Roca Hernan, Maughan-Egbert Gretchen, Garcia Brittany N, Kazmers Nikolas H
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
J Hand Surg Am. 2025 Jun;50(6):648-655. doi: 10.1016/j.jhsa.2025.03.006. Epub 2025 Apr 29.
Utilization of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI) computer adaptive tests (CAT) has grown in the hand surgery literature. However, these instruments were derived using data from a general population rather than cohorts with UE pathology. As such, our primary purpose was to evaluate the test-retest reliability of the UE and PI CATs in a sample of hand surgery patients.
At a tertiary academic center, we recruited adult (≥18 years) orthopedic hand surgery patients who completed the PROMIS UE and PI CAT 1-7 days prior to their office appointment, plus a subsequent response to both instruments in clinic. Patients were included only if their upper extremity symptoms were stable between questionnaires, as assessed by an anchor question (eg, no change in scores is expected). Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability. Bland-Altman Plots were created to visualize the proportion of patients whose scores differed by a value greater than the minimally clinically important difference for both instruments (4.1 for UE CAT, 4.3 for PI CAT).
The 88 included patients had a mean age of 54 ± 18 years, and 56% (56/88) were women. There was a mean of 4 ± 2 days between surveys. The UE CAT demonstrated an ICC of 0.87 (95% confidence intervals [CI], 0.80-0.91), consistent with "good" to "excellent" reliability. The PI CAT ICC was 0.84 (95% CI, 0.76-0.89), consistent with "good" reliability. However, 34% (30/88) and 23% (20/88) of patients had UE CAT and PI CAT score differences that exceeded minimally clinically important difference thresholds.
For a hand surgery cohort (population level), the UE CAT demonstrated "good" to "excellent" test-retest reliability, and the PI CAT demonstrated "good" reliability. However at the patient level, score differences were clinically relevant in approximately one of three patients for UE CAT and one of four patients for the PI CAT. We conclude that these instruments are reliable at the population level, but should not be used at the level of individual hand surgery patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
患者报告结局测量信息系统（PROMIS）上肢（UE）和疼痛干扰（PI）计算机自适应测试（CAT）在手部外科文献中的应用日益增多。然而，这些工具是使用来自普通人群而非患有上肢疾病队列的数据得出的。因此，我们的主要目的是评估手部外科患者样本中UE和PI CAT的重测信度。
在一家三级学术中心，我们招募了成年（≥18岁）骨科手部外科患者，他们在门诊预约前1 - 7天完成了PROMIS UE和PI CAT，并且在诊所对这两种工具进行了后续回答。仅当通过一个锚定问题（例如，预期分数无变化）评估患者在上肢症状在两次问卷调查之间稳定时，患者才被纳入。组内相关系数（ICC）用于评估重测信度。绘制Bland - Altman图以直观显示两种工具中分数差异大于最小临床重要差异值的患者比例（UE CAT为4.1，PI CAT为4.3）。
纳入的88例患者平均年龄为54±18岁，56%（56/88）为女性。两次调查之间平均间隔4±2天。UE CAT的ICC为0.87（95%置信区间[CI]，0.80 - 0.91），与“良好”至“优秀”的信度一致。PI CAT的ICC为0.84（95% CI，0.76 - 0.89），与“良好”信度一致。然而，分别有34%（30/88）和23%（20/88）的患者UE CAT和PI CAT分数差异超过最小临床重要差异阈值。
对于手部外科队列（人群水平），UE CAT显示出“良好”至“优秀”的重测信度，PI CAT显示出“良好”信度。然而在患者个体水平，大约三分之一的UE CAT患者和四分之一的PI CAT患者分数差异具有临床相关性。我们得出结论，这些工具在人群水平是可靠的，但不应在个体手部外科患者水平使用。
研究类型/证据水平：治疗性II级。
