Establishing A Crosstalk Between Pediatric and Adult Promis Domains in Sports Medicine

Abstract

Introduction:Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in athletes participating in orthopedic research and clinical care. PROMIS domains are separately validated in both pediatric (<18 years) and the adult (>18 years) populations. However, the utilization of PROMIS in the adolescent athlete is complicated by the inability to convert between pediatric and adult PROMIS domains.Purpose:This study sought to establish conversion factors to transition between pediatric and adult values of the commonly tested PROMIS domains.Methods:This study consisted of 100 participants, aged 14-21 years old, who presented to orthopedic outpatient clinics with lower extremity complaints in various stages from initial presentation to postoperative recovery (excluding any within three months of surgery). All participants completed both adult and pediatric versions of the following PROMIS domains: Adult/Pediatric Mobility, Adult/Pediatric Pain Interference (PI), and Adult Physical Function (PF). Linear regression was utilized to determine a conversion factor between the two age groups within each domain by the mean difference. To evaluate the clinical significance of this difference, a 5-point threshold (representing minimally clinically important difference) between the two scores was set and 1-sided t-tests were performed.Results:Overall, 50 pediatric patients (mean age of 15.6 ± 1.1) and 50 young adult patients (18.9 ± 1.0) were included. Each group had roughly the same ratio of males to females (18:32 v. 17:33 for the pediatric and adult groups, respectively). Adult and Pediatric domains were all strongly correlated (range of r=0.85-0.87). In both groups, subjects scored higher on Adult domains than Pediatric domains (mean difference ranging from 4.2-6.3 points), all of which were significantly different (p<0.05 for all domains). When assessed for clinical significance, only Mobility and Pain Interference performance in the pediatric group were found to be significantly different (mean difference of 5.8 and 5.4, respectively). To convert between the scores for both populations, the following were calculated: Adult Mobility to Pediatric Mobility -4.2, Adult Physical Function to Pediatric Mobility -6.3, and Adult Pain Interference to Pediatric Pain Interference -4.3.Conclusion:This study demonstrated that while Adult and Pediatric domains are highly correlated, over half of patients demonstrated clinically significant differences between scores. This study established correction factors to allow conversion between Pediatric and Adult PROMIS domains with high correlation.