Preoperative psychometric properties of Patient-Reported Outcomes Measurement Information System Upper Extremity, Pain Interference, and Depression in Bankart repair and rotator cuff repair

Abstract

To examine the preoperative performance of PROMIS Upper Extremity 2.0, PROMIS Pain Interference 1.1, and PROMIS Depression 1.0 across multiple orthopedic procedures for the upper extremity and define its susceptibility to preoperative floor and ceiling effects. Retrospective analysis of prospectively collected patient-reported outcome measures (PROMs) data was conducted utilizing an electronic outcome registry for procedures between May 2017 and August 2018. Current procedural terminology (CPT) codes were utilized to examine cohorts for two upper extremity orthopedic procedures: Bankart repair and arthroscopic rotator cuff repair (ARCR). Shapiro-Wilks normality testing was used to assess score distributions for normalcy; given non-normal score distributions, Spearman correlation coefficients were calculated for preoperative PROMs scores. Absolute floor and ceiling effects were calculated for preoperative time points based on CPT code. A total of 488 patients were included across Bankart repair (n=109, 29.3 + 12.5 years) and ARCR (n=379, 57.5 + 9.5 years) cohorts. In the Bankart repair cohort, PROMIS PI demonstrates strong correlations with ASES (r=-0.63), Constant (r=-0.75), PROMIS UE (r=-0.75), and the VR6D (r=-0.61). PROMIS Depression (r=0.23 vs. 0.17), SF12 MCS (r=0.34 vs. 0.11), and VR12 MCS (r=0.44 vs. 0.15) exhibited poor correlations with PROMIS PI and UE, respectively. In the ARCR cohort, PROMIS PI scores demonstrated a good correlation with PROMIS UE (r=0.61). Constant (r=0.58 vs. 0.67), VR12 PCS (r=0.58 vs. 0.47), and VR6D (r=0.67 vs. 0.53) exhibited good correlations with both PROMIS PI and UE measures, respectively. No significant absolute floor or ceiling effects were observed for the PROMIS instruments except PROMIS Depression; an absolute floor was noted for both Bankart (n=12, 30%) and ARCR (n=38, 14.7%) groups. PROMIS PI and UE instruments perform favorably to legacy outcome instruments in patients receiving Bankart repair, as well as those undergoing ARCR. Furthermore, in both populations, the PROMIS Depression instrument exhibits absolute floor effects, whereas PROMIS PI and UE instruments fail to demonstrate any absolute floor or ceiling effects.