Preoperative PROMIS Scores Research Articles

Clinical and Radiographic Comparison of Lateral Malleolar Ankle Fractures Treated with or without Deltoid Fixation

Category: Ankle; Other Introduction/Purpose: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Inclusion criteria included patients aged 18 or older who underwent open fixation for a SER IV equivalent lateral malleolar ankle fracture with a deltoid injury and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral ankle surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 146 patients were included. 80 patients received a deltoid repair (DR) and 66 patients did not receive a deltoid repair (NDR). Preoperative and postoperative medial clear space (MCS) were reviewed for all patients. Results: Both DR and NDR cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. There were no significant differences in preoperative and postoperative PROMIS domains between the two cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the two cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain. Conclusion: This study compares short- to medium-term patient-reported clinical outcomes and complications of lateral malleolar ankle fractures with and without deltoid repair. Repairing the deltoid did not increase the incidence of postoperative complications and produced similar PROMIS scores at 1-year minimum follow-up. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes.

Preoperative Degenerative Changes at the Medial Sesamoid-Metatarsal Joint Is Associated with Postoperative Patient-Reported Outcomes in Hallux Valgus

Introduction/Purpose: While hallux valgus (HV) is understood to be a triplanar deformity of the first metatarsal, less is known about the contribution of the sesamoid-metatarsal joint (SMJ) to pain and function. Osteoarthritis of the SMJ is frequently present in HV feet, with an incidence rate ranging from 32% to 81%. Following surgical correction, approximately 10% of HV patients remain dissatisfied, but factors affecting postoperative outcomes are poorly understood. The primary aim of our study was to describe the relationship between degenerative changes at the SMJ as measured on weightbearing CT (WBCT) scans and 1-year patient-reported outcome scores following a modified Lapidus procedure for correction of HV. We hypothesized that decreased joint space at the SMJ would affect postoperative patient-reported outcomes. Methods: This study included 48 consecutive patients who underwent a modified Lapidus procedure for HV, had preoperative and at least 5-month postoperative WBCT scans, and had preoperative PROMIS scores and at least 1-year postoperative PROMIS Physical Function (PF), Pain Interference, and Pain Intensity scores. For each patient, the first metatarsal and sesamoids on pre- and postoperative WBCT scans were segmented using Disior Bonelogic software and uploaded to Geomagic Design X to perform distancing mapping. The minimum and average distances between the first metatarsal head and medial sesamoid (medial-SMJ) for each patient pre- and postoperatively were calculated. Sesamoid subluxation was measured on WBCT scans using the grading system from 0 to 3 (Yildirim et al.). A simple linear regression model was used to investigate the correlations between minimum preoperative and postoperative medial-SMJ distances and 1-year postoperative PROMIS scores in patients with postoperative reduction of the sesamoids (grade 0). Results: Preoperatively, the mean minimum and average medial-SMJ distances were 0.76 ± 0.37 mm and 1.54 ± 0.33 mm, respectively. Postoperatively, the mean minimum and average medial-SMJ distances were 1.08 ± 0.25 mm and 1.73 ± 0.24 mm, respectively. Thirty-five of 48 patients had a complete reduction of the sesamoids. Lower preoperative minimum distances at the medial-SMJ were significantly correlated with worse 1-year PROMIS PF scores (r=0.405, P=0.016) (Figure 1). Similarly, lower preoperative minimum distances at the medial-SMJ were significantly correlated with worse 1-year PROMIS Pain Intensity scores (r=-0.350, P=0.039) but did not reach significance for 1-year PROMIS Pain Interference scores (r=-0.286, P=0.095). The postoperative minimum medial-SMJ distance was not correlated with 1-year PROMIS PF, Pain Interference, and Pain Intensity scores. Conclusion: In HV patients undergoing a modified Lapidus procedure with postoperatively reduced sesamoids, decreased joint space at the medial sesamoid-metatarsal head articulation was associated with worse 1-year postoperative function as measured by PROMIS PF scores and worse 1-year postoperative pain as measured by PROMIS Pain Intensity scores. In contrast, postoperative degenerative changes at the SMJ were not found to be associated with patient-reported outcomes. Our results suggest that pre-existing SMJ arthritic changes may affect postoperative outcomes and may be a source of dissatisfaction following HV surgery despite appropriate correction of the deformity. Figure 1. Preoperative medial sesamoid to the first metatarsal head minimum distance relative to 1-year PROMIS Physical Function, Pain Intensity, and Pain Interference scores. A simple linear regression demonstrates a significant association between preoperative medial sesamoid –metatarsal head minimum joint distance and 1-year PROMIS Physical Function (r=0.405, P=0.016) and Pain Intensity (r=‒0.305, P=0.039) scores.

Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Total Ankle Replacement

Category: Ankle Arthritis; Other Introduction/Purpose: Patient-reported outcomes (PROs), such as PROMIS, are a key element of evaluating success after total ankle replacement (TAR). To date, most PROs are described using absolute values or parameters like the minimum clinically important difference. However, these interpretations do not explicitly tell the surgeon the most important factor of postoperative success: is the patient satisfied with their outcome after TAR? The patient acceptable symptom state (PASS) is a novel PRO metric that attempts to bridge this gap. PASS represents the symptom threshold above which patients consider themselves well. This study aimed to establish the PROMIS thresholds for PASS in a primary cohort of TAR patients. We hypothesized that TAR patients would meet PASS and that PASS would vary with demographic variables. Methods: This is a single-institution retrospective cohort study of primary TAR patients (n=127; mean age 63.2 years; mean BMI 29.0 kg/m2; 58% male) with preoperative and 2-year postoperative PROMIS scores (domains: Physical Function, Pain Interference, Pain Intensity, Global Mental Health, Global Physical Health, & Depression). At 2 years postoperatively, patients also answered 2 PASS anchor questions with Likert-scale responses: 1) Are you satisfied with the results of your surgery?; and 2) the Delighted- Terrible symptom scale. PASS thresholds with 95% confidence intervals (CI) were calculated using the anchors “Very satisfied” or “Satisfied” for question 1 and “Delighted,” “Pleased,” or “Mostly Satisfied” for question 2. Using bootstrapping technique with 1000 iterations, the Youden Index was then calculated to determine the best coordinates of specificity and sensitivity to maximize the Area Under the Curve (AUC). Finally, we analyzed preoperative variables (demographics, clinical/surgical data, and preoperative PROMIS scores) on the likelihood of achieving PASS. Results: There was a strong association between PASS thresholds and PROMIS domains, especially Physical Function (PASS threshold >44.7, AUC 0.883), Pain Interference (< 56.0, AUC 0.940), and Pain Intensity (< 48.4, AUC 0.936). Covariate stratification demonstrated that the likelihood of achieving PASS was not affected by age, race, gender, ASA score, or BMI. PASS was less likely to be achieved by patients who had undergone prior orthopaedic surgery (P=0.013). Patients with diabetes mellitus and peripheral vascular disease were less likely to meet PASS for Physical Function (P=0.010, P=0.037), but did meet PASS for Pain domains. Patients with worse preoperative Physical Function and Depression scores were less likely to meet PASS for Physical Function postoperatively (P=0.028, P=0.041), but achieved similar PASS for Pain Interference and Pain Intensity domains. Conclusion: After TAR, the ability to reach the postoperative PASS was most strongly associated with postoperative pain scores, as evidenced by the Pain Interference and Pain Intensity domains. However, the thresholds for PASS were generally lower than population means. This demonstrates that TAR patients do not need to reach normal pain or physical function levels in order to have an acceptable symptom state postoperatively. Moreover, the ability to achieve PASS was not affected by demographic variables. Further research on PASS is warranted, and may shift how surgeons and researchers evaluate TAR patients pre- and post-operatively.

Poster 203: Worse Postoperative Outcomes and Higher Reoperation in Smokers Compared to Nonsmokers for Arthroscopic Rotator Cuff Repair

Objectives: Smoking significantly impairs healing potential and is a significant risk factor for complications after various orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS- UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmoking patients. Methods: A retrospective review of a prospectively collected database of patients undergoing arthroscopic rotator cuff was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 standard deviations above the mean. A cohort of nonsmokers was compared to a cohort of patients currently or former smokers at time of surgery in terms of their clinical outcomes and PROMIS scores. A sub-analysis was also performed where a cohort of nonsmokers were propensity matched 1:1 to a cohort of current/former smokers via age, body mass index (BMI), and tear size. Results: A total of 182 patients, 80 current or former smokers and 102 nonsmokers, who underwent rotator cuff repair were included in the study. Smokers had statistically different sized tears with more rated massive and more reoperations (16.3% vs 5.9%, P=0.02). No differences were found in preoperative PROMIS scores, change in PROMIS scores, proportion meeting MCID for PROMIS scores, and retear rate. In the sub-analysis, 74 current or former smokers were matched to 74 nonsmokers. Smokers had a lower change in PROMIS-UE (8.6 ± 9.8 vs 12.3 ± 10.0, P=0.007) and PROMIS-PI (-9.1 ± 8.5 vs -12.8 ± 10.1, P=0.03) postoperatively. Fewer met MCID for PROMIS UE postoperatively (60.3% vs 82.4%, P=0.003) and more had reoperations (16.2% vs 4.1%, P=0.02). Conclusions: Patients who smoke currently or had a history of smoking preoperatively demonstrated smaller improvements in function, pain scores, and were less likely to meet MCID for PROMIS-UE when compared to nonsmokers after arthroscopic rotator cuff repair. Smokers were more likely to undergo reoperations within 6 months. [Table: see text][Table: see text][Table: see text][Table: see text]

A Patient-Reported Outcome Based Comparison of Cheilectomy with and without Proximal Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Cheilectomy with and without Moberg osteotomy is used to improve function and remove pain in early- moderate stage hallux rigidus. The rise of patient-reported outcome measurements allows greater precision in comparing treatments as value-driven paradigms become increasingly important in clinical decision-making. This study provides the first comparison of patient-reported outcomes between isolated cheilectomy (C) and cheilectomy with Moberg (CM) osteotomy for hallux rigidus. We compared one and two-year PROM scores between patients who underwent C and CM for hallux rigidus using PROMIS, a validated patient-reported outcomes measurement system, and compared rates of complications and subsequent operations between the two groups. We hypothesized that patients who underwent CM would experience better clinical outcomes and fewer returns to the operating room than patients undergoing cheilectomy alone. Methods: A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent cheilectomy, with and without concomitant proximal phalangeal dorsiflexion osteotomy, for hallux rigidus between January 2016 and December 2020. An a priori power analysis determined that 24 patients per cohort were needed to detect a previously published minimum clinically important difference of 5.8 points on the PROMIS Physical Function scale with alpha = .05 and 80% power. However, all C patients were included. Because there were far fewer isolated cheilectomies (62), all C patients were compared with a commensurate number of consecutive CM cases (67) using preoperative, one-year, and two-year PROMIS scores for Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression, as well as complication and revision data from chart review. Age, sex, BMI, preoperative radiographic hallux rigidus grade, and preoperative range of motion were compared between the two cohorts. Results: PROMIS outcome data is given in Table 1. Both groups demonstrated statistically significant improvements in PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health (P <.001 for all, both preoperative to one-year and preoperative to two-year), but not Global Mental Health or Depression. There were no differences between groups among the demographic and preoperative variables compared. The CM cohort reported worse Pain Interference scores preoperatively (58.1+- 5.9 vs. 52.4 +- 7.01, P < .001) and at one year (50.0 +- 9.3 vs. 45.1 +- 9.8, P = .01), while the C cohort reported worse Pain Intensity scores preoperatively (55.6 +- 7.3 vs. 49.6 +- 6.8, P < .001) and at one year (45.9 +- 8.0 vs. 39.9 +- 8.2, P < .001). These differences were no longer significant at two years postoperatively. There were no statistically significant differences between cohorts for additional PROMIS scores or complications data. Conclusion: The addition of a Moberg osteotomy does not appear to significantly change short-medium term outcomes of cheilectomy for hallux rigidus treatment. Our data contradicts the notion that addition of a Moberg osteotomy increases the likelihood of postoperative complications. The overall good results found for both procedures, as well as the general similarity between outcomes between them, suggest that external considerations like recovery time, comfort level with a more invasive osteotomy, and overall goals with surgery may be of greater importance than short-term clinical outcomes when deciding on the appropriate course of treatment for a given patient.

149. PROMIS anxiety and sleep scores are associated with high barriers to proper opioid use after adult spinal deformity

BACKGROUND CONTEXT Inappropriate opioid use in the United States continues to be a health crisis. Previous studies have shown that patient reported questionnaires can identify barriers to proper opioid use. PURPOSE The aim of this study is to identify whether preoperative PROMIS scores are associated with high barriers to proper opioid use. We hypothesize socioeconomic differences will predict patients with high barriers to proper opioid use. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Adult spinal deformity (ASD) patients with at least four levels fused were identified in a single-institution database. OUTCOME MEASURES Barriers to proper opioid use. METHODS Barriers to opioid use were measured with a previously validated Barriers Questionnaire-Taiwan (S-BQT) with total scores ranging from 0-35. The top 25% (>17) were identified as patients with high barriers to proper opioid use. Threshold linear regression with Bayesian information criteria was utilized to identify thresholds associated with high barriers to proper opioid use. Multivariable analysis was employed controlling for age, gender, comorbidity, income and education level. RESULTS A total of 106 total patients were included in this study. Of these, 23 (22%) had high barriers to proper opioid use. Mean age was 51 with 72 (68%) female participants. On bivariate analysis, patients with high barriers to proper opioid use were more likely to be older (61.1 vs 48.2), be less comorbid (0.544), be living with others (22% vs 54%), have more fatigue (PROMIS fatigue 57.2 vs 52.2), have more anxiety (57.2 vs 52.2), have more sleep (58.3 vs 52.8) and have less social satisfaction (PROMIS 39.4 vs 43.9) (P<0.05 for all). Threshold regression identified cut-offs of =59.5 for PROMIS anxiety and = 61.7 for PROMIS sleep. On multivariable logistic regression, patients with of =59.5 for PROMIS anxiety (OR 3.85; P=0.018) and = 61.7 for PROMIS sleep (OR 6.04; P=0.006) had greater odds of high barriers to proper opioid use. CONCLUSIONS Thresholds of PROMIS =59.5 for anxiety and = 61.7 for sleep can be utilized to counsel patients who may be more likely to have higher barriers to proper opioid utilization. This can aid in shared decision making and patient counseling to ensure more responsible use of narcotics for patients undergoing ASD surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Inappropriate opioid use in the United States continues to be a health crisis. Previous studies have shown that patient reported questionnaires can identify barriers to proper opioid use. The aim of this study is to identify whether preoperative PROMIS scores are associated with high barriers to proper opioid use. We hypothesize socioeconomic differences will predict patients with high barriers to proper opioid use. Retrospective review. Adult spinal deformity (ASD) patients with at least four levels fused were identified in a single-institution database. Barriers to proper opioid use. Barriers to opioid use were measured with a previously validated Barriers Questionnaire-Taiwan (S-BQT) with total scores ranging from 0-35. The top 25% (>17) were identified as patients with high barriers to proper opioid use. Threshold linear regression with Bayesian information criteria was utilized to identify thresholds associated with high barriers to proper opioid use. Multivariable analysis was employed controlling for age, gender, comorbidity, income and education level. A total of 106 total patients were included in this study. Of these, 23 (22%) had high barriers to proper opioid use. Mean age was 51 with 72 (68%) female participants. On bivariate analysis, patients with high barriers to proper opioid use were more likely to be older (61.1 vs 48.2), be less comorbid (0.544), be living with others (22% vs 54%), have more fatigue (PROMIS fatigue 57.2 vs 52.2), have more anxiety (57.2 vs 52.2), have more sleep (58.3 vs 52.8) and have less social satisfaction (PROMIS 39.4 vs 43.9) (P<0.05 for all). Threshold regression identified cut-offs of =59.5 for PROMIS anxiety and = 61.7 for PROMIS sleep. On multivariable logistic regression, patients with of =59.5 for PROMIS anxiety (OR 3.85; P=0.018) and = 61.7 for PROMIS sleep (OR 6.04; P=0.006) had greater odds of high barriers to proper opioid use. Thresholds of PROMIS =59.5 for anxiety and = 61.7 for sleep can be utilized to counsel patients who may be more likely to have higher barriers to proper opioid utilization. This can aid in shared decision making and patient counseling to ensure more responsible use of narcotics for patients undergoing ASD surgery.

Clinically Significant Improvement in Pre vs Post-Operative PROMIS Scores after Cavovarus Reconstruction in Patients with Charcot-Marie-Tooth Disease

Category:Ankle; Hindfoot; Midfoot/Forefoot; OtherIntroduction/Purpose:Charcot-Marie-Tooth (CMT) disease is an inherited progressive neurologic disorder characterized by extremity deformities and functional deficits. Surgery is indicated for substantial functional deficits and severe deformity.Reconstructive surgery is individualized and multifaceted to correct the cavovarus deformity, and maximize function with tendon transfers and joint stabilization procedures. No previous study has reported improvement from pre-operative baseline patient reported outcome measures to post-operative outcome measures. We studied PROMIS scores and patient satisfaction surveys to report improvements in physical function, pain interference, and depression. Our hypothesis was that CMT patients' preoperative baseline would be significantly worse than the control population in all domains, and that they would experience demonstrable improvement greater than the minimally clinically important difference (MCID) for the 3 PROMIS score domains tested post- operatively.Methods:Prospective PROMIS scores were collected on 147 feet in 89 patients who had reconstructive foot surgery for CMT during a 40-month period (June 2016-December 2020) by a single surgeon. Radiographic and clinical data were recorded prospectively to identify complications. Each patient completed a battery of physical function (PROMIS-PF), pain interference (PROMIS-PI), and mood/depression (PROMIS-M) instruments pre-operatively, every 3 months for the first post-operative year, and annually thereafter. Pre-operative PROMIS scores are reported for patients prior to any surgery on either foot to establish a functional baseline. Post-operative PROMIS values are reported only after the last planned surgery was completed in the common setting of staged bilateral surgeries. Patient satisfaction surveys were administered at last follow-up. Post-operative complications were recorded. Statistical analysis was performed with students t-test for continuous variables and chi-squared analysis for categorical variables. PROMIS scores are reported as mean (+/- standard deviation).Results:41 patients met inclusion criteria for reporting pre-operative baseline PROMIS scores, and 57 patient's post-operative PROMIS data were included after the final reconstructive surgery within the study window. Mean follow-up was 26 months. Pre- operative baseline PROMIS demonstrate CMT patients have worse PROMIS-PF, PROMIS-PI, and PROMIS-M than the population which is statistically and clinically significant. All PROMIS domains were improved by clinically and statistically significant values. PROMIS-PF improved from 38 (+/-6) to 46 (+/-5), a 4-5x improvement over MCID (2). PROMIS-PI improved from 59 (+/-8) to 51 (+/-7) representing a 1-2x improvement in the MCID (4). PROMIS M improved from 53 (+/-10) to 49 (+/- 5) achieving MCID 2. >90% were highly satisfied and would undergo surgery again. There were 7 complications: 1 deep infection, 2 superficial infections, 1 superficial wound dehiscence, and 3 unplanned hardware removals. 5/7 of these patients experiencing complications remained 'satisfied' or 'very satisfied'.Conclusion:Patients with CMT disease have baseline functional deficits in physical and mental health as judged by PROMIS measures that were worse than the population means in all 3 tested domains. Surgical reconstruction produced clinically significant improvements in PROMIS-PI, PF, and M domains at up to 4 years of follow-up. Patients were highly satisfied with the results with an acceptable rate of post-operative complications.

P134. Preoperative PROMIS scores can predict patient satisfaction following surgery for cervical degeneration

BACKGROUND CONTEXT Satisfaction with treatment is a primary goal of health care providers. However, factors contributing to patient satisfaction in cervical spine surgery are poorly understood. Preoperative identification of patients likely to be satisfied with surgery can help guide treatment, and set appropriate patient expectations. This study examines whether preoperative PROMIS scores can predict postoperative satisfaction with treatment in patients undergoing surgery for cervical degeneration. PURPOSE To determine whether preoperative PROMIS scores can predict patient satisfaction with treatment after 1 year following surgery for cervical degeneration. STUDY DESIGN/SETTING Restrospective review. PATIENT SAMPLE A total of 86 surgical cervical degeneration patients. OUTCOME MEASURES NASS Patient Satisfaction Index. METHODS Patients undergoing surgery for cervical degeneration in 2015-2018 with minimum 1-year follow-up were evaluated. PROMIS questionnaires were obtained preoperatively and at 1 year postoperatively. NASS Patient Satisfaction Index (PSI) scores were obtained at the postoperative encounter. To determine whether preoperative data could be used to predict patient satisfaction at 1-year postoperatively, we performed a logistic regression analysis using with NASS PSI as outcome, including all preoperative PROMIS scores as well as age, gender and race. PROMIS domains assessed were pain interference, physical function, anxiety, depression, fatigue, sleep disturbance and satisfaction with participation in social roles. RESULTS A total of 86 patients undergoing surgery for cervical degeneration (mean age 63.6 years) were included. At 12 months, 56% (48/86) reported that “the treatment met their expectations,” as outlined by NASS PSI scores. Logistic regression analysis showed that low preoperative PROMIS depression (OR=0.96, CI=[0.93, 0.99], p=0.008) and high preoperative PROMIS satisfaction with participation in social roles led to increased NASS PSI (OR= 1.03, CI=[1.01, 1.07], p=0.04) scores. Also, white race was found to lead to higher NASS PSI scores (OR= 8.69, CI=[1.49, 50.6], p=0.02). No significant relationships were found with respect to preoperative PROMIS pain interference, physical function, anxiety, sleep disturbance, age or gender. CONCLUSIONS Low preoperative PROMIS depression and high preoperative PROMIS satisfaction with participation in social roles can predict patient satisfaction with treatment following surgery for cervical degeneration, as measured by NASS PSI. Thus, patients with few depressive symptoms and a strong social support system preoperatively are most likely to be satisfied with surgical treatment. Also, white race can predict higher patient satisfaction. By assessing preoperative PROMIS scores and demographic data, clinicians may be better equipped to identify patients likely to be satisfied, and inform point-of-care shared decision-making. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT The PROMIS provides severity ranges for scores in many domains. These ranges are determined based on the general population, using a normalized mean score of 50 and standard deviation of 10. However, lumbar degenerative patients have worse scores on average compared to the general population, making PROMIS severity ranges clinically meaningless in the care of patients. PURPOSE This study determines PROMIS severity ranges specific to lumbar degenerative patients. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 407 lumbar degenerative patients with PROMIS Computerized Adaptive Tests (CATs). OUTCOME MEASURES The PROMIS Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles CATs. METHODS Preoperative PROMIS scores in Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles were obtained for 407 lumbar degenerative patients. To create a severity classification of PROMIS scores specific to lumbar degenerative patients, the average and standard deviation (SD) for each PROMIS domain were calculated for the lumbar degenerative cohort. Scores 1.0-2.0 SD worse than the mean were considered “moderately worse” than the average for lumbar degenerative patients, scores 2.0 or more SD worse than the mean were “severely worse,” and scores 1.0 or more SD better than the mean were “moderately better.” RESULTS A total of 407 lumbar degenerative patients were included (avg. age 57.2 years; 51.8% male; 78.7% White, 12.4% AA, 8.9% other). Average PROMIS score and severity ranges were determined as follows: pain interference average: 64.5, moderately better: 79.2;physical function average: 35.3, moderately better: >43.2, moderately worse: 19.6-27.5, severely worse: 76.9; anxiety average: 53.8, moderately better: 72.7; depression average: 49.6, moderately better: 68.9; sleep disturbance average: 56.0, moderately better: 74.4;satisfaction with participation in social roles average: 40.4, moderately better: >49.0; moderately worse: 23.3-31.8; severely worse: CONCLUSIONS While PROMIS provides severity ranges useful for the general population, on average, lumbar degenerative patients have worse scores than the general population. This analysis provides clinically meaningful PROMIS severity ranges in seven domains for lumbar degenerative patients. These ranges will allow surgeons to better assess severity in their patients and will aid in point-of-care decision-making.

When are the Patients Satisfied with Their Outcome? Correlation of PROMIS Values with Patient Acceptable Symptom State (PASS) Scores in Foot and Ankle Patients

Category: Outcomes Introduction/Purpose: PROMIS values are being adopted due to ease of use and influence on clinical decision making. Studies support the use of PROMIS physical function (PF), pain interference (PI), and Depression (D) for pre-surgical decision making. Patient Acceptable Symptom State (PASS) is a validated outcome measure commonly used in other areas of medicine and surgery that captures when patient’s symptoms reach a daily acceptable level. Knowing what PROMIS scores are associated with a patient’s PASS(Yes)/(No) rating would further enhance the use of PROMIS scales. The purpose of this study: 1) association of PROMIS scales with a PASS rating, 2) threshold values of PROMIS PF, PI, D associated with PASS rating, and 3) whether PROMIS, and patient demographics are predictive of a PASS rating. Methods: 464 consecutive foot and ankle patients (variety of foot and ankle conditions) over a 4 week interval prospectively completed PROMIS PF, PI and D as well as the PASS question: “Taking into account all of the activities that you do during your daily life, your level of pain, and also your function, do you consider that the current state of your foot and ankle is satisfactory?” PROMIS assessments are used as the standard of care however, the point patients feel they have improved to an acceptable degree (PASS) is not known. The analysis included 1) a two-way ANOVA to compare PROMIS scores (PF, PI, D) between patients grouped as PASS(Yes) and PASS(No); 2) ROC analysis to determine AUC, cut offs, and 95% sensitivity/specificity for PASS(Yes), PASS Ambiguous, and PASS(No); 3) Logistic regression analysis with PROMIS scales, age, gender, and visit type as predictors and PASS(Yes)/(No). Results: PROMIS PF was lower (p&lt;0.01) and PI higher (p&lt;0.01), however, PROMIS D (p=0.26) was similar between PASS(Yes/No) groups. The AUC for PROMIS PF(p&lt;0.01) and PI(p&lt;0.01) were significant but not PROMIS D (p=0.21). The cut offs for PASS(Yes) with 95% specificity were 52.0 and 50.7 for PF and PI, respectively. The cut offs for PASS(No) with 95% sensitivity were 23.6 and 69.6 for PF and PI, respectively. PROMIS values between 23.6 and 52 for PF and between 50.7 and 69.6 for PI were PASS ambiguous. Regression analysis showed that gender, visit type, and PROMIS (PI/PF) significantly predicted PASS(Yes)/(No) (75% accuracy). Conclusion: PROMIS t-scores of near 50 (average of US population) correspond to PASS(Yes) cut offs for both PF and PI. When feasible a benchmark of 50 on PROMIS T-scores may be a reasonable goal for patient outcome after foot and ankle treatments. For patients that are PASS ambiguous, other factors such as preoperative PROMIS scores (PF and PI), gender, and visit type (new or follow up) may motivate discussions with patients about their expectations of treatment. Longer term follow-up, may result in a higher percentage of PASS YES patients and alter cut off scores.