Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores predict postoperative outcome in total shoulder arthroplasty patients
These authors sought to determine whether preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores could predict achievement of the minimal clinically important difference (MCID) in 62 patients at a minimum of 3 months after total shoulder arthroplasty.
The PROMIS computer adaptive testing algorithm for each scale produced standardized T scores based on a normative US population. The mean score was 50, with a standard deviation of 10. Of note, higher PF scores indicated increased function, higher PI scores represented increased pain, and higher depression scores represented increased depression.
These authors sought to determine whether preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores could predict achievement of the minimal clinically important difference (MCID) in 62 patients at a minimum of 3 months after total shoulder arthroplasty.
The PROMIS computer adaptive testing algorithm for each scale produced standardized T scores based on a normative US population. The mean score was 50, with a standard deviation of 10. Of note, higher PF scores indicated increased function, higher PI scores represented increased pain, and higher depression scores represented increased depression.
PROMIS physical function (PF), pain interference (PI), and depression scores were associated with postoperative achievement of the MCID (area under the receiver operating characteristic curve, 0.70-0.87). Ninety percent cutoff scores showed that patients with a preoperative PF score lower than 31.7 PI score greater than 66.9, and depression score greater than 55.5 were more likely to achieve the MCID.
Comment: In order to examine the predictive value of a model, one needs to "train" the model on a given data set (as was done here) and then test the model against a new data set to determine how often the predictions were accurate (which was not done here).
Based on a relatively small sample and short term outcomes, the authors derived hairsplitting "thresholds" that were applied to data that are continuous: 37.1 and 47.8 for the upper graph and 66.9 and 55.1 for the lower graph. Is there really a difference in the patients on either side of these "thresholds"? Would these thresholds be the same if there had been 100 rather than 62 patients in the training sample or if 2 year followups had been used?
Finally, is this complex and expensive approach of greater value than the traditional approach as shown in this article based on over twice as many patients: "Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease (see this link)?" Note the use of the term "correlate" rather than the term "predict".
This study correlated patient demographics, preoperative health status, and preoperative shoulder function with 3 outcome metrics: comfort, physical role function, and shoulder-specific function. One hundred thirty-four shoulders having total shoulder arthroplasty for degenerative glenohumeral joint disease had an average follow-up of 3.4 ± 1.8 years. The SF-36 Comfort score improved from 39 to 61 (P <0001). The SF-36 Physical Role Function score improved from 30 to 52 (P <0001). The average number of Simple Shoulder Test functions performable (out of 12) improved from 4 to 9 (P <0001). The strongest correlates with postoperative comfort included preoperative physical function (P <0001), general health (P <0001), and social function (P <001). The strongest correlates with postoperative physical role function included preoperative physical function (P <0001) and general health (P <001). The strongest correlates with postoperative shoulder function included male gender (P <0001), and preoperative physical function (P <0001), social function (P <0001), mental health (P <0001) and shoulder function (P <0001).
These data indicate that the overall well-being of the patient before surgery is strongly correlated with the quality of the outcome from total shoulder arthroplasty for degenerative glenohumeral joint disease.
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