Impact of Patient Demographic Factors on Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Interference, and Depression Computer Adaptive Testing Scores in Patients Undergoing Shoulder and Elbow Surgery

Background: There has been a growing emphasis in orthopaedics on providing patient-centered care. The US National Institutes of Health launched the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative that incorporates patient-reported outcome measures across a number of medical domains. The relationship between PROMIS domains and the impact of patient demographic factors in those undergoing upper extremity surgery remains unclear. Purpose/Hypothesis: The goal of this study was to investigate the correlation between physical function, pain interference, and depression in patients undergoing shoulder and elbow surgery as measured by PROMIS computer adaptive testing (CAT) forms and to determine the impact of patient demographic factors. We hypothesized that there would be a significant negative correlation between physical function and both pain interference and depression in this patient population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent elective shoulder or elbow surgery by 3 shoulder, elbow, and/or sports medicine fellowship–trained orthopaedic surgeons were included in the study. Preoperative PROMIS–Upper Extremity (PROMIS-UE), PROMIS–Pain Interference (PROMIS-PI), and PROMIS-Depression (PROMIS-D) CAT scores were analyzed. Pearson correlations were calculated between PROMIS domains as well as between PROMIS outcomes with patient demographic factors. Results: Preoperative PROMIS CAT scores for all 3 domains were collected and analyzed from 172 unique patients (516 individual CAT forms) with shoulder and elbow injuries. A negative correlation of moderate strength was found between the PROMIS-UE and PROMIS-PI (R = –0.61; P \u3c.001), and a negligible correlation was found between the PROMIS-UE and PROMIS-D (R = –0.28; P \u3c.001). When stratified by patient demographic factors, the correlation between the PROMIS-UE and PROMIS-PI was stronger in female patients compared with male patients (R = –0.77 vs –0.46, respectively; P \u3c.001 for both), stronger in black patients compared with white patients (R = –0.72 vs –0.56, respectively; P \u3c.001 for both), and highest in current tobacco users (R = –0.80; P \u3c.001). Conclusion: Before shoulder and elbow surgery, patients demonstrated impairments in physical function and pain interference as measured by CAT forms, with a moderate negative correlation between baseline upper extremity physical function and pain interference scores. In certain subpopulations, such as female patients, black patients, and current tobacco users, the correlations between these tested domains were stronger than in other groups

Impact of Patient Demographic Factors on Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Interference, and Depression Computer Adaptive Testing Scores in Patients Undergoing Shoulder and Elbow Surgery

Background: There has been a growing emphasis in orthopaedics on providing patient-centered care. The US National Institutes of Health launched the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative that incorporates patient-reported outcome measures across a number of medical domains. The relationship between PROMIS domains and the impact of patient demographic factors in those undergoing upper extremity surgery remains unclear. Purpose/Hypothesis: The goal of this study was to investigate the correlation between physical function, pain interference, and depression in patients undergoing shoulder and elbow surgery as measured by PROMIS computer adaptive testing (CAT) forms and to determine the impact of patient demographic factors. We hypothesized that there would be a significant negative correlation between physical function and both pain interference and depression in this patient population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent elective shoulder or elbow surgery by 3 shoulder, elbow, and/or sports medicine fellowship-trained orthopaedic surgeons were included in the study. Preoperative PROMIS-Upper Extremity (PROMIS-UE), PROMIS-Pain Interference (PROMIS-PI), and PROMIS-Depression (PROMIS-D) CAT scores were analyzed. Pearson correlations were calculated between PROMIS domains as well as between PROMIS outcomes with patient demographic factors. Results: Preoperative PROMIS CAT scores for all 3 domains were collected and analyzed from 172 unique patients (516 individual CAT forms) with shoulder and elbow injuries. A negative correlation of moderate strength was found between the PROMIS-UE and PROMIS-PI ( Conclusion: Before shoulder and elbow surgery, patients demonstrated impairments in physical function and pain interference as measured by CAT forms, with a moderate negative correlation between baseline upper extremity physical function and pain interference scores. In certain subpopulations, such as female patients, black patients, and current tobacco users, the correlations between these tested domains were stronger than in other groups

Feasibility of PROMIS CAT Administration in the Ambulatory Sports Medicine Clinic With Respect to Cost and Patient Compliance: A Single-Surgeon Experience.

Background: Pay-for-performance reimbursement models are becoming increasingly popular, but the implementation of a routine patient-reported outcome (PRO) collection system places additional burden on both the patient and the provider. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed in an effort to make PRO collection more practical and efficient, but providers may be reluctant to embrace a transition to a PROMIS-based clinical outcome registry. Hypothesis: PROMIS can be successfully incorporated into daily clinical practice, with an overall patient compliance rate of 80%. Study Design: Cross-sectional study; Level of evidence, 3. Methods: As part of routine practice, all patients presenting to a single surgeon\u27s sports medicine clinic for an appointment were asked to complete a series of PROMIS computerized adaptive tests (CATs), including PROMIS Physical Function, Physical Function-Upper Extremity, Pain Interference, and Depression subscales. Overall compliance was calculated by dividing the number of survey sets completed by the number of eligible clinic visits. Compliance rates were further assessed by patient age, type of clinic visit, and location of injury. Costs associated with this system of routine PRO collection were categorized as start-up or maintenance costs. Results: From August 7, 2017, to December 8, 2017, there were 581 patients (1109 clinic encounters) who met inclusion criteria for the study. Of the 1109 clinic encounters, there was an overall compliance rate of 91.3% (1013/1109 visits during which the patient completed the entire PROMIS survey set). Overall, the full survey set consisted of a mean 15.3 questions and took a mean of 2.6 minutes to complete. Patients who were aged ≥62 years had a significantly lower compliance rate (81.8%; Conclusion: The routine electronic collection of PROMIS scores in the ambulatory orthopaedic clinic resulted in a compliance rate of over 90%, although older patients were generally less compliant than younger patients. Our system of data collection is practical and efficient in a high-volume orthopaedic clinic and places minimal financial burden on the provider

Correlation of PROMIS Physical Function, Pain Interference, and Depression in Pediatric and Adolescent Patients in the Ambulatory Sports Medicine Clinic.

Background: Recently, interest has increased in incorporating the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes into clinical and research applications in sports medicine. The PROMIS forms have not been studied in pediatric and adolescent sports medicine patients. Purpose/Hypothesis: The goal of this study was to determine the correlation between PROMIS Computer Adaptive Test (CAT) forms measuring physical function, pain interference, and depression in pediatric and adolescent patients seen in the ambulatory sports medicine clinic. We hypothesized that there would be a negative correlation between physical function and pain interference as well as depression, as has been demonstrated in adult patient populations. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients aged 8 to 17 years seen by 3 shoulder and sports medicine providers were included in this study. Patients completed a series of PROMIS CAT forms at clinic visits, including the PROMIS-PF and PROMIS-UE (Physical Function and Upper Extremity; depending on the nature of the complaint), PROMIS-PI (Pain Interference), and PROMIS-Depression subscales. Pearson correlation coefficients were calculated between the PROMIS forms as well as with other patient demographic data. Results: A total of 236 patient visits (152 patients) were included in the study, comprising 712 total PROMIS CAT forms. A negative correlation was found between PROMIS-PF and both PROMIS-Depression (R = –0.34) and PROMIS-PI (R = –0.76). These correlations with PROMIS-Depression and PROMIS-PI were –0.21 and –0.75, respectively, when considering the PROMIS-UE CAT. Patient demographic information had minimal impact on PROMIS scores as well as on correlations between scores. Conclusion: Correlations between physical function, pain interference, and depression were found to be similar in pediatric patients as they are in adult patients, as measured by PROMIS CAT forms

Impact of ball weight on medial elbow torque in youth baseball pitchers.

HYPOTHESIS: Our hypothesis was that an increase in ball weight would result in an increase in medial elbow torque during the pitching motion. METHODS: Youth pitchers were recruited for this study and instructed to throw 5 maximum-effort fastballs from ground level using baseballs of 4 different weights: 85 g (3 oz), 113 g (4 oz), 142 g (5 oz), and 170 g (6 oz). The validated Motus sensor was used to assess medial elbow torque, arm speed, arm slot, and shoulder rotation for each pitch. Pitch velocity was measured using a radar gun. Relationships between baseball weight and pitching kinetics and/or kinematics were evaluated using linear mixed-effects analysis. An exit survey was conducted detailing the pitcher\u27s evaluation of the ball weights used. RESULTS: A total of 19 youth baseball pitchers (average age, 11.8 +/- 1.1 years; age range, 9-14 years) completed the study. For every 1-oz (28-g) increase in ball weight, ball velocity decreased 2.0 +/- 0.1 mph (chi(2) = 52.68, P \u3c .001), medial elbow torque increased 0.92 +/- 0.37 newton meters (chi(2) = 5.36, P = .02), and arm speed decreased 8.52 +/- 3.68 rpm (chi(2) = 5.03, P = .02). Shoulder rotation and arm slot were not significantly impacted by ball weight (P \u3e .05). Survey results indicated that the 85-g (3-oz) baseball was most favored (8 of 19 pitchers) and believed to result in the highest pitch velocity (15 of 19 pitchers). The 170-g (6-oz) baseball was least favored (17 of 19 pitchers) and believed to result in the slowest pitch velocity (18 of 19 pitchers). No adverse outcomes were reported with the use of any ball weight or the mobile sensor. CONCLUSION: Among youth pitchers, an increase in ball weight correlated with greater medial elbow torque, decreased pitch velocity, and decreased arm speed