The Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 measures physical and mental health and provides an estimated EuroQol-5 Dimension (EQ-5D) score. These authors goal was to determine the correlation between the PROMIS Global-10 and several conventional measures to validate its overall performance and usefulness in patients with shoulder arthritis.
Correlation between the PROMIS and EQ-5D was excellent (0.72, P < .001). However, agreement for estimated EQ-5D ranged from 0.37 below to 0.36 above actual EQ-5D scores. Correlation of the PROMIS physical score was good with the ASES score (0.57, P < .001) and poor with the SANE score (0.23, P = .0045) and WOOS score (0.11, P = .3743). Correlation of the PROMIS mental score was poor when compared with all patient-reported outcome instruments investigated (ASES score, 0.26 [P = .0012]; SANE score, 0.13 [P = .1004]; andWOOS score, 0.09 [P = .4311]).
The authors concluded that the PROMIS Global-10 physical scores show excellent correlation with the EQ-5D. However, the PROMIS Global-10 cannot replace actual EQ-5D scores for cost-effectiveness assessment in this population because of the large variance in agreement between actual and PROMIS Global-10–estimated EQ- 5D scores. PROMIS Global-10 physical scores showed good correlation with the ASES score but poor correlation with other gold-standard patient-reported outcome instruments, suggesting that it is an inappropriate instrument for outcome measurement in populations with shoulder arthritis.
Comment: This study points out so of the shortcomings of PROMIS, but there are others. Use of PROMIS requires the patient to have access to and be comfortable using a computer interface, such as an iPad
While patient user support and access to such an interface may be facilitated in the surgeon's office, these resources are unlikely to available at the patient's home. As a result the ability to capture outcome data after a treatment is compromised. The actual cost and patient compliance with PROMIS have not been studied
On the other hand, the use of a simple and short paper form (see below) that can be mailed in or sent via email greatly facilitates the tracking of the patient's progress and minimizes the risk of loss to followup.
Here's commentary another PROMIS study:
Correlation of PROMIS Physical Function Upper Extremity Computer Adaptive Test with American Shoulder and Elbow Surgeons shoulder assessment form and Simple Shoulder Test in patients with shoulder arthritis
The purpose of this study was to evaluate the Patient-Reported Outcomes Measurement Informative System Physical Function Upper Extremity Computer Adaptive Test (PROMIS PFUE CAT) measurement tool against the already validated American Shoulder and Elbow Surgeons (ASES) shoulder assessment form and the Simple Shoulder Test (SST) in patients with shoulder arthritis.
Fifty-two patients with the primary diagnosis of shoulder arthritis were asked to fill out the ASES, SST, and PROMIS PFUE CAT.
The PROMIS PFUE CAT showed a strong-moderate correlation with the SST (r = 0.64; P < .001) and a moderate correlation with the ASES (r = 0.57; P < .001). The average times to complete the SST, ASES, and PROMIS PFUE CAT were determined to be 96.9 ± 25.1 seconds, 160.6 ± 51.5 seconds, and 62.6 ± 22.8 seconds, respectively.
These authors suggest that computerized adaptive technology be used to decrease the burden placed on patients by currently accepted patient-reported outcome measurement tools.
These authors suggest that computerized adaptive technology be used to decrease the burden placed on patients by currently accepted patient-reported outcome measurement tools.
The burden of the PROMIS approach is that the patient needs to have access to and use a computer uploaded with the necessary software. The cost of implementing this system is not mentioned in this paper. In contrast, the SST can be completed anywhere and requires only a pencil or a pen.
The scatter plot from this article also brings up another issue with the PROMIS: four patients who indicated that they could perform none of the 12 functions of the SST, still had PROMIS scores in the same range as three patients what could perform eight of these functions. Thus, the PROMIS was unable to discriminate between a non-functioning shoulder and a reasonably functional one.
At this point the promise of PROMIS does not seem compelling.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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