Medicine and Health Sciences Commons^™

Improving Interpretation Of The Patient-Reported Outcomes Measurement Information System (Promis) Physical Function Scale For Specific Tasks In Community-Dwelling Older Adults, Jeff Houck, Ryan Jacobson, Michael Bass, Chris Dasilva, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Background and purpose: New generic patient-reported outcomes like the Patient-Reported Outcomes Measurement Information System (PROMIS) are available to physical therapists to assess physical function. However, the interpretation of the PROMIS Physical Function (PF) T-score is abstract because it references the United States average and not specific tasks. The purposes of this study were to (1) determine convergent validity of the PROMIS PF scale with physical performance tests; (2) compare predicted performance test values to normative data; and (3) identify sets of PROMIS PF items similar to performance tests that also scale in increasing difficulty and align with normative data.

Methods: …

Pattern Of Recovery And Outcomes Of Patient Reported Physical Function And Pain Interference After Ankle Fusion: A Retrospective Cohort Study, Jessica M. Kohring, Jeff Houck, Irvin Oh, Adolf S. Flemister, John P. Keptz, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Background: Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication.

Methods: This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected …

Role Of Patient-Reported Outcome Measures On Predicting Outcome Of Bunion Surgery, Ashlee Macdonald, Jeff Houck, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Background: Prior studies have suggested preoperative patient-reported outcome scores could predict patients who would achieve a clinically meaningful improvement with hallux valgus surgery. Our goal was to determine bunionectomyspecific thresholds using Patient-Reported Outcomes Measurement Information System (PROMIS) values to predict patients who would or would not benefit from bunion surgery.

Methods: PROMIS physical function (PF), pain interference (PI), and depression assessments were prospectively collected. Forty-two patients were included in the study. Using preoperative and final follow-up visit scores, minimally clinically important differences (MCID), receiver operating characteristic (ROC) curves, and area under the curve (AUC) analyses were performed to determine if …

Do Patients Judge Success Of Treatment And Patient Acceptable Symptom State Based On Current Self-Reported Health Status?, Ryan Jacobson, Daniel Kang, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: Value-based care models call for better interpretation of patient-reported outcomes. Patients may reference health status differently when appraising if an intervention was successful versus if their current state is acceptable. The purpose of this study was to determine the association between success of treatment (SOT), patient acceptable symptom state (PASS), and PROMIS measure T-scores, following a single primary care physical therapy encounter.

Methods: Cross-sectional study. Ninety-two patients with musculoskeletal complaints were administered standard SOT and PASS questions, and PROMIS Physical Function, Pain Interference, and Self-Efficacy for Managing Symptoms measures. Association of PASS and SOT was determined using rank biserial …

Overall Health And The Influence Of Physical Therapy On Physical Function Following Total Ankle Arthroplasty, Frank E. Diliberto, Daniel H. Aslan, Jeff R. Houck, Bryant S. Ho, Anand M. Vora, Steven L. Haddad

Faculty Publications - College of Physical Therapy

Background: The overall health and the importance of physical therapy for people following total ankle arthroplasty (TAA) have been understudied. Our purpose was to characterize the overall health of patients following TAA, and explore the frequency, influence, and patient-perceived value of physical therapy.

Methods: People who received a TAA participated in this retrospective cohort online survey study. The survey included medical history questions and items from the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms. Seven PROMIS domains, reflecting the biopsychosocial model of care (physical, mental, social), were included to examine participant overall health status in comparison to the general …

Can Patient-Reported Outcomes Measurement Information System® (Promis) Measures Accurately Enhance Understanding Of Acceptable Symptoms And Functioning In Primary Care?, Ryan Jacobson, Daniel Kang, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: Value-based healthcare models will require prioritization of the patient’s voice in their own care toward better outcomes. The Patient-Reported Outcomes Measurement Information System® (PROMIS) gives patients a voice and leads providers to actionable treatments across a broad range of diagnoses. However, better interpretation of PROMIS measures is needed. The purpose of this study was to evaluate the accuracy of PROMIS Physical Function (PF), Self-Efficacy for Managing Symptoms (SE), Pain Interference (PI), Fatigue, and Depression measures to discriminate patient acceptable symptom state (PASS) in primary care, determining if that accuracy is stable over time and/or retained when PROMIS score thresholds …

Do Patient Reported Outcome Measurement Information System (Promis) Scales Demonstrate Responsiveness As Well As Disease-Specific Scales In Patients Undergoing Knee Arthroscopy?, Raymond J. Kenney, Jeff Houck, Brian D. Giordano, Judith F. Baumhauer, Meghan Herbert, Michael D. Maloney

Faculty Publications - College of Physical Therapy

Background: The Patient Reported Outcomes Information System (PROMIS) is an efficient metric able to detect changes in global health. Purpose: To assess the responsiveness, convergent validity, and clinically important difference (CID) of PROMIS compared with disease-specific scales after knee arthroscopy. Study Design: Cohort study (Diagnosis); Level of evidence, 2.

Methods: A prospective institutional review board–approved study collected PROMIS Physical Function (PF), PROMIS Pain Interference (PI), International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) results in patients undergoing knee arthroscopy. The change from preoperative to longest follow-up was used in analyses performed to determine responsiveness, convergent …

Promis Pain Interference Is Superior Vs Numeric Pain Rating Scale For Pain Assessment In Foot And Ankle Patients, David N. Bernstein, Meghan Kelly, Jeff Houck, John P. Ketz, Samuel Flemister, Benedict F. Digiovanni, Judith F. Baumhauer, Irvin Oh

Faculty Publications - College of Physical Therapy

Background: The Numeric Pain Rating Scale (NPRS) is a popular method to assess pain. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been suggested to be more accurate in measuring pain. This study aimed to compare NPRS and PROMIS Pain Interference (PI) scores in a population of foot and ankle patients to determine which method demonstrated a stronger correlation with preoperative and postoperative function, as measured by PROMIS Physical Function (PF).

Methods: Prospective PROMIS PF and PI and NPRS data were obtained for 8 common elective foot and ankle surgical procedures. Data were collected preoperatively and postoperatively at a …

Preoperative Promis Scores Predict Postoperative Promis Score Improvement For Patients Undergoing Hand Surgery, David N. Bernstein, Jeff Houck, Ronald M. Gonzalez, Danielle M. Wilbur, Richard J. Miller, David J. Mitten, Warren C. Hammert

Faculty Publications - College of Physical Therapy

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) can be used alongside preoperative patient characteristics to set postsurgery expectations. This study aimed to analyze whether preoperative scores can predict significant postoperative PROMIS score improvement. Methods: Patients undergoing hand and wrist surgery with initial and greater than 6-month follow-up PROMIS scores were assigned to derivation or validation cohorts, separating trauma and nontrauma conditions. Receiver operating characteristic curves were calculated for the derivation cohort to determine whether preoperative PROMIS scores could predict postoperative PROMIS score improvement utilizing minimal clinically important difference principles. Results: In the nontrauma sample, patients with baseline Physical Function (PF) …

Determining Success Or Failure After Foot And Ankle Surgery Using Patient Acceptable Symptom State (Pass) And Patient Reported Outcome Information System (Promis), Michael R. Anderson, Judith F. Baumhauer, Benedict F. Digiovanni, Sam Flemister, John P. Ketz, Irvin Oh, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery.

Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = …

Validation And Generalizability Of Preoperative Promis Scores To Predict Postoperative Success In Foot And Ankle Patients, Michael R. Anderson, Jeff Houck, Charles L. Saltzman, Man Hung, Florian Nickisch, Alexej Barg, Timothy Beals, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population.

Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and …

Identifying Foot And Ankle Patients At Risk To Fall Based On Patient Reported Outcomes Assessments, Judith Baumhauer, Jack Teitel, Allison Mciyntyre, David Mitten, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post- operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) …

Can Women Live With More Symptoms Than Men?: Defining Gender Differences In The Patient Acceptable Symptom State (Pass) In Orthopaedic Foot And Ankle Surgery, Judith Baumhauer, Adolph Flemister, Irvin Oh, Benedict Digiovanni, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Over the last few years an increasing focus has been directed to define cut-off points for important health improvement. Minimal clinically important difference (MCID) values have traditionally been used to determine if a statistical change translates to a clinical improvement to the patient. Although MCID is helpful, it may be even more important to identify if the current treatment is adequate or that the patient has achieved an acceptable symptom state (symptoms minimal enough to live with). The purpose of this study was to determine if gender influenced patient reported outcomes (patient acceptable symptom state (PASS) and PROMIS Physical …

Does Identifying Provider Expectations Improve Adoption Of Patient Reported Outcomes?, Jeff Houck, Jillian Santer, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: New instruments like the Patient Reported Outcome Information System (PROMIS) minimize the burden to patients and providers addressing significant barriers to adoption. Despite these advances provider adoption remains lackluster. Models of technology adoption suggest adoption is more likely to occur when PRO’s directly improve patient care (performance expectancy) and it’s easy to implement (effort expectancy). Problems with effort expectancy are dealt with by training and improving logistics (i.e. eHR presentation, alerts), where performance expectancy is addressed through research (i.e. validation of thresholds). The purposes of this study were to: 1) evaluate the proportion of orthopedic rehabilitation providers who use …

Can Understanding Provider Expectations Improve Provider Adoption Of Patient Reported Outcomes?, Jeff Houck, Jillian Santer, Kostantinos Vasalos, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: New instruments like the Patient Reported Outcome Information System (PROMIS) minimize the burden to patients and providers addressing significant barriers to adoption. Despite these advances provider adoption remains lackluster. Models of technology adoption suggest adoption is more likely to occur when PRO’s directly improve patient care (performance expectancy) and it’s easy to implement (effort expectancy). Problems with effort expectancy are dealt with by training and improving logistics (i.e. eHR presentation, alerts), where performance expectancy is addressed through research (i.e. validation of thresholds). The purposes of this study were to: 1) evaluate the proportion of orthopedic rehabilitation providers who use …

Clinical Utilization Of Patient Reported Outcome (Promis) Scores For Surgical Reconstruction Of Posterior Tibialis Tendon Dysfunction, Michael Anderson, Jeff Houck, Adolph Flemister, Judith Baumhauer, John Ketz, Benedict Digiovanni, David Ciufo, Irvin Oh

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Previous studies have demonstrated that preoperative Patient Reported Outcome Instrumentation System (PROMIS) scores effectively predict improvement in foot and ankle surgery. Adult acquired flatfoot deformity (AAFD) and Posterior Tibialis Tendon Dysfunction (PTTD) are a common surgical problem, but it is unclear if the specific thresholds for the physical function (PF), pain interference (PI) and depression published previously for all foot and ankle surgeries apply to a specific diagnosis. Furthermore, the interplay of PROMIS scores and clinical variables has not been evaluated. The purpose of this study was: 1) to investigate the change in PROMIS scales and radiographic measurements from …

What Does A Promis T-Score Mean For Physical Function?, Jeff Houck, Zane Wise, Amanda Tamanaha, Judith Baumhauer, Luke Skerjanec, Alexandra Wegner, Chris Dasilva, Michael Bass

Faculty Publications - College of Physical Therapy

Introduction/Purpose: The use of patient-reported outcomes (PRO) continues to expand beyond research to involve standard of care assessments. Although the PROMIS physical function (PF) is normalized to a T-score it is unclear how to interpret and apply this information in the daily care of patients. The T-score is abstract and unanchored to patient abilities impairing its clinical utility when shared with the patient. Patient questions are concrete such as “when will I be able to run again after this procedure?” The purpose of this research was to link PROMIS PF T-scores with physical function activities and provide a visual map …