Clinical Orthopaedics and Related Research®

, Volume 471, Issue 11, pp 3466–3474 | Cite as

Validation of PROMIS® Physical Function Computerized Adaptive Tests for Orthopaedic Foot and Ankle Outcome Research

  • Man HungEmail author
  • Judith F. Baumhauer
  • L. Daniel Latt
  • Charles L. Saltzman
  • Nelson F. SooHoo
  • Kenneth J. Hunt
  • National Orthopaedic Foot & Ankle Outcomes Research Network
Symposium: ABJS Carl T. Brighton Workshop on Outcome Measures



In 2012, the American Orthopaedic Foot & Ankle Society® established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.


We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System® (PROMIS®) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients’ physical function.


After informed consent, 288 patients with a mean age of 51 years (range, 18–81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS® Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients’ physical function levels. Instrument coverage was based on a person-item map.


Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of −0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach’s alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect.


The PROMIS® PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS® item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.


Item Response Theory Item Bank Computerize Adaptive Test Foot Function Index Hallux Rigidus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Ian Alexander MD (Cleveland Clinic–Medina Hospital, Medina, OH, USA) for his extensive contributions to the AOFAS OFAR Network and this project. We acknowledge the contributing investigators of the OFAR Network, including Timothy R. Daniels MD (University of Toronto, Toronto, ON, Canada), James Brodsky MD (Baylor University, Houston, TX, USA), Jon Deland MD (Hospital for Special Surgery, New York, NY, USA), Scott Ellis MD (Hospital for Special Surgery, New York, NY, USA), Phinit Phisitkul MD (University of Iowa, Iowa City, IA, USA), W. Hodges Davis MD (OrthoCarolina Research Institute, Charlotte, NC, USA), Susan Ishikawa MD (The University of Tennessee–Campbell Clinic, Memphis, TN, USA), Loretta B. Chou MD (Stanford University, Redwood City, CA, USA), John Ketz MD (University of Rochester, Rochester, NY, USA), Margaret Chilvers MD (University of Arizona, Tucson, AZ, USA), Sam Flemister MD (University of Rochester, Rochester, NY, USA), Florian Nickisch MD (University of Utah, Salt Lake City, UT, USA), and Timothy Beals MD (University of Utah, Salt Lake City, UT, USA). We are thankful for the contributions of each of the 10 clinical testing sites in the OFAR Network. We also thank Lousanne Lofgren BS (AOFAS, Rosemont, IL, USA) and Rose Olea BS (AOFAS, Rosemont, IL, USA) for their tireless work on this project. Special thanks go to Christine Cheng BS (University of Utah, Salt Lake City, UT, USA) and Shirley D. Hon BS (University of Utah, Salt Lake City, UT, USA) for their tremendous support in data collection, analysis, manuscript preparation, and review. Finally, the study design, statistical and psychometric support, and computing resources provided by the Center for Outcomes Research and Assessment at the University of Utah Department of Orthopaedics are gratefully acknowledged.

Supplementary material

11999_2013_3097_MOESM1_ESM.doc (50 kb)
Supplementary material 1 (DOC 49 kb)
11999_2013_3097_MOESM2_ESM.docx (35 kb)
Supplementary material 2 (DOCX 35 kb)


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Man Hung
    • 1
    Email author
  • Judith F. Baumhauer
    • 2
  • L. Daniel Latt
    • 3
  • Charles L. Saltzman
    • 1
  • Nelson F. SooHoo
    • 4
  • Kenneth J. Hunt
    • 5
  • National Orthopaedic Foot & Ankle Outcomes Research Network
    • 6
  1. 1.Department of Orthopaedic Surgery OperationsUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of ArizonaTucsonUSA
  4. 4.Department of Orthopaedic SurgeryUniversity of California Los Angeles School of MedicineLos AngelesUSA
  5. 5.Department of Orthopaedic SurgeryStanford UniversityRedwood CityUSA
  6. 6.American Orthopaedic Foot and Ankle Society®RosemontUSA

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