Purpose
The Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity
(UE) and PROMIS Physical Function (PF) are increasingly referenced patient-reported
outcomes. To interpret treatment effects with these patient-reported outcomes, investigators
must understand magnitudes of change that represent clinically relevant improvement.
This study assessed the responsiveness of PROMIS UE and PF in patients with cubital
tunnel syndrome.
Methods
A retrospective analysis of PROMIS UE and PROMIS PF computer adaptive test scores
was performed for patients treated nonoperatively for cubital tunnel syndrome over
3 years at a tertiary institution. The Patient-Reported Outcomes Measurement Information
System UE and PROMIS PF outcome scores were collected at initial and return clinic
visits. At follow-up appointments, patients completed clinical anchor questions evaluating
their degree of interval clinical improvement. Anchor questions allowed categorization
of patients into groups that had experienced “no change,” “minimal change,” and “much
change.” Minimal clinically important difference (MCID) values were calculated for
the PROMIS assessments with anchor-based and distribution-based methods.
Results
A total of 304 patients with PROMIS PF scores and 111 with PROMIS UE scores were analyzed.
The MCID for the PROMIS UE was 3.1 (95% confidence interval, 1.4–4.8) using the anchor-based
method and 3.7 (95% confidence interval, 2.9–4.4) using the distribution-based method.
These point estimates exceeded the minimal detectable change of 2.3. The MCID for
the PROMIS PF was unable to be determined in this patient sample because patients
reporting mild change did not have score changes exceeding measurement error.
Conclusions
The PROMIS UE v2.0 computer adaptive test detected minimal change in patients managed
nonoperatively for cubital tunnel syndrome with an estimated MCID range of 3.1–3.7.
While PROMIS PF has demonstrated acceptable performance in patients with a variety
of upper extremity conditions, for cubital tunnel syndrome, it was less able to detect
subtle change. PROMIS UE appears more responsive to subtle changes in cubital tunnel
syndrome symptoms.
Clinical Relevance
Patient-reported outcomes may have varied responsiveness depending on the condition
studied.
Key words
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References
- What is value in health care?.N Engl J Med. 2010; 363: 2477-2481
- Upper extremity-specific measures of disability and outcomes in orthopaedic surgery.J Bone Joint Surg Am. 2012; 94: 277-285
- Clinical research and patient-rated outcome measures in hand surgery.J Hand Surg Am. 2012; 37: 851-855
- What is the impact of comorbidities on self-rated hand function in patients with symptomatic trapeziometacarpal arthritis?.Clin Orthop Relat Res. 2015; 473: 3477-3483
- Predictors of pain intensity and disability after minor hand surgery.J Hand Surg Am. 2010; 35: 956-960
- The Disabilities of the Arm, Shoulder, and Hand questionnaire in intercollegiate athletes: validity limited by ceiling effect.J Shoulder Elbow Surg. 2010; 19: 349-354
- The minimal clinically important difference of the Michigan hand outcomes questionnaire.J Hand Surg Am. 2009; 34: 509-514
- Validity and responsiveness of the Jebsen-Taylor Hand Function Test.J Hand Surg Am. 2010; 35: 30-37
- Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) versus Physical Function (PF) computer adaptive tests (CATs) in upper extremity clinics.J Hand Surg Am. 2017; 42: 867-874
- Evaluation of version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in nonshoulder upper extremity patients.J Hand Surg Am. 2019; 44: 267-273
- Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System.J Hand Surg Am. 2014; 39: 1160-1165
- Evaluation of the PROMIS physical function computer adaptive test in the upper extremity.J Hand Surg Am. 2014; 39: 2047-2051.e4
- Ceiling Effect of the PROMIS Upper Extremity Function Assessment.J Hand Surg Am. 2017; 42: S28-S29
- Minimal clinically important difference for PROMIS physical function in patients with distal radius fractures.J Hand Surg Am. 2019; 44: 454-459.e1
- The minimal clinically important difference of the PROMIS and QuickDASH instruments in a nonshoulder hand and upper extremity patient population.J Hand Surg Am. 2020; 45: 399-407.e6
- Responsiveness of the PROMIS and its concurrent validity with other region- and condition-specific PROMs in patients undergoing carpal tunnel release.Clin Orthop Relat Res. 2019; 477: 2544-2551
- Functional impact of congenital hand differences: early results from the congenital upper limb differences (CoULD) registry.J Hand Surg Am. 2018; 43: 321-330
- The impact of social deprivation on pediatric PROMIS health scores after upper extremity fracture.J Hand Surg Am. 2018; 43: 897-902
- Variability of PROMIS scores across hand conditions.J Hand Surg Am. 2019; 44: 186-191.e1
- Long-term clinical and radiographic follow-up of preaxial polydactyly reconstruction.J Hand Surg Am. 2019; 44: 244.e1-244.e6
- Early results of surgical treatment of triangular fibrocartilage complex tears in children and adolescents.J Hand Surg Am. 2020; 45: 449.e1-449.e9
- Outcomes of the medial femoral trochlea osteochondral free flap for proximal scaphoid reconstruction.J Hand Surg Am. 2020; 45: 317-326.e3
- The ability of upper extremity surgeons to assess patient's functional status.J Hand Surg Am. 2021; 46: 819.e1-819.e8
- Correlation of patient-reported outcomes measurement information system questionnaires with the brief Michigan Hand Questionnaire in patients with 5 common hand conditions.J Hand Surg Am. 2021; 46: 709.e1-709.e11
- Radiographic and clinical outcomes of the shoulder in long-term follow-up of brachial plexus birth injury.J Hand Surg Am. 2020; 45: 1115-1122
- Minimal clinically important difference of the PROMIS upper-extremity computer adaptive test and QuickDASH for ligament reconstruction tendon interposition patients.J Hand Surg Am. 2021; 46: 516-516.e7
- A randomized controlled trial of decision aids for upper-extremity conditions.J Hand Surg Am. 2021; 46: 338.e1-338.e15
- Social deprivation and congenital upper extremity differences—an assessment using PROMIS.J Hand Surg Am. 2021; 46: 114-118
- The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years.Med Care. 2007; 45: S3-S11
- The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.J Clin Epidemiol. 2010; 63: 1179-1194
- PROMIS for Orthopaedic outcomes measurement.J Am Acad Orthop Surg. 2016; 24: 744-749
- Understanding PROMIS.J Hand Surg Am. 2020; 45: 650-654
- Evaluation of PROMIS’ ability to detect immediate postoperative symptom improvement following carpal tunnel release.J Hand Surg Am. 2021; 46: 445-453
- Minimal clinically important differences for PROMIS physical function, upper extremity, and pain interference in carpal tunnel release using region- and condition-specific PROM tools.J Hand Surg Am. 2019; 44: 635-640
- Nonoperative management of cubital tunnel syndrome: an 8-year prospective study.Neurology. 1993; 43: 1673-1677
- Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome.J Hand Surg Am. 2013; 38: 1125-1130.e1
- Conservative treatment of the cubital tunnel syndrome.J Hand Surg Eur Vol. 2009; 34: 201-207
- Cubital tunnel syndrome: current concepts.J Am Acad Orthop Surg. 2017; 25: e215-e224
- Transforming how health is measured 2018.http://www.healthmeasures.netDate accessed: July 30, 2020
- Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement.Ann Rheum Dis. 2005; 64: 29-33
- The minimal clinically important difference for PROMIS physical function in patients with thumb carpometacarpal arthritis.Hand (N Y). 2021; 16: 638-643
- Determining a minimal important change in a disease-specific Quality of Life Questionnaire.J Clin Epidemiol. 1994; 47: 81-87
- Minimally important differences for Patient Reported Outcomes Measurement Information System pain interference for individuals with back pain.J Pain Res. 2016; 9: 251-255
- Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients.J Clin Epidemiol. 2011; 64: 507-516
- Approaches for estimating minimal clinically important differences in systemic lupus erythematosus.Arthritis Res Ther. 2015; 17: 143
- Understanding the minimum clinically important difference: a review of concepts and methods.Spine J. 2007; 7: 541-546
- Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.Med Care. 2003; 41: 582-592
- Statistics corner: a guide to appropriate use of correlation coefficient in medical research.Malawi Med J. 2012; 24: 69-71
- User’s guide to correlation coefficients.Turk J Emerg Med. 2018; 18: 91-93
- Correlation coefficients: appropriate use and interpretation.Anesth Analg. 2018; 126: 1763-1768
- Health Measures: meaningful change for PROMIS. 2021.https://www.healthmeasures.net/score-and-interpret/interpret-scores/promis/meaningful-changeDate accessed: April 23, 2021
- A point of minimal important difference (MID): a critique of terminology and methods.Expert Rev Pharmacoecon Outcomes Res. 2011; 11: 171-184
- The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness.Clin Orthop Relat Res. 2015; 473: 311-317
Article info
Publication history
Published online: June 24, 2022
Accepted:
November 5,
2021
Received:
May 1,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
