Abstract
BackgroundChronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated “legacy” instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments.MethodsWe enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC.ResultsOf the 71 Veterans recruited, the median (IQR) age was 67 (63–71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4–1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001.ConclusionsGiven time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
Highlights
Chronic low back pain results in significant physical, psycho-social and socioeconomic burden
Patient Reported Outcomes Measurement Information System (PROMIS) instruments were administered as computer adaptive testing (CAT) using the PROMIS Assessment Center, and all of the legacy instruments were administered on the computer for ease of use and ability to automatically measure time to completion, with exception of the graphics from Brief Pain Inventory (BPI), and the Numerical Rating Scale for Pain Intensity (NRS-PI)
The most common International Classification of Disease (ICD)-9/10 diagnoses that were associated with the epidural steroid injection (ESI) procedure included: degenerative arthritis, degenerative disc disease, spinal stenosis and lumbago
Summary
Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated “legacy” instruments in older adults with cLBP. While various patient reported outcomes (PRO) measures have been validated and widely used throughout the back pain literature (hereafter referred to as “legacy” instruments), they are frequently criticized as being too burdensome to use in research and clinical practice [12]. These instruments can be costly to obtain and time consuming to perform on a routine basis which led to the development of more accessible and efficient measures
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