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Resident PGY 2
Henry Ford Hospital
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a valid and efficient means of collecting patient outcomes in patients with rotator cuff tear. The purpose of this study was to examine the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting post-operative PROMIS CAT scores as well as likelihood of achieving minimal clinically important difference (MCID) following rotator cuff repair. We hypothesize that pre-operative PROMIS CAT scores will directly impact both post-operative PROMIS CAT scores and likelihood of achieving MCID.Methods: Patients undergoing arthroscopic rotator cuff repair by one of three fellowship-trained surgeons were identified over a 12-month period. Only patients that completed pre-operative and 6-month post-operative PROMIS CAT assessments were included in this cohort. PROMIS CAT forms for upper extremity physical function (PROMIS-U), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Preoperative cutoffs were used to predict which patients would likely meet MCID using 95% specificity. Results: A total of 80 patients met our inclusion criteria. PROMIS-UE, PROMIS-PI and PROMIS-D improved 6 months after surgery (p<0.001). 76% of patients met MCID for PROMIS-UE, while 89% met MCID for PROMIS-PI, and 54% met MCID for PROMIS-D. Preoperative PROMIS scores were predictive of post-operative outcomes based on ROC analysis which demonstrated significant area under the curve (AUC) of .725 (p=0.003), .757 (p=0.013), and .789 (p<0.001) for PROMIS-UE, PROMIS-PI, and PROMIS-D, respectively. Individuals with PROMIS-UE scores below 24.95 and PROMIS-PI scores above 65.65 yielded a 100% probability of achieving MCID, while a cutoff of 56.45 for PROMIS-D yielded a 91% probability of achieving MCID with 95% specificity. Conclusion: Patients undergoing arthroscopic rotator cuff repair experience significant improvements in upper extremity physical function, pain interference and depression as measured by PROMIS CAT domains. In particular, patients presenting with PROMIS upper extremity scores of <24.95 are especially likely to achieve MCID.
Tramer, Joseph S; Franovic, Sreten; Kuhlmann, Noah A.; Gulledge, Caleb; Moutzouros, Vasilios; Muh, Stephanie J.; and Makhni, Eric C, "Preoperative PROMIS Scores Predict Postoperative Improvements Following Rotator Cuff Repair" (2019). Clinical Research. 51.