gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Comparing the Responsiveness and Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) domains to Region- and Condition-Specific Patient-Reported Outcome (PRO) Tools in Carpal Tunnel Release

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  • presenting/speaker Warren Warren Hammert - University of Rochester Medical Center, Rochester, NY, United States
  • David N. Bernstein - University of Rochester Medical Center, Rochester, NY, United States
  • Jeff R. Houck - George Fox University, Newberg, OR, United States
  • Constantinos Ketonis - University of Rochester Medical Center, Rochester, NY, United States
  • Bilal Mahmood - University of Rochester Medical Center, Rochester, NY, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-524

doi: 10.3205/19ifssh0861, urn:nbn:de:0183-19ifssh08613

Published: February 6, 2020

© 2020 Warren Hammert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: There is a growing trend in surgical care to utilize patient-reported outcomes (PROs) to improve shared decision-making, guide expectation setting, and improve clinical care. We aimed to determine if PROMIS Physical Function (PF), Upper Extremity (UE), and Pain Interference (PI) domains were as responsive and valid in evaluating carpal tunnel release as region-specific (Michigan Hand Question (MHQ)) and condition-specific PRO tools (Boston Carpal Tunnel Questionnaire (BCTQ)).

Methods: Patients undergoing carpal tunnel release with a single surgeon from November 2014 to April 2017 were asked to complete the BCTQ, MHQ and PROMIS PF, UE, and PI CAT at each visit. Patients who had completed questionnaires both at a preoperative and either a six-week or three-month postoperative visit were included. The effect size index (ESI), a common index of change to judge responsiveness, was utilized. Convergent validity was evaluated using Spearman correlation coefficients.

Results and Conclusions: A total of 70 patients fit our inclusion criteria. The average age was 61 years (range, 27-86 years) and a minority were men (34.3%). All PRO domains demonstrated at least a medium effect size at final follow-up except for PROMIS PF (ESI = 0.25) and MHQ Aesthetic (ESI = 0.02). Within PROMIS, the PI domain demonstrated the best responsiveness (ESI = 0.74), followed by the UE domain (ESI = 0.66). Within the MHQ, the Satisfaction domain demonstrated the largest effect size (ESI = 1.48), followed by the total score (ESI = 1.22). Within the BCTQ, the symptom severity domain demonstrated the best responsiveness (ESI = 1.54), followed by the average of the two BCTQ domains (ESI = 1.27). PROMIS UE and PI demonstrated significant correlations with MHQ Satisfaction and the average of the two BCTQ domains, which are two anchors in the literature; however, PROMIS PF did not.

PROMIS UE and PI demonstrated concurrent validity with the MHQ and BCTQ, while PROMIS PF did not. While PROMIS UE and PI were responsive, the domains were not as responsive as MHQ and BCTQ domains. These findings suggest that PROMIS UE and PI domains are valid and may add value in being universal but that there is a minor trade-off in responsiveness.