Preoperative Patient-Reported Outcomes Measurement Information System Scores Research Articles

A Comparison of PROMIS Scores of Metatarsophalangeal Joint Arthrodesis and Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty for Hallux Rigidus.

The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure. A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared. The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data. While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Defining the Patient Acceptable Symptom State Using PROMIS Following Reconstruction of the Progressive Collapsing Foot Deformity

Introduction/Purpose: Although reconstruction of the flexible progressive collapsing foot deformity (PCFD) has been shown to improve patient-reported outcomes (PROs), there is limited data describing postoperative success as defined by patient satisfaction following surgery. Distinct from the minimal clinically important difference (MCID), the patient acceptable symptom state (PASS) is a novel PRO measurement that represents the symptom threshold beyond which patients are satisfied with their postoperative outcome. The primary aim of this study was to use Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores in combination with anchor questions to define PASS thresholds following reconstruction of the flexible PCFD. A secondary aim was to analyze how patient-specific variables and certain PCFD reconstruction procedures may impact the probability of reaching PASS thresholds. Methods: Using data collected from a foot and ankle orthopedic registry at a large academic institution, 109 patients who underwent reconstruction of a flexible PCFD between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS PF and PI scores, and 2-year postoperative responses to two PASS anchor questions (the delighted-terrible scale and the satisfied scale) were included in the study. Patients who underwent either a double or triple arthrodesis were excluded. Patient responses to the anchor questions were dichotomized and receiver operating characteristic (ROC) curve analyses were performed. Using the Youden Index to balance sensitivity and specificity and maximize the area under the curve (AUC), PASS thresholds with 95% confidence intervals were quantified using 2000 bootstrapped iterations. Lastly, multivariable logistic regressions were performed to analyze the influence of patient demographics, preoperative PROMIS scores, and certain PCFD reconstruction procedures on the probability of reaching the PASS thresholds. Results: The PASS threshold for PROMIS PF was found to be 42.6 using both the delighted-terrible and the satisfied scale and 73.4% of patients (80/109) reached the threshold (both AUCs: 0.91) (Table 1). The PASS thresholds for PROMIS PI defined using the delighted-terrible scale and the satisfied scale were 54.5 (AUC: 0.90) and 57.5 (AUC: 0.91), respectively, with 72.5% of patients (79/109) and 81.7% of patients (89/109) meeting the respective thresholds. Neither patient demographics nor specific PCFD reconstruction procedures affected the probability of meeting the PASS thresholds. However, a lower preoperative PROMIS PF score or a higher preoperative PROMIS PI score significantly decreased the probability of achieving the PASS thresholds. Conclusion: Following reconstruction of the flexible PCFD, PASS thresholds for the PROMIS PF and PI domains were found to be lower and higher, respectively, than population norms. This suggests that patients may be satisfied with the outcome of their surgery despite not returning to the population mean. The probability of achieving the PASS thresholds was influenced by both preoperative PROMIS PF and PI scores but not by patient demographics or certain PCFD reconstruction procedures. In addition to guiding future outcomes research, these results may help foot and ankle surgeons optimize treatment for the flexible PCFD and better manage patient expectations.

Do preoperative PROMIS scores independently predict 90-day readmission following primary total knee arthroplasty?

The rising demand for total knee arthroplasty (TKA) is expected to increase the total number of TKA-related readmissions, presenting significant public health and economic burden. With the increasing use of Patient-Reported Outcomes Measurement Information System (PROMIS) scores to inform clinical decision-making, this study aimed to investigate whether preoperative PROMIS scores are predictive of 90-day readmissions following primary TKA. We retrospectively reviewed a consecutive series of 10,196 patients with preoperative PROMIS scores who underwent primary TKA. Two comparison groups, readmissions (n = 79; 3.6%) and non-readmissions (n = 2091; 96.4%) were established. Univariate and multivariate logistic regression analyses were then performed with readmission as the outcome variable to determine whether preoperative PROMIS scores could predict 90-day readmission. The study cohort consisted of 2170 patients overall. Non-white patients (OR = 3.53, 95% CI [1.16, 10.71], p = 0.026) and patients with cardiovascular or cerebrovascular disease (CVD) (OR = 1.66, 95% CI [1.01, 2.71], p = 0.042) were found to have significantly higher odds of 90-day readmission after TKA. Preoperative PROMIS-PF10a (p = 0.25), PROMIS-GPH (p = 0.38), and PROMIS-GMH (p = 0.07) scores were not significantly associated with 90-day readmission. This study demonstrates that preoperative PROMIS scores may not be used to predict 90-day readmission following primary TKA. Non-white patients and patients with CVD are 3.53 and 1.66 times more likely to be readmitted, highlighting existing racial disparities and medical comorbidities contributing to readmission in patients undergoing TKA.

Disparate Impact: How Does Social Deprivation Affect Patient-reported Outcomes After ACL Reconstruction in Children and Adolescents?

Research has indicated that lower socioeconomic status is associated with delays in the treatment of anterior cruciate ligament (ACL) injuries; however, there is a paucity of literature evaluating its association with patient-reported outcomes (PROs). Using the Area Deprivation Index (ADI), a validated proxy for socioeconomic status, the study aimed to determine how relative socioeconomic disadvantage is related to PROs after primary ACL reconstruction (ACLR) in pediatric patients. This retrospective cohort study included all patients 18 years old or above who underwent primary ACLR at an academic institution between 2018 and 2021. Exclusion criteria included multiligament injury, congenital ACL absence, and absent outcomes data. The minimum follow-up was 6 months. A Patient-reported Outcomes Measurement Information System (PROMIS) 50 Pediatric self-report questionnaire was completed at postoperative visits, and domain scores for pain, physical function/mobility, fatigue, anxiety, depression, and peer relationships were generated. The National ADI percentile was calculated using the patients' addresses. Patients were divided into quartiles (low, moderate, moderate-severe, and severe ADI), and comparative analyses were performed to determine the relationship between ADI and PROMIS. A total of 413 patients were identified, including 49% (n=207), 33% (n=139), 11% (n=48), and 7% (n=30) from the low, moderate, moderate-severe, and severe deprivation areas, respectively. As compared with those in the low-deprivation quartile, patients in the severe deprivation quartile had delayed time to the first clinic visit (11 vs. 16.5d, P=0.044) and surgery (51 vs. 80d, P=0.004). There were no differences in the number of additional procedures required at index surgery. All quartiles had progressive improvements in physical function/mobility and pain scores throughout recovery, but at 9 months, there was significantly more pain in the severe deprivation cohort, despite no difference in self-reported physical function and mobility. Those with severe socioeconomic disadvantage had worse psychosocial outcomes, including significantly increased depression, fatigue, and anxiety and decreased peer relationship scores. Although there were no differences in preoperative PROMIS scores, pediatric patients living in areas with higher levels of socioeconomic deprivation/disadvantage had worse psychosocial PROs after ACLR. Level III-retrospective comparative study.

Correlating the Patient Reported Outcomes Measurement Information System (PROMIS) to the Foot and Ankle Outcome Score and Patient Functional Testing in Total Ankle Arthroplasty Patients

Category: Ankle Arthritis; Other Introduction/ Purpose: The orthopaedic field, including foot and ankle surgery, continues to rely on patient reported outcome measures (PROMs) as the cornerstone of research studies. Various questionnaires exist, each with their advantages and disadvantages. The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular due to its reliability, validity, and efficiency. This system has been tested against the Foot and Ankle Outcome Score (FAOS) for foot and ankle conditions, however little is known about its validity for patients with ankle arthritis undergoing total ankle arthroplasty (TAA). Additionally, its relationship to functional tests is unknown, which could reveal whether it could be used in lieu of these resource-intensive assessments. Therefore, we aimed to validate PROMIS against the FAOS and functional tests in TAA patients. Methods: This prospective cohort study included 102 patients (mean age: 63.5 years) who were diagnosed with ankle arthritis and underwent subsequent TAA. Preoperative PROMIS scores, FAOS, and functional tests including the 4 square test (4SST), timed up and go (TUG), and sit-to-stand (STS) were gathered and analyzed preoperatively. PROMIS physical function and pain interference domains were tested for reliability using Rasch partial credit models. Convergent validity between PROMIS physical function and pain interference, and FAOS function, daily living was evaluated using Spearman’s correlation coefficient. In addition, the relationship between the functional tests and all 6 PROMIS domains were evaluated using Spearman’s correlation coefficient. Results: Infit and outfit mean squares (MSQs) for PROMIS physical function ranged from 0.61 – 0.78, indicating a good fit in the Rasch model. Similarly, infit and outfit MSQs for PROMIS pain interference ranged from 0.77 – 0.8, also indicating a good fit. Separation reliability was 0.89 for physical function and 0.85 for pain interference, indicating good reliability to actual patient function and pain levels. PROMIS physical function demonstrated a moderate positive correlation with FAOS function, daily living (r=0.52) while pain interference demonstrated a moderate negative correlation (r=-0.52). PROMIS physical function demonstrated statistically significant weak negative correlations for all 3 functional tests (r=-0.19 for 4SST, r=-0.27 for TUG, r=-0.2 for STS) [Figure 1]. Conclusion: Our study revealed good reliability of PROMIS physical function and pain interference domains, with a moderate correlation to FAOS function, daily living. Additionally, we found weak correlations between PROMIS physical function and functional tests and no significant correlations between pain interference and functional tests. This indicates acceptable convergent validity to the FAOS but not to functional tests. Therefore, while PROMIS provides reliable and valid measures, it does not replace the need for functional tests, which should be pursued in conjunction to deliver a complete assessment of TAA patients.

Do Preoperative PROMIS Scores Predict Postoperative Outcomes in Hallux Rigidus Patients Undergoing Cheilectomy

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Prior studies have shown that preoperative patient reported outcome scores, specifically the Patient- Reported Outcomes Measurement Information System (PROMIS) score, predict improvement in foot and ankle surgery. This has been shown in hallux valgus, progressive collapsing foot deformity (PCFD), and end-stage ankle arthritis. However, no studies have investigated whether preoperative PROMIS scores are predictive of postoperative outcomes following a cheilectomy for hallux rigidus. The purpose of this study was to determine if preoperative PROMIS scores were predictive of which patients undergoing cheilectomy for hallux rigidus would achieve the minimal clinically important difference (MCID). Additionally, we sought to determine if preoperative PROMIS thresholds could be estimated to help guide surgical decision-making.Methods:This retrospective cohort study included patients > 18 years, who underwent cheilectomy with or without a Moberg osteotomy for treatment of hallux rigidus and had preoperative and ≥2-year postoperative PROMIS physical function scores. Preoperative to 2-year postoperative change in PROMIS scores in the physical function, pain interference, pain intensity, and depression domains were recorded, and receiver operating curve (ROC) analyses were performed to determine if preoperative scores were predictive of achieving the MCID for each domain. Area under the curve (AUC) was used to determine if preoperative PROMIS scores were predictive of achieving the MCID for each domain. 95% sensitivity and specificity thresholds were determined for statistically significant AUCs (AUC0.70). Positive and negative likelihood ratios (LRs) were calculated for the specificity and sensitivity thresholds, respectively. For statistically significant LRs, posttest probabilities were calculated for meeting MCID if patients met the preoperative PROMIS cutoff.Results:Statistically significant AUCs were found for PROMIS physical function (AUC=0.71), pain intensity (AUC=0.70) and depression (AUC=0.79) when using MCIDs defined as ½ of the standard deviation of the preoperative to 2-year postoperative change (Table 1). The AUC for pain interference was not statistically significant (AUC=0.69). The preoperative 95% sensitivity threshold was 53.2 for the physical function domain, the negative LR was 1.36, and the posttest probability of achieving the MCID for physical function with a preoperative t-score greater than 53.2 was 63%. However, the LRs were not statistically significant for the physical function specificity threshold and the pain intensity sensitivity and specificity thresholds, so posttest probabilities could not be calculated.Conclusion:Our results suggest that preoperative PROMIS physical function, pain interference, and pain intensity scores had limited predictive value in determining of which patients would achieve meaningful clinical improvement following a cheilectomy. Patients with worse functional limitations were not necessarily more likely to clinically improve after a cheilectomy. The pain interference domain was not predictive of meeting the MCID postoperatively. Additionally, the calculated thresholds for pain intensity, and depression were not reliable predictors of clinical improvement. This is in contrast to prior studies that have found useful procedure-specific thresholds such for bunionectomy, flatfoot reconstruction, and total ankle replacement.

Association of Preoperative Physical Function and Changes in Mental Health After Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Few investigations have focused on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores, patient depression measured by the Patient Health Questionnaire-9 (PHQ-9), and their relationship in the setting of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). This study aims to detail the association between preoperative physical function with postoperative change in physical function and in depressive symptoms. A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to February 2019. Inclusion criteria were primary, single-level MIS TLIF procedures. Multilevel procedures and patients without PROMIS or PHQ-9 were excluded. Patients were grouped by preoperative PROMIS score (<35.0 and ≥35.0), with higher scores indicating greater physical function. A t test analyzed differences between PROMIS subgroups for operative time (skin incision to closure), estimated blood loss, length of stay, and discharge day. A t test also assessed the difference in PROMIS Physical Function (PF) and PHQ-9. Linear regression evaluated the relationship between pre- and postoperative PROMIS and PHQ-9. Of 119 patients, 53.8% were male and 47.9% were obese. The mean ± SD age was 52.2 ± 10.7 years. The PROMIS <35.0 group had a larger improvement of PROMIS scores compared to the PROMIS ≥35.0 group at 6 weeks, 12 weeks, and 6 months. There was a negative association between preoperative PROMIS and PROMIS score improvement at 6 weeks, 12 weeks, and 6 months. For all time points, improvement in PHQ-9 was not associated with preoperative PROMIS scores. From 0 weeks to 6 months after MIS TLIF, patients with lower preoperative physical function had larger improvements in PROMIS PF scores. Preoperative function was not predictive of postoperative changes in PHQ-9. While relationships between mental and physical health cannot be discounted, the lack of PHQ-9 association with physical function demonstrates the impact that MIS TLIF can have, regardless of PROMIS PF score. Patients demonstrating lower levels of preoperative physical function may be in position for greater improvements in physical function following MIS TLIF surgery. In this study, there was no clear relationship between preoperative physical function levels and postoperative improvement in mental health, suggesting that all patients may achieve similar mental health improvement following MIS TLIF. 3.

Preoperative Physical Function Association With Mental Health Improvement After Anterior Cervical Discectomy and Fusion.

This was a retrospective study. This study investigates the influence of physical function and their influence on postoperative depressive symptom scores as measured by Patient Health Questionnaire-9 (PHQ-9) among anterior cervical decompression and fusion (ACDF) patients. While ACDF is one of the most commonly performed ambulatory surgeries, research is limited on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores and their influence on depressive symptoms as measured by the PHQ-9. A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to January 2019. Inclusion criteria were primary or revision ACDF procedures. Patients were grouped by preoperative PROMIS score (≥35.0, <35.0), with higher scores indicating greater physical function. The χ2 and Student t tests assessed categorical and continuous variables (eg, demographics, perioperative, and postoperative values). A t test evaluated postoperative improvement in PROMIS Physical Function (PF) scores between subgroups among PROMIS PF scores and PHQ-9 score improvement at 6, 12 weeks, 6 months, and 1 year. Linear regression assessed preoperative PROMIS scores influence on PHQ-9 score improvement. The 121 subject cohort was 61.2% male with an average age of 49.6±9.8 years. Compared with the PROMIS ≥35.0 group, the PROMIS <35.0 group also had larger improvement of PROMIS scores at 6 weeks. No significant difference in postoperative PHQ-9 improvement was observed between subgroups. There was a negative association between preoperative PROMIS scores and improvement in PROMIS scores at 6, 12 weeks, 6 months, and 1 year. There was a positive association between preoperative PROMIS scores and magnitude of 1-year PHQ-9 change. Individuals with lower preoperative PROMIS PF scores had significantly higher PHQ-9 scores at 1 year. Patients with lower preoperative physical function, as evaluated by PROMIS PF scoring, had greater improvement of mental health at 1 year postoperatively. This suggests that many patients experience multidimensional health benefits after ACDF procedures.

Patients With Preoperative Clinical Depression Symptomology Experience Significant Improvements in Postoperative Pain, Function, and Depressive Symptoms Following Rotator Cuff Repair

To determine the impact of clinical depression on outcomes after rotator cuff repair (RCR), as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) health domains. RCR patients were given PROMIS CAT assessments for physical function (PROMIS UE), pain interference (PROMIS PI), and depression (PROMIS D) during preoperative and postoperative clinic visits. PROMIS D scores ≥55 correlate with mild clinical depression; thus patients with PROMIS D scores ≥ 55 were placed in the clinical depression (CD) group, whereas patients with scores <55 were placed in the "no clinical depression" (NCD) group. Categorical variables were compared at preoperative and postoperative (6 months and ≥1 year) timepoints using χ2 tests. Continuous variables were compared using Student's t-tests. Of the 340 RCR patients included in this study, 65 (19.1%) were found to have mild clinical depression preoperatively, with that number being reduced to 23 (6.8%) at 6 months and 19 (5.6%) at ≥1 year after surgery. Compared with preoperative PROMIS scores, CD patients had significant postoperative improvements at 6 months and ≥1 year in mean PROMIS UE (26.7 vs 35.5 vs 38.9; P < .001) and PROMIS PI (67.6 vs 56.7 vs 56.4; P < .001). NCD patients had similar postoperative improvements at 6 months and ≥1 year in mean PROMIS UE (30.8 vs 38.6 vs 46.9; P < .001) and PROMIS PI (61.7 vs 53.0 vs 47.6; P < .001). The improvement in PROMIS scores was similar for the CD and NCD groups in both PROMIS UE (12.2 vs 16.1, respectively) and PROMIS PI (-11.2 vs-14.1, respectively). Despite starting with worse PROMIS UE and PROMIS PI scores, patients undergoing RCR with symptoms of CD experienced significant improvement in function, pain, and depressive symptoms. Preoperative depression should not be a contraindication to arthroscopic RCR in patients who are otherwise appropriate operative candidates. Level III, retrospective comparative trial.

Determining validity, discriminant ability, responsiveness, and minimal clinically important differences for PROMIS in adult spinal deformity.

The aim of this study was to determine the concurrent validity, discriminant ability, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) in adult spinal deformity (ASD) and to calculate minimal clinically important differences (MCIDs) for PROMIS scores. The authors used data obtained in 186 surgical patients with ASD. Concurrent validity was determined through correlations between preoperative PROMIS scores and legacy measure scores. PROMIS discriminant ability between disease severity groups was determined using the preoperative Oswestry Disability Index (ODI) value as the anchor. Responsiveness was determined through distribution- and anchor-based methods, using preoperative to postoperative changes in PROMIS scores. MCIDs were estimated on the basis of the responsiveness analysis. The authors found strong correlations between PROMIS Pain Interference and ODI and the Scoliosis Research Society 22-item questionnaire Pain component; PROMIS Physical Function and ODI; PROMIS Anxiety and Depression domains and the 12-Item Short Form Health Survey version 2, Physical and Mental Components, Scoliosis Research Society 22-item questionnaire Mental Health component (anxiety only), 9-Item Patient Health Questionnaire (anxiety only), and 7-Item Generalized Anxiety Disorder questionnaire; PROMIS Fatigue and 9-Item Patient Health Questionnaire; and PROMIS Satisfaction with Participation in Social Roles (i.e., Social Satisfaction) and ODI. PROMIS discriminated between disease severity groups in all domains except between none/mild and moderate Anxiety, with mean differences ranging from 3.7 to 8.4 points. PROMIS showed strong responsiveness in Pain Interference; moderate responsiveness in Physical Function and Social Satisfaction; and low responsiveness in Anxiety, Depression, Fatigue, and Sleep Disturbance. Final PROMIS MCIDs were as follows: -6.3 for Anxiety, -4.4 for Depression, -4.6 for Fatigue, -5.0 for Pain Interference, 4.2 for Physical Function, 5.7 for Social Satisfaction, and -3.5 for Sleep Disturbance. PROMIS is a valid assessment of patient health, can discriminate between disease severity levels, and shows responsiveness to changes after ASD surgery. The MCIDs provided herein may help clinicians interpret postoperative changes in PROMIS scores, taking into account the fact that they are pending external validation.

Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) scores compared with legacy metrics in evaluating outcomes after surgical treatment for osteochondritis dissecans of the humeral capitellum

Patient-Reported Outcomes Measurement Information System (PROMIS) scores have not previously been used to measure long-term outcomes in operatively treated capitellar osteochondritis dissecans (OCD) patients. The aims of our study were to (1) assess patients' long-term outcomes using PROMIS scores, (2) compare the performance of PROMIS with other validated elbow legacy metrics, and (3) evaluate ceiling and floor effects in these outcome measures in patients undergoing surgical treatment for capitellar OCD. We evaluated demographic characteristics, procedure details, preoperative PROMIS scores, and associated sports information in surgically treated pediatric capitellar OCD patients. An online survey was sent to the study participants, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow score, the quick Disabilities of the Arm, Shoulder and Hand questionnaire, and the Liverpool Elbow Score patient-answered questionnaire, as well as the Mobility, Pain Interference, and Upper Extremity questionnaires from the PROMIS pediatrics bank. Correlations were evaluated between outcome measures. Ceiling and floor effects were evaluated for each outcome measure. Completed surveys were obtained for 57 patients (59 elbows). The mean patient age at surgery was 14 years (range, 10-18 years). The mean follow-up time was 6 years (standard deviation, 5 years; range, 1-18 years). The mean PROMIS Mobility score improved from 41.2 preoperatively to 55.2 postoperatively (P < .001). The mean Pain Interference score decreased from 46.9 preoperatively to 38 postoperatively (P < .001). The mean Upper Extremity score improved from 42.7 preoperatively to 53.2 postoperatively (P < .001). Significant correlations were observed between all legacy metrics and postoperative PROMIS scores (|r| > 0.54, P < .001). Ceiling or floor effects were seen in all legacy metrics and PROMIS scores. The KJOC score was least affected by ceiling or floor effects. There is a strong correlation between PROMIS scores and legacy measures evaluating outcomes after surgical management of capitellar OCD. However, large ceiling and floor effects were present in all measures, likely owing to the favorable clinical results. The KJOC score was limited the least by ceiling and floor effects.

95. PROMIS scores alone are not a reliable measure of patient outcomes after surgery for lumbar stenosis

BACKGROUND CONTEXT As the health care industry shifts to a value-based care model, patient-reported outcome instruments such as the NIH-supported Patient-Reported Outcomes Measurement Information System (PROMIS), which evaluates patients’ global well-being, are increasingly used to gauge the cost-effectiveness of care. The Swiss Spinal Stenosis Questionnaire (SSSQ) is considered the gold standard validated disease-specific outcome measure for the treatment of lumbar spinal stenosis and has been found to be internally consistent, reproducible and responsive to clinical change. As PROMIS is further integrated into clinical care, its benefit must be evaluated relative to traditional PRO instruments such as the SSSQ. PURPOSE This study aims to establish the strength of relationship between three commonly used PROMIS measures and the SSSQ. STUDY DESIGN/SETTING Not applicable. PATIENT SAMPLE See methods section. OUTCOME MEASURES See methods section. METHODS Eighty-two patients with spinal stenosis at a single academic medical center were enrolled. They filled out one SSSQ during their enrollment visit. Patients completed the PROMIS Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) instruments at each visit. For patients who had undergone lumbar decompressive surgery, PROMIS scores from the first two postop visits were averaged. Regression analysis was performed to evaluate the pain and physical function domains of the SSSQ against their respective PROMIS counterparts (PI and PF), treatment satisfaction component of the SSSQ against postop PROMIS scores, and combined pretreatment SSSQ against PROMIS AD. RESULTS PROMIS PF correlates moderately well with the SSSQ physical function domain (R2 0.14, p=0.0008) while PROMIS PI correlates poorly with the SSSQ pain domain (R2 0.03, p= 0.13). PROMIS AD correlates relatively poorly to the pretreatment SSSQ (R2 0.07, p= 0.02). In patients who have undergone surgery, postoperative PROMIS scores in all three domains correlate reasonably well with the treatment satisfaction component of the SSSQ [PROMIS AD (R2 0.13, p=0.01), PROMIS PI (R2 0.25, p= 0.003), PROMIS PF (R2 0.18, p= 0.003)]. CONCLUSIONS While postoperative PROMIS scores reflect patient outcomes after surgery for spinal stenosis reasonably well, preoperative PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis on patients’ overall wellbeing. Therefore, PROMIS scores should not be used in isolation to assess outcomes in patients with spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Preoperative Prediction of Postoperative Physical Function in Infected Diabetic Foot Ulcer Patients

Category:DiabetesIntroduction/Purpose:Diabetic foot ulcers (DFU) is a prevalent problem that can lead to devastating results such as limb loss if left untreated. Nevertheless, the prolonged treatment course can limit the patient’s overall function and quality of life. Utilization of Patient-Reported Outcomes Measurement Information System (PROMIS) in Orthopaedic practice has previously shown that preoperative PROMIS scores can predict postoperative outcomes in foot and ankle surgeries. However, PROMIS assessment has not been used to determine the impact of surgical treatment for DFU on patients’ physical function. We sought to investigate the impact of preoperative PROMIS scores (Physical Function (PF), Pain Interference (PI), Depression (D)), demographic and laboratory values on postoperative PF in this unique patient population.Methods:From an academic orthopaedic surgeon’s practice, we identified infected DFU patients who underwent surgical interventions between February 2015 and November 2018 using ICD-10 code E11.621 (n=240). Patients with at least 3 consecutive visits, 3 month minimum post-surgical follow up and completed PROMIS Computer Adaptive Testing (CAT) assessments for each visit were included (n=92). Demographic data, BMI, medical comorbidities, Hemoglobin A1C, procedure performed, and wound healing status were collected. Amputation level was categorized as the following: 0 = irrigation & debridement (I&D) (n=39), 1 = forefoot amputations (n=46), 2 = mid/hindfoot amputations (n=14), 3 = Syme or above amputations (n=12). Uni- and multivariate analysis were performed to identify factors affecting the post-operative PF within the cohort. Spearman’s rank correlation coefficient, Chi-Squared tests and multidimensional modelling were applied to all variables’ pre-operative and post-operative time points. Based on the results, we formulated a numeric equation to predict post-surgical PROMIS PF.Results:The mean age was 60.5 (33-96) and 4.7 (3-12) months follow up. Mean preoperative PF, PI, and D changed from 34.4, 58.7, 51.4 to postoperative 36.1, 58.8, 51.1, respectively (ΔPF = 1.7, ΔPI=0.1, ΔD = -0.3). Preoperative PF (p < 0.01), PI (p < 0.01), depression (p < 0.01), chronic renal failure (p < 0.02) and amputation level (p < 0.04) showed significant univariate correlation with post-operative PF. Multivariate model (r = 0.6) revealed postoperative PF is predicted by initial PF (p = 0.094), depression (p= 0.008), amputation level (p = 0.002), and wound healing status (p = 0.001). The model had greater prediction power than the best univariate association (Δr = +0.17). Follow up length was not significant (p = 0.08).Conclusion:This study demonstrates that preoperative PROMIS scores combined with clinical factors can predict postoperative PF in DFU patients. Postoperative PF is predicted by: PFlongest_FU = 45.4 +0.20 PFinitial -0.21 Dinitial -6.1 (Heal =1) -2.9 (Amputation Category, 1-3). Additional diseased states not captured in this study and psychosocial variables may improve prediction power of the multivariate model. 70% of the patients’ initial PF were 1 to 2 standard deviations below the US population (n = 49; 28). Therefore, the reported model may serve as a valuable tool for patient education, setting expectations and post-surgical PF prediction in infected DFU patients.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 195. Preoperative PROMIS score is not predictive of postoperative pain, narcotics consumption, or patient-reported outcomes after minimally invasive transforaminal lumbar interbody fusion

BACKGROUND CONTEXT Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is an effective therapy for the treatment of lumbar degenerative disease. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been utilized to quantify patients’ physical health prior to surgery. However, no study has identified if preoperative PROMIS score is associated with postoperative pain, narcotics utilization, or patient reported outcomes (PROs) after spinal procedures. PURPOSE To determine if preoperative physical health as measured by PROMIS is predictive of immediate postoperative patient pain, narcotics consumption, or PROs after MIS TLIF procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 99 patients who underwent primary, single-level MIS TLIF from 2015 to 2017. OUTCOME MEASURES Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) back, and VAS leg scores, postoperative inpatient narcotic consumption. METHODS A prospectively-maintained surgical registry was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology from 2015 to 2017 were identified. Patients were grouped by PROMIS score (≥35, RESULTS A total of 99 patients with complete PROMIS data were included. 58.6% (N=58) had PROMIS scores ≥35, while 41.4% (N=41) had PROMIS scores CONCLUSIONS Patient physical function, as defined by PROMIS, did not predict increased pain or narcotics consumption after MIS TLIF. While patients with worse physical function had higher preoperative disability and leg pain, this was not associated with decreased postoperative improvement.