, 6, and 12 months. P-Intensity was the only instrument to demonstrate large responsiveness at 2-weeks with its addition to P-UE showing an improved responsiveness at all-time points. Moreover, the addition of P-Intensity had a lower response burden at all-time points when compared to the legacy measures (ASES, Simple Shoulder Test, and Oxford Shoulder Score) at all-time points albeit no difference to ASES (P = .55) at 12-months after surgery. P-Interference and other legacy scores demonstrated large responsiveness starting at 6-weeks postoperatively.
The responsiveness of PROMIS UE can be improved by coupling the outcome measure to P-Intensity scores with a significantly lower response burden when compared to the legacy measures evaluated at nearly all time points.
患者报告结局测量信息系统（PROMIS）在美国正越来越多地被用作多种肌肉骨骼疾病的患者报告结局评估工具。然而，PROMIS上肢（P-UE）身体功能在全肩关节置换术（TSA）后的术后早期显示出有限的反应性。本研究的目的是确定添加PROMIS疼痛干扰（P-干扰）或疼痛强度（P-强度）评分是否能提高在TSA术后1年期间检测术后变化的能力。
前瞻性纳入2020年至2022年间被建议并选择接受TSA的患者。在2周、6周、3个月、6个月和12个月时间点前瞻性收集患者调查数据（美国肩肘外科医师学会（ASES）、简易肩关节测试、P-UE、P-干扰和P-强度）。使用效应量（ES；Cohen d）评估每个PROM的工具反应性。反应性由每个测量的绝对值定义，先前报告为小（0.2）、中（0.5）或大（0.8）。使用R studio版本4.2.3（美国马萨诸塞州波士顿）进行统计分析（双样本t检验和Fisher检验）。
本研究共纳入127名受试者。所有调查工具在3个月、6个月和12个月时均显示出较大的反应性（>0.8）。P-强度是唯一在2周时显示出较大反应性的工具，将其添加到P-UE中在所有时间点均显示出改善的反应性。此外，与传统测量方法（ASES、简易肩关节测试和牛津肩关节评分）相比，在所有时间点添加P-强度的反应负担都更低，尽管在术后12个月时与ASES无差异（P = 0.55）。P-干扰和其他传统评分从术后6周开始显示出较大的反应性。
将结局测量与P-强度评分相结合可提高PROMIS UE的反应性，与几乎所有时间点评估的传统测量方法相比，反应负担显著降低。
