PROMIS computerized adaptive testing is effective and efficient for outcome assessment in patients with wrist or hand fractures.

INTRODUCTION

Various patient-reported outcome measures (PROMs) are available to assess functional outcomes in patients treated for wrist-hand fractures. Among the most frequently applied instruments are the Patient-Rated Wrist/Hand Evaluation (PRWHE), Quick Disabilities of the Arm, Shoulder and Hand and Short Musculoskeletal Function Assessment. Computerized adaptive tests (CATs) utilizing the PROM-Information System (PROMIS) offers a standardized alternative. This study compared the psychometric properties of PROMIS CATs with these three legacy instruments and assessed independent factors associated with worse PROMIS scores.

METHODS

Patients treated for wrist-hand fractures were recruited in a Level I trauma centre. Construct validity was assessed by correlating instruments (Pearson's R > 0.7 was considered sufficient). Reliability (standard error (SE), α), efficiency (items/time needed to completion) and floor/ceiling effects were assessed per instrument. A mean SE < 2.2 was deemed sufficient and an α > 0.7. Factors associated with worse PROMIS scores were also identified.

RESULTS

Correlations between PROMIS measures and legacy instruments were high (r = 0.74-0.84), except for a moderate correlation between PROMIS-Physical Function and PRWHE (r = 0.63). Reliability for all PROM's was sufficient (SE 2.1-2.2, α 0.92-0.97). PROMIS required fewer items (4-8 vs. 11-46) and less time (51-84 vs. 131-314 seconds). The PROMs did not exhibit floor/ceiling effects. An elevated level of depression was one of the strongest factors independently associated with worse PROMIS scores.

CONCLUSION

PROMIS CATs showed strong correlations with legacy instruments, supporting its ability to provide comparable functional assessments. Computerized adaptive tests maintain high reliability while offering greater efficiency than legacy instruments. Elevated depressive symptoms emerged as one of the strongest independent predictors of worse CAT scores in this study.

LEVEL OF EVIDENCE: Diagnostic study, Level II.