57 - Validation of Patient Reported Outcomes Measurement Information System...

#57 Validation of Patient Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Tests (CATs) in Cervical Spine Surgery

Value and Outcomes in Spine Surgery

Poster Presented by: A. Patel


A. Patel (1)
B. Boody (1)
S. Bhatt (1)
A. Mazmudar (1)
J. Savage (2)
W. Hsu (1)
N. Rothrock (3)

(1) Northwestern University, Orthopaedic Surgery, Chicago, IL, United States
(2) Cleveland Clinic Main Campus, Center for Spine Health, Cleveland, OH, United States
(3) Northwestern University, Medical Social Sciences, Chicago, IL, United States


Background: PROMIS®, funded by the National Institutes of Health (NIH), is a set of adaptive, responsive assessment tools that measures patient-reported health status. Cervical spine disorders are common, often debilitating conditions that are treated surgically. The objective of this project is to evaluate the validity (e.g., convergent validity, known groups validity, responsiveness to change) of the PROMIS pain behavior, pain interference, and physical function computer adaptive tests (CATs) in patients undergoing cervical spine surgery. The legacy outcome measures Neck Disability Index (NDI) and Short-Form 12 (SF-12) were used as comparisons.

Purpose: To validate PROMIS CATs for physical function, pain interference, and pain behavior for patients undergoing a cervical spine surgery.

Methods: PROMIS CATs, NDI-10, and SF-12 measures were administered to 59 consecutive tertiary hospital patients treated surgically for degenerative cervical spine disorders. A sub score of NDI-5 was calculated using the Lifting, Headaches, Pain Intensity, Reading, and Driving sections and multiplying the final score by 4. Assessments were administered pre-operatively (baseline) and post-operatively at 6 weeks and 3 months. We excluded patients presenting for revision surgery, tumor, infection, or trauma. Participants completed the measures in Assessment Center, an online data collection tool accessed by using a secure login and password on a tablet computer.

Results: Convergent validity for PROMIS CATs was supported with multiple statistically significant correlations with existing legacy measures NDI and SF-12 in the expected direction at baseline. Furthermore, PROMIS CAT demonstrated known group validity, identifying clinically significant improvements when patient subgroups were stratified by patient self-reported symptom improvement. Within the cervical radiculopathy and myelopathic cohorts, PROMIS measures demonstrated responsiveness similar to SF-12 and NDI scores for patient groups self-identifying as clinically improved post-operatively. PROMIS CATs required 3.1 minutes total for PROMIS Pain Behavior (0.9 minutes, SD 0.5 minutes), Pain Interference (1.2 minutes, SD 1.9 minutes), and Physical Function (1.1 minutes, SD 1.4 minutes), comparing favorably with 3.4 minutes for NDI and 4.1 minutes for SF-12 measures.

Conclusions: This study suggests that PROMIS CATs demonstrate convergent and known groups validity and comparable responsiveness to change as existing legacy measures. When used for patients with cervical spine pathology, the PROMIS CAT can be a useful clinical outcome tool and compares favorably with the NDI and SF-12. The real-time scoring and interpretation provided by the PROMIS platform allows for capturing accurate and meaningful functional outcome data and incorporation into clinical practice.