Performance of the PROMIS in Patients Undergoing 3 Common Elbow Procedures

Abstract

Background: Ulnar collateral ligament (UCL) reconstruction, distal biceps tendon repair, and elbow arthroscopic surgery are common elbow procedures performed in active patients. Hypothesis: We hypothesized (1) good to excellent correlation between Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and traditional orthopaedic upper extremity patient-reported outcome (PRO) measures; (2) that PROMIS instruments would demonstrate ceiling effects; and (3) that the PROMIS physical function computer adaptive test (PF CAT) would demonstrate a low question burden compared with other PRO instruments. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 76 patients undergoing UCL repair/reconstruction, distal biceps tendon repair, or elbow arthroscopic surgery filled out the Short Form–36 Health Survey (SF-36) Physical Function subscale, EuroQol–5 Dimensions (EQ-5D) questionnaire, PROMIS PF CAT, and PROMIS upper extremity item bank (UE). Excellent correlation between PROs was defined as ≥.70. Results: The PROMIS PF CAT had excellent correlation with the SF-36 (r = 0.74; P \u3c .0001), Disabilities of the Arm, Shoulder and Hand (DASH) survey (r = –0.76; P \u3c .0001), and PROMIS UE (r = 0.73; P \u3c .0001). The PROMIS UE demonstrated excellent correlation with the SF-36 (r = 0.73; P \u3c .0001) and DASH survey (r = –0.81; P \u3c .0001). The PROMIS UE had ceiling effects in 33% of patients. The SF-36 showed ceiling effects in 20% of patients. On average, patients answered 5.1 ± 2.2 questions on the PROMIS PF CAT. Conclusion: The PROMIS PF CAT and PROMIS UE are valid in patients undergoing distal biceps tendon repair, elbow arthroscopic surgery, and UCL repair. The PROMIS UE demonstrated high ceiling effects in younger, higher functioning patients and should be used with caution in this group. A further evaluation and modification of the PROMIS UE in younger, high-functioning patients are warranted. Finally, the PROMIS PF CAT exhibited a low question burden relative to traditional PRO instruments without the loss of reliability