PROMIS Pain Interference Scores Research Articles

Changes in Patient-Reported Pain Interference After Surgical Treatment of Painful Lower Extremity Neuromas

Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted. We performed a retrospective cohort study by administering follow-up surveys to all surgical patients treated in our department for lower-extremity neuroma from September 1, 2015, to October 22, 2021, that could be contacted, excluding those with Morton neuroma. In addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) questionnaire, survey questions covered the time to pain reduction, use of physical or occupational therapy, and characteristics of the pain. When available, previously collected preoperative and postoperative PROMIS PI data were used for patients who could not be contacted for the telephone survey. Paired-sample nonparametric testing was used to compare preoperative and postoperative PROMIS PI scores. Initial query in the medical record by Current Procedural Terminology codes yielded 1,812 patients for chart review, of whom 33 were eligible to call. In total, 9 (27%) patients completed bothpreoperative and postoperative PROMIS PIs: 6 (18.2%) completed full telephone surveys and 3(9.1%) had preoperative and postoperative PROMIS PI data in the chart review but could not becontacted for the full telephone survey. Four of the 6 telephone-survey respondents reported painreduction within 12 months of their surgery. Wilcoxon signed-rank testing demonstrated a moderate but nonstatistically significant reduction in PROMIS PI scores, with a median difference of-4.85 (P= .1;95% CI -12 to 1.2). There were notable improvements in our cohort, but larger studies are needed to determine whether surgical treatment of lower-extremity neuroma results in a clinically important and significant difference in PROMIS PI scores, as well as to discern the advantages each treatment. Therapeutic IV.

Characterizing preoperative expectations for patients undergoing reverse total shoulder arthroplasty.

There remains a paucity of information analyzing which factors most influence preoperative expectations for patients undergoing reverse total shoulder arthroplasty (RTSA). The purposes of our study were to characterize preoperative patient expectations for those scheduled to undergo RTSA and to determine the impact of demographic factors, shoulder function, and shoulder pain on these preoperative expectations. Patients were prospectively recruited into the study if they were scheduled to undergo an elective unilateral primary RTSA for a diagnosis of glenohumeral arthritis. Preoperative patient expectations were evaluated using the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Patients also completed the American Shoulder and Elbow Surgeons shoulder score, the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function-Upper Extremity computer adaptive test (version 2.0), the PROMIS Pain Interference (PI) computer adaptive test (version 1.1), the PROMIS Depression computer adaptive test (version 1.0), visual analog scores, and an itemized satisfaction questionnaire, which paralleled the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Demographic data and preoperative shoulder range of motion (ROM) were also recorded. A total of 107 patients scheduled to undergo RTSA were included in the study. Relief of daytime pain (n = 91, 85%), improvement in self-care (n = 86, 80%), and improvement in shoulder ROM (n = 85, 79%) were most commonly cited as "very important" expectations. In the item-specific analysis, lower PROMIS Upper Extremity scores were correlated with greater expectations for the ability to reach sideways (P = .015) and the ability to perform daily activities (P = .018). Patients with lower shoulder ROM had greater expectations for improved shoulder ROM (internal rotation with arm at 90°, P = .004) and an improved ability to perform daily activities (forward elevation, P = .038; abduction, P = .009). In the cumulative analysis, a greater number of very important expectations was associated with African American race (P = .013), higher PROMIS PI score (r = 0.351, P = .004), and lower overall preoperative satisfaction (r = 0.334, P < .001). Patients scheduled to undergo RTSA have the greatest expectations for relief of daytime pain, improvement in self-care, and improvement in shoulder ROM. Patients with limited preoperative ROM have greater expectations for improvement in self-care and the ability to perform daily activities in addition to expectations for improvement in shoulder ROM. Greater overall expectations for surgery were not associated with preoperative physical function but were instead associated with lower preoperative satisfaction and higher PROMIS PI scores.

Patient Perception of Being “Completely Better” After Anterior Cruciate Ligament Reconstruction

Background: Contextualizing patient-reported outcomes (PROs) by defining clinically relevant differences is important. Considering that anterior cruciate ligament reconstruction (ACLR) ideally results in the restoration of normal knee function, an assessment of patients’ perception of being “completely better” (CB) may be of particular value. Purpose: The purpose of this study was to assess the prevalence and characteristics of patients who self-report a CB status after ACLR. Additionally, we aimed to determine whether PROs were associated with a CB status after ACLR as well as to determine CB status thresholds for 2-year and change in values. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively analyzed data from an orthopaedic registry at a single institution. Patients were administered the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), and International Knee Documentation Committee (IKDC) Subjective Knee Form preoperatively and at 2 years after ACLR. Additionally, patients completed a CB anchor question at 2 years after ACLR. Thresholds for 2-year and change in PRO scores associated with achieving a CB status were identified with 90% specificity. Results: Overall, 95 of the 136 patients (69.9%) considered their condition to be CB at 2 years after surgery. The 2-year and change in PROMIS PF, PROMIS PI, and IKDC scores were significantly better in the CB group than in the non-CB group. Thresholds associated with a CB status for 2-year PROMIS PF, PROMIS PI, and IKDC scores were more reliable than those for changes in scores and were ≥63, ≤44, and ≥80, respectively. Thresholds for the change in PROMIS PF, PROMIS PI, and IKDC scores were ≥19, ≤–16, and ≥44, respectively. Conclusion: The majority of patients reported that they were CB at 2 years after ACLR. This study may serve as a reference for orthopaedic surgeons and researchers when considering outcomes after ACLR.

Concurrent Validity of PROMIS With DASH and DVPRS in Transhumeral Amputees.

We sought to assess whether select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) significantly correlate with the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Defense and Veterans Pain Rating Scale (DVPRS) among transhumeral amputees. We prospectively administered DASH, DVPRS, and PROMIS (including Upper Extremity, Pain Interference, and Pain Behavior domains) testing to patients presenting for consideration of osseointegration after transhumeral amputation. Concurrent validity was assessed via Pearson correlation testing. The mean DASH score of the cohort was 32.8. The mean DVPRS score was 1.8. The mean PROMIS scores were 33.8, 50.5, and 50.6 for Upper Extremity, Pain Interference, and Pain Behavior domains, respectively. Pearson testing demonstrated a significant, inverse correlation between DASH and PROMIS Upper Extremity scores (r = -0.85, P = .002). There was also significant correlation between DVPRS and PROMIS Pain Interference scores (r = 0.69, P = .03). The PROMIS Pain Behavior domain did not significantly correlate with either DASH or DVPRS. Patient-Reported Outcomes Measurement Information System Upper Extremity and Pain Interference scores demonstrated significant concurrent validity with traditional measures (DASH and DVPRS) of patient-reported outcome in our population of transhumeral amputees.

Tracking Patient Reported Outcomes in Orthopaedic Surgical Patients at a Single Institution

Category:Ankle; OtherIntroduction/Purpose:As the American healthcare system evolves into a value-based reimbursement model, emphasis on tracking and reporting healthcare outcomes has expounded. Patient reported outcome Measures (PROMs) are exceedingly valuable to orthopedists as a means to measure improvement and satisfy regulatory requirements. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are favored due to their accessibility, efficiency, and minimal floor and ceiling effects. Furthermore, they have been shown to predict outcomes after orthopedic surgeries. Psychosocial factors have also become increasingly important in predicting surgical outcomes. We aim to report the development and implementation of an institutional PRO data collection platform, including PRO completion rates and improvements in PROs for patients undergoing orthopaedic surgery.Methods:We implemented a secure, HIPAA compliant, automated and EHR integrated, institutional platform to collect PROMs using a cloud-based tool. Patients undergoing surgery by sports medicine and foot and ankle surgeons were included and organized into four surgical pathways: (1) foot and ankle, (2) sports-knee, (3) sports-hip, and (4) sports-shoulder. PROMIS Physical Function (PF), PROMIS Pain interference (PI), site-specific (foot and ankle, knee, hip, and shoulder) Single Assessment Numeric Evaluation (SANE), and the brief resiliency scale (BRS) were collected at the patient's pre-operative visit. The PROMIS and SANE surveys were again collected at 3-, 6-, and 12-month post-operative visits. Surveys were disseminated automatically and patients were able to complete PROMs onsite on secure tablets or remotely through their personal device. Primary outcomes included compliance rates, baseline PRO scores, and change in scores at the various post-operative timepoints for patients in the four surgical pathways.Results:More than 6,000 patients were included, with majority of patients from the sports-knee (47%), followed by sports- shoulder (27%), foot and ankle (23%), and sports-hip (4%) pathways. Average completion rate was highest at the pre-operative timepoint for all pathways (81%), with completion rates of 62% at 50% at 6 months and 45% at 12MO. Compliance rates were lowest highest in the foot and ankle pathway at 12 months (62%). Average baseline scores for all patients were 40.8 for PROMIS PF, 61.1 PROMIS PI, 41 SANE, and 3.9 for BRS. Baseline scores didn't significantly vary between the surgical pathways. Scores improved for all patient pathways at all timepoints for PROMIS PF, PI and SANE PROMs (Table 1). No workflow disruptions were noted for survey administration.Conclusion:Tracking PROs using an automated platform is feasible in orthopaedic clinics. Compliance rates are very good and dependent on provider, staff, and patient buy-in. Patients undergoing surgery had an average baseline PROMIS PI scores >=1 standard deviation from the normal population and all scores improved after surgery. Importantly, statistical significance doesn't always reflect minimum clinically important differences (MCIDs). MCIDs for PROMIS PF and PI have been reported to fall between 5-10 points depending on range of values and methods of calculation. Further investigation into outcomes by procedure type and patient factors is warranted to identify predictive factors of surgical outcomes.

Multimodal Nonopioid Pain Protocol Provides Better or Equivalent Pain Control Compared to Opioid Analgesia Following Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial

To evaluate the efficacy of a multimodal nonopioid analgesic protocol in controlling postoperative pain compared to opioids following a primary arthroscopic rotator cuff repair. Seventy consecutive patients undergoing a primary rotator cuff repair were assessed for eligibility. An observer-blinded prospective randomized controlled trial was designed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal nonopioid pain regimen for the experimental group, and a standard of care narcotics for the control group. The primary outcome was visual analog scale (VAS) pain scores for the first 10 postoperative days. Secondary outcomes included PROMIS-PI (Patient-Reported Outcomes Measurement Information System-Pain Interference) scale, patient satisfaction, and adverse drug events. Thirty patients declined to participate or were excluded, and 40 patients were included in the final analysis. A total of 23 patients were in the traditional group, and 17 patients were in the nonopioid group. Control patients on opioid pain management reported a significantly higher VAS pain score on postoperative day 1 (opioid: 5.7 ± 2, nonopioid: 3.7 ± 2.2; P= .011) and postoperative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2; P= .023). No significant difference was seen on any other postoperative day. When mixed measured models were used to control for confounding factors, the nonopioid group demonstrated significantly lower VAS and PROMIS-PI scores (P < .01) at every time point. Patients in the traditional analgesia group reported significantly more days with constipation (P= .003) and days with upset stomach (P= .020) than those in the nonopioid group. The present study found that a multimodal nonopioid pain protocol provided equivalent or better pain control compared to traditional opioid analgesics in patients undergoing primary arthroscopic rotator cuff repair. Minimal side effects were noted with some improvement in the multimodal nonopioid pain cohort. All patients reported satisfaction with their pain management. Level I, prospective randomized controlled trial.

48. Depression severity and its impact on spine surgery outcomes

<h3>BACKGROUND CONTEXT</h3> Patients with chronic back pain have an estimated two to three times greater prevalence of depression than the general population. Approximately one-third of patients with chronic back pain who undergo surgery suffer from symptoms of depression. Several studies have demonstrated preoperative depression to be a positive predictor of lower quality of life, greater pain, and morbidity in patients undergoing spine surgery. Depression is a disease with a wide spectrum of symptoms and severity. To our knowledge, there is a lack of information regarding what severity of depression leads to poorer outcomes following spine surgery. <h3>PURPOSE</h3> The purpose of this study is to investigate the impact of depression severity on perioperative outcomes in spine surgery patients using prospectively collected PROMIS Depression Scores. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis. <h3>PATIENT SAMPLE</h3> All patients >18 years of age who underwent spine surgery between January 1, 2010 and January 31, 2019. <h3>OUTCOME MEASURES</h3> Measures examined include: PROMIS depression scores, PROMIS physical functional scores, PROMIS pain interference scores, opioid use, length of stay and complications. <h3>METHODS</h3> A single center, retrospective review of patients >18 years of age who underwent spine surgery was performed. Study subjects undergoing spine surgery between January 1, 2017 – January 31, 2019 were included. Spine surgery was defined as the ICD-9/10 codes for laminectomy, discectomy and spinal arthrodesis. To be included in the study, patients required completed pre and postoperative PROMIS depression scores, as well as minimum 1-year follow up. Patient charts were reviewed for demographic and surgical data, PROMIS physical functional scores, PROMIS pain interference scores, opioid use, length of stay and complications. Patients were then divided into 4 groups based on severity of depression, PROMIS depression T scores 0 – 49 (no depression, Group 1), 50 – 54 (mild depression, Group 2), 55- 64 (moderate depression, Group 3) and 65+ (severe depression, Group 4). <h3>RESULTS</h3> A total of 139 patients were included: 39 (28.1%) Group 1, 30 (21.6%) Group 2, 54 (38.8%) Group 3, and 16 (11.5%) Group 4. There were no differences in regards to age, sex, BMI, smoking, procedure and Frailty index scores (p>0.05). Differences existed between preoperative diagnosis of depression (p=0.004) and preoperative depression medication use (p=0.013). Preoperative opioid use was highest in Group 4 at 35.7%, compared to 27.9% (Group 3), 4.2% (Group 2) and 9.4% (Group 1). Preoperative physical functional scores were worst in Group 4 and statistically significant as compared to Group 1 (p=0.015). Preoperative pain interference scores were worst in Group 4 and statistically significant as compared to Group 1 (p =0.004). Postoperative function and postoperative pain at 6 months were worst in Group 4 (p=0.008). <h3>CONCLUSIONS</h3> Patients with the most severe depression have both the worst pre- and postoperative functional and pain scores when compared to mild and moderate depression. Preoperative depression PROMIS scores may be an accurate method to judge control of depression symptoms prior to operating and ultimately may help in improving outcomes in spine surgery patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

154. What PROMIS scores correlate with severe disability in cervical spine surgery

BACKGROUND CONTEXT In recent years, the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) has been shown to correlate well with legacy instruments such as the neck disability index (NDI) in patients with cervical pathology. However, because PROMIS is a global outcome measure, the clinical implications of a PROMIS score in patients with cervical spine surgery can be difficult to interpret. PURPOSE To better define the clinical implications of a PROMIS score in patients with cervical pathology indicated for surgery, we sought to determine how a disease-specific legacy instrument (NDI) correlated with PROMIS Pain Interference (PI) to define levels of substantial and minimal disability. We hypothesized that there would be a strong correlation between PROMIS PI and NDI, allowing for a definition of disability in cervical spine patients. STUDY DESIGN/SETTING This is an institutional review board-approved prospective cohort study. PATIENT SAMPLE Adults undergoing cervical spine surgery at a single institution were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. OUTCOME MEASURES Primary outcome measures included NDI and PROMIS PI scores. Methods Patients completed the NDI and PROMIS PI questionnaires preoperatively. Demographic data, presenting complaint, and procedural data were recorded. Correlation and regression analyses were performed. Results A total of 196 patients met inclusion criteria. The average age was 56.9 ± 12.9 years. The mean NDI score was 68.6 ± 38 and PROMIS PI was 60.9 ± 7.3. PROMIS PI was strongly correlated to NDI (r=0.76, p<0.001). Linear regression analysis revealed the following formula: PROMIS PI = 51.042 + 0.289*NDI (R2 = 0.57). Using an NDI score of 50 as a cut-off for severe disability, we found that PROMIS PI score of 65.5 or greater correlated with significant disability. Conclusions We performed a regression analysis allowing for conversion of PROMIS PI scores with NDI. In keeping with previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score greater than 66 was correlated to substantial disability (NDI=50). While a PROMIS PI score less than 59 was correlated to minimal relative impairment (NDI=28). These results provide an important reference as PROMIS reporting becomes more widespread in the literature. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. In recent years, the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) has been shown to correlate well with legacy instruments such as the neck disability index (NDI) in patients with cervical pathology. However, because PROMIS is a global outcome measure, the clinical implications of a PROMIS score in patients with cervical spine surgery can be difficult to interpret. To better define the clinical implications of a PROMIS score in patients with cervical pathology indicated for surgery, we sought to determine how a disease-specific legacy instrument (NDI) correlated with PROMIS Pain Interference (PI) to define levels of substantial and minimal disability. We hypothesized that there would be a strong correlation between PROMIS PI and NDI, allowing for a definition of disability in cervical spine patients. This is an institutional review board-approved prospective cohort study. Adults undergoing cervical spine surgery at a single institution were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. Primary outcome measures included NDI and PROMIS PI scores. Patients completed the NDI and PROMIS PI questionnaires preoperatively. Demographic data, presenting complaint, and procedural data were recorded. Correlation and regression analyses were performed. A total of 196 patients met inclusion criteria. The average age was 56.9 ± 12.9 years. The mean NDI score was 68.6 ± 38 and PROMIS PI was 60.9 ± 7.3. PROMIS PI was strongly correlated to NDI (r=0.76, p<0.001). Linear regression analysis revealed the following formula: PROMIS PI = 51.042 + 0.289*NDI (R2 = 0.57). Using an NDI score of 50 as a cut-off for severe disability, we found that PROMIS PI score of 65.5 or greater correlated with significant disability. We performed a regression analysis allowing for conversion of PROMIS PI scores with NDI. In keeping with previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score greater than 66 was correlated to substantial disability (NDI=50). While a PROMIS PI score less than 59 was correlated to minimal relative impairment (NDI=28). These results provide an important reference as PROMIS reporting becomes more widespread in the literature.

ANTERIOR CRUCIATE LIGAMENT RECONSRUCTION IN CHILDREN: OUTCOMES OF QUADRICEPS VERSUS HAMSTRING AUTOGRAFTS

Background:Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) grafts. No studies in children comparing QT versus HT autografts have assessed postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs).Hypothesis/Purpose:The purpose of this study was to directly compare clinical and patient-reported outcomes of pediatric patients undergoing QT and HT autograft ACL reconstructions. We hypothesized that use of QT autografts would result in similar clinical and PROMs to HT autografts.Methods:A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-12/2019 without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments.Results:84 patients met inclusion criteria (Table 1). The 40 patients receiving QT were more often male (62.5% vs 34.1%, p=0.009). There were no differences in operative time (p=0.053) or proportion of patients requiring meniscus repair (p=0.958). At 3 months postoperative, those with HT had lower H/Q ratios (62.2 ± 15.8 vs 78.6 ± 19.9, p<0.001) and limb symmetry index (LSI) in flexion (86.1 ± 17.1 vs 94.3 ± 17.6, p=0.042), while patients with QT had lower LSI in extension (66.8 ± 13.2 vs 77.3 ± 12.6, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (59.7 ± 11.2 vs 66.3 ± 8.2, p=0.004). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at all postoperative visits. Patients with QT were more likely to have a postoperative wound issue (20.0% vs 2.3%, p=0.012).Conclusion:Significant differences in quadriceps and hamstrings strength at 3 months were observed for ACLR patients by graft type. This contributed to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. QT grafts appear to have a higher rate of postoperative infection/wound issues.Tables/Figures:

NERVE BLOCKS FOR PEDIATRIC ACL RECONSTRUCTION: COMPARING FUNCTION, PATIENT-REPORTED OUTCOMES, AND EFFICIENCY

Background:Previous studies have compared the use of continuous nerve catheter versus single-shot nerve block approaches to regional anesthesia in ACL Reconstruction (ACLR), but they have primarily focused on adult populations. A paucity of data exists comparing these regional anesthesia techniques in children.Hypothesis/Purpose:To compare postoperative pain, strength, and functional outcomes between pediatric ACLR patients undergoing femoral nerve catheter (FNC) placement with single-shot sciatic block and those receiving femoral and sciatic single-shot nerve blocks (SSNB).Methods:Pediatric patients (≤18 years) undergoing primary ACLR between 1/2018-8/2019 at an urban tertiary care children’s hospital were identified. Patients were grouped based on regional anesthetic technique (FNC vs. SSNB). Emergency department (ED) visits, clinic visits, and calls for uncontrolled pain and narcotic refills were compared between these two groups. Outcomes including PROMIS scores, strength testing, and active range of motion (AROM) were also compared. Multiple imputation analysis was used to reduce bias as a result of missed follow-up.Results:78 patients met inclusion criteria (FNC-36 patients, SSNB-42 patients). There were no differences in age, sex, BMI, or surgical technique between cohorts (Table I). Block preparation time (p<0.001) and surgical duration (p<0.001) were significantly longer for the FNC group. Ropivacaine dose (mg) of the sciatic nerve block was significantly higher in the SSNB group (35.0 ± 7.5 vs. 30.1 ± 4.1, p=0.001). All SSNB cases were performed at a satellite surgical center compared to 1 (2.8%) FNC case (p<0.001). There were no differences in uncontrolled pain or required narcotic refills between groups, and at 1 week follow-up, the proportion of patients with continued opioid consumption was not different (Table II). At 1 week, SSNB patients reported higher PROMIS physical function - mobility scores (25.5 ± 5.6 vs. 22.1 ± 4.9, p=0.009) with no difference in PROMIS pain interference scores. PROMIS scores were not different between cohorts at 6 weeks, 3 months or 6 months. AROM in extension and flexion also showed no difference between groups. SSNB was associated with a higher hamstrings to quadriceps ratio (quadriceps deficit) at 3 months (77.4 ± 23.8 vs. 66.2 ± 18.0, p=0.028), but there were no differences in isokinetic strength at 6 months.Conclusion:SSNB was associated with shorter operative times and better PROMIS physical function – mobility scores at 1 week compared to FNC. No other differences were observed in post-operative pain management, and cohorts were without differences in AROM and isokinetic strength by 6 months.Tables/Figures:

Does the Patient-Reported Outcomes Measurement Information System Correlate to Legacy Scores in Measuring Physical Health in Young Total Hip Arthroplasty Patients?

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institutes of Health to collect outcome data in rapid dynamic fashion on electronic platforms. The potential role of PROMIS in monitoring pain and function in young total hip arthroplasty (THA) patients has been under-investigated. The purpose of this study is to investigate correlation between PROMIS Physical Function (PF) and PROMIS Pain Interference (PI) and legacy scores with similar considerations. MethodsWe identified 298 hips who underwent primary THA over 40 months. Patients without preoperative PROMIS or legacy scores, or >50 years were excluded. Demographic data included age, gender, and body mass index. Outcome data included PF, PI, modified Harris Hip Score (mHHS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) domains, and Short Form 12 components. Floor/ceiling effects were considered to be significant if ≥15% of patients responded with the lowest or highest possible score. Spearman correlation (R) was performed to investigate correlation between legacy scores and PROMIS domains. ResultsMean age was 40 years, mean body mass index was 30.1 kg/m2, and 55% were female. None of the patient-reported outcome measures showed any floor/ceiling effects. PI showed moderate correlation to mHHS (R = −0.60), WOMAC Pain (R = −0.62), and WOMAC PF (R = −0.60). PF showed moderate correlation to mHHS (R = 0.66) and WOMAC PF (R = 0.55). Mean PF and PI scores differed significantly from the general population mean of 50 (36.7, 65.4, respectively; both P < .001). ConclusionPROMIS is an attractive alternative to legacy scoring measures, showing moderate correlations between PROMIS physical domains and legacy PROMs of WOMAC and mHHS in young patients undergoing THA.

Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion.

Retrospective review. To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student's t-test (P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use (P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

BackgroundZones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes.MethodsWe retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender.ResultsThe average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=−0.478; p=0.045). Metatarsus adductus angle (r=−0.606; p=0.008), lateral talo-1st metatarsal angle (r=−0.592; p=0.01), and medial cuneiform height (r=−0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=−0.7526; p=0.005), lateral talo-1st metatarsal angle (r=−0.7539; p=0.005), and medial cuneiform height (r=−0.627; p=0.029).ConclusionPatients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

Patient-Reported Outcomes Measurement Information System Validation in Hip Arthroscopy: A Shift Towards Reducing Survey Burden.

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide measures of patient-reported symptoms and healthcare outcomes across a variety of conditions in an easily accessible manner. The purpose of this study was to validate PROMIS against traditional legacy measures in patients undergoing hip arthroscopy for femoral acetabular impingement (FAI).MethodologyOutcome measures collected pre- and post-operatively included PROMIS Pain Interference (PI) and Physical Function (PF), modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living and Sport (HOS-ADL and HOS-Sport), Nonarthritic Hip Score (NAHS), and Visual Analog Scale (VAS). Pearson’s correlation coefficients were calculated between each outcome measure.ResultsStrong correlations were observed between the PROMIS PF T-Score and the mHHS (r = 0.64-0.83, p < 0.0001), HOS-ADL (r = 0.54-0.81, p < 0.0001), HOS-Sport (r = 0.55-0.74, p < 0.0001), and NAHS (r = 0.61-0.78, p < 0.0001) measurement tools. PROMIS Computer Adaptive Testing PI T-Score and VAS also demonstrated a strong correlation (r = 0.64-0.80, p < 0.0001).ConclusionsPROMIS PF scores correlate strongly with mHHS, HOS-ADL, HOS-Sport, and NAHS scores at all time points. Likewise, PROMIS PI scores correlate strongly with VAS pain scores. On average, patients completing PROMIS need to fill out only four or five questions. This study supports the use of PROMIS as an efficient, valid outcome tool for patients with FAI undergoing hip arthroscopy.

Is there a Difference in Outcomes between Patients who Received a Double or Triple Arthrodesis for Hindfoot Arthritis?

Category:HindfootIntroduction/Purpose:Triple arthrodesis has historically been considered the standard of treatment for arthritis of the hindfoot with or without deformity. The complications of this surgery including non-union, malunion, nerve injury, infection and wound healing problems can occur at any of the three joints. Double arthrodesis is capable of producing a similar reduction in degrees of motion and correction of foot deformity but may also cause less patient morbidity in regard to these complications due to one less joint being incorporated into the fusion procedure. What is unknown is the patient reported outcomes, specifically physical function (PF) and pain interference (PI) between these two procedures. The purpose of this study is to evaluate the clinical outcomes for hindfoot deformity using a triple compared to a double arthrodesis.Methods:A retrospective medical record review was performed (February 2015-December 2019), of 96 identified cases, 54 had complete data over 4 months post operation for either a double (Age = 58 (11); Body Mass Index (BMI) = 34.4 (6.0); n=24) or triple arthrodesis (Age= 55 (13); BMI = 33.0 (10.0); n = 30). Patient Reported Outcome Measurement Information System (PROMIS) physical function and pain interference were assessed at last available pre-operation and last follow up time points. Medical records were reviewed for complications (yes/no). ANOVA models were used to assess differences pre to post surgery (covariates included age, BMI, and length of follow up). Chi Square analysis was used to assess proportions of patients achieving a minimal clinically important difference (34.5) and complications by group.Results:There were no differences between groups in terms of age (p = 0.51), BMI (p = 0.44), or length of follow up (triple = 540 (334) days versus double = 390 (336) days; p=0.12). There were no significant differences in PROMIS PF (pre-post change 95% CI: triple= 1.2 (-4.1 to 1.6) versus double = 0.2 (-2.5 to 2.0)). The for PROMIS PI both groups experienced lower pain (average 5.1 (1.0) with the greater decrease in pain in the triple group (Figure 1; pre-post change 95% CI: triple= 7.1 (-10.2 to -4.0) versus double = 3 (-5.5 to -0.6)). Chi square analysis showed that a greater proportion of patients undergoing a triple (triple 61.9 % versus double 33.3 %) experienced MCID improvement in PROMIS PI (X2=4.4, p=0.04). There were 4 complications in the double group, and 6 in the triple group.Conclusion:Double arthrodesis can allow for similar correction of foot deformities without the increased risk of wound complication, infection or nonunion/malunion. However, we found that patients who underwent a triple arthrodesis were more likely to have an improvement in minimally important clinical difference (MCID) in the PROMIS pain interference scores than those who underwent a double arthrodesis.

Establishing and comparing reference preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients undergoing shoulder surgery

The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular among orthopedic surgeons treating shoulder pathology. Despite this, there have been few studies that have described and compared preoperative reference scores for specific shoulder surgical procedures. The primary purpose of this study was to establish and compare baseline preoperative PROMIS scores for 3 common types of shoulder surgery: rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and labral repair (LR). The secondary goal was to stratify these operative groups by diagnosis and compare preoperative PROMIS scores. In this cross-sectional study, adult and pediatric patients who underwent surgery for either RCR, TSA, or LR were included. PROMIS-Upper Extremity (UE), PROMIS-Pain Interference (PI), and PROMIS-Depression (D) scores that were collected at each patient's preoperative visit were reviewed. Continuous and categorical variables were compared between operative groups using analysis of variance and χ2 or Fisher exact tests, respectively. Multivariable general linear models were used to identify significant independent predictors of PROMIS scores when controlling for age, sex, and body mass index. A total of 413 patients were included in the study: 272 in the RCR group, 84 in the TSA group, and 57 in the LR group. The average PROMIS-UE score was 39.8 in the LR group vs. 29.9 in the RCR group (P < .001) and 29.6 in the TSA group (P < .001). There was no difference between the mean RCR and TSA PROMIS-UE scores (P = .93). The average PROMIS-PI score was 56.6 in the LR group vs. 62.8 in the RCR group (P < .001) and 63.9 in the TSA group (P < .001). There was no difference between RCR and TSA PROMIS-PI scores (P = .09). The average PROMIS-D score was 43.5 in the LR group vs. 47.7 in the RCR group (P = .004) and 50.3 in the TSA group (P < .001). The TSA group had a higher mean PROMIS-D score than the RCR group (P = .03). For PROMIS-UE scores, age and body mass index were not found to be significant independent predictors (P = .98 and P = .88, respectively). For PROMIS-PI scores, age, body mass index, and sex were not found to be significant independent predictors (P = .31, P = .81, and P = .48, respectively). Patients undergoing shoulder LR had higher preoperative function scores and lower pain interference and depression scores than those undergoing TSA and RCR. These baseline PROMIS scores should be taken into consideration when tracking a patient's outcomes after surgery, as a certain score could mean drastically different functional and pain outcomes depending on the underlying pathology.

Evaluating the Impact of Patient Social Deprivation on the Level of Symptom Severity at Carpal Tunnel Syndrome Presentation.

Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores. Results: All PROMIS domain scores were significantly worse in the most deprived cohort at the national level (P < .05) but not at the state level (P > .05). In multivariable regression at the national level, ADI values were associated with PROMIS UE (β = -0.06, P < .01) and PROMIS PI (β = .05, P < .01) but not PROMIS PF or PROMIS Depression. In multivariable regression at the state level, ADI values were associated with PROMIS UE (β = -0.79, P = .03) and PROMIS PI (β = 0.58, P < .05) but not PROMIS PF or PROMIS Depression. Conclusions: Higher levels of social deprivation are associated with worse PROMIS UE and PROMIS PI scores on both the state and national levels when initially seeking care for carpal tunnel syndrome.

Estimation of Minimally Important Differences and Patient Acceptable Symptom State Scores for the Patient-Reported Outcomes Measurement Information System Pain Interference Short Form in Rheumatoid Arthritis.

ObjectiveStudies have supported the validity of the Patient‐Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) scale in rheumatoid arthritis (RA). Here, we characterize minimally important differences (MIDs) and patient acceptable symptom state (PASS) values.Methods PROMIS PI scores were collected in four periods at 6‐month intervals from patients with RA (n > 3200 per period). Both anchor‐ and distribution‐based methods estimated MIDs. Anchors were pain comparisons, pain interference, and general health. Time responses for each anchor‐response group (four administrations, each with three change periods) were averaged. The mean changes of the “somewhat worse” and “somewhat better” groups were used as estimates for MID for worsening and improvement, respectively. Distribution‐based MID analyses used standardized error of measurement (SEM) and SD. PASS was estimated with the question “If your health was to remain for the rest of your life as it has been in the past 48 hours, would this be acceptable?” MIDs and PASS values were also estimated by baseline pain levels.ResultsAnchor‐based methods yielded estimates of 1.65 to 1.84 for worsening and −1.29 to −1.73 for improvement. The SEM estimate was 1.84. The PASS estimate for the entire group was 41.6. Substantial differences in MIDs and PASS were noted among baseline pain groups.ConclusionThe best estimate of a group‐level MID was approximately 2 points, similar to MIDs suggested in other conditions. The PASS value for the entire group was almost an SD better than the population mean. Results should enhance use of PROMIS PI in RA by facilitating interpretation of scores and changes.

Surgery for lower extremity symptomatic neuroma: Long-term outcomes

Traumatic neuroma caused by injuries or surgery can result in neuropathic pain, functional impairment, and psychological distress, which has an impact on quality of life. The aim of this study was to identify the factors related to successful treatment of symptomatic lower extremity symptomatic neuromas using patient-reported outcome measures (PROMs). Thirty-two patients with 48 symptomatic neuromas completed the PROMIS mobility, PROMIS pain interference (PI), Numeric Rating Scale (NRS) for pain (0-10) for both pre- and post-operative pain, and the PROMIS depression at a mean of 8.9±4.5 years following neuroma surgery. Neuromas were located around the foot and ankle (n=18, 38%), leg (n=14, 29%), around the knee (n=13, 27%), and in the thigh (n=3, 6.3%). Surgical treatment included neuroma excision and implantation (n=29, 60%) followed by neuroma excision alone or excision with placement in the subcutaneous tissue (n=12, 25%). We performed multivariable analysis to identify the factors influencing the PROMs. Patients reported significant reduction in mean NRS pain after surgery (7.3 vs 4.9, p=0.0013). Higher PROMIS depression scores were independently associated with inferior PROMIS mobility scores (β=-0.38, p=0.001), higher PROMIS PI scores (β=0.68, p<0.001), and higher NRS pain scores (β=0.1, p=0.001). Additionally, smoking was independently associated with higher NRS pain scores (β=1.59, p=0.049) CONCLUSION: Surgical treatment of symptomatic neuromas of the lower extremity provides a long-term improvement in 59% of patients, but 19% of patients still reported severe persistent pain despite surgical treatment. Smoking and negative mood have negative effects on patient-reported outcomes after neuroma surgery.

Mapping physical functions of the shoulder to American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information System scores

We sought to correlate physical functions of the shoulder to American Shoulder and Elbow Surgeons (ASES) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. We reviewed 3300 patient encounters with completed ASES scores, representing 2447 patients. Patients were seen for shoulder-related complaints. The most common diagnoses were rotator cuff disease (56%) and arthritis (9%); 54% and 46% of encounters were in operatively and nonoperatively treated patients, respectively. A total of 2632 PROMIS Physical Function (PF), 2574 PROMIS Pain Interference (PI), and 959 PROMIS Upper Extremity (UE) scores were simultaneously collected with the ASES form. The ASES form specifically asks about the ability to perform 8 physical functions. Receiver operating characteristic curves were calculated to determine 90% positive predictive value (PPV) and 90% negative predictive value (NPV) cutoffs for the ability to perform at high function for the ASES and PROMIS-PF, -UE, and -PI scores for the entire shoulder cohort and for rotator cuff disease and arthritis subgroups. ASES scores had consistently excellent ability, PROMIS-UE scores had reasonable to excellent ability, and PROMIS-PF and PROMIS-PI scores had overall reasonable ability to determine high- and low-function states. For reaching a high shelf in the rotator cuff disease subgroup, the 90% NPV and PPV cutoff scores were 41 and 66, respectively, for the ASES instrument. For reaching a high shelf in the arthritis subgroup, the cutoff scores were 50 and 78, respectively, for the ASES instrument. The 90% NPV and PPV cutoffs for each score, physical function, and diagnosis group were depicted by visual representations ("maps") for easier interpretation. Shoulder physical functions were mapped to outcome scores. Physical function mapping adds clinical meaning to the orthopedic literature, facilitating improved, more-informed decision making between physicians and patients.