Utility of PROMIS Measures in Predicting Shoulder Arthroplasty in Patients with Shoulder Osteoarthritis

Abstract

The decision to treat shoulder osteoarthritis definitively with shoulder arthroplasty (SA) is multifactorial, considering objective findings, subjective information, and patient goals. The first goal of this study was to determine if Patient Reported Outcome Measurement Information System (PROMIS) measures correlated with patients with shoulder osteoarthritis (OA) who underwent SA within 1 year. The second goal of this study was to determine if score cut-offs in PROMIS domains could further discriminate which shoulder OA patients underwent SA within 1 year. This retrospective case-control study examined patients with a diagnosis of shoulder OA who consulted an orthopedic provider from November 1, 2020, to May 23, 2022, and recorded PROMIS measures in the domains of Physical Function (PF), Depression, and/or Pain Interference (PI). A surgical group was defined as patients who underwent SA within 1 year of the most recent PROMIS measures, and the non-surgical patients were defined as the control group. Mean PROMIS scores were compared between the surgical and control groups. Separate logistic regression models controlling for age, race, ethnicity, and comorbidity count were performed for each PROMIS domain as a 1) continuous variable, then as 2) binary variable defined by PROMIS score cut-off points to determine which scores correlated with undergoing SA to further characterize the potential clinical utility of PROMIS score cut-offs in relating to undergoing SA. The surgical group of 478 patients was older (68.2 vs. 63.8 years), more often of White race (82.6% vs. 70.9%), and less often of Hispanic Ethnicity (1.5% vs. 2.9%) than the control group of 3343 patients. Using optimal cut-offs in PROMIS scores, PI ≥ 63 (Odds Ratio (OR) = 2.97 (2.41-3.64), p < 0.001), PF ≤ 39 (OR = 1.81 (95% CI, 1.48-2.22), p < 0.001), and Depression ≥ 49 (OR = 1.82 (95% CI, 1.50-2.22), p < 0.001) were all found to correlate with undergoing SA within 1 year in multivariable logistic regressions. The results of this study demonstrate that cut-off scores for PROMIS measures differentiated patients undergoing SA within 1 year. These cut-off scores may have clinical utility in aiding in decision-making regarding surgical candidates for SA. Further research is needed to validate these cut-off scores and determine how they relate to patient outcomes after SA.