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PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to assess the validity, floor and ceiling effects, and dimensionality of PROMIS Physical Function (PF) and Pain compared to legacy patient reported outcome (PRO) measures in patients undergoing medial patellofemoral ligament (MPFL) reconstruction.

Methods

Patients who underwent MPFL reconstruction between 2018 to 2020 were retrospectively reviewed. Preoperatively, patients completed the IKDC, VR-12, Kujala, SF-12, KOOS JR, PROMIS PF and Pain surveys. Inter-survey convergence was assessed with Spearman correlations. Psychometric analysis included investigations of inter-survey convergent validity, intra-survey floor and ceiling effects, and Rasch analyses with person–item fit and iterative question elimination model fit testing.

Results

A total of 76 patients (mean age: 22.6 ± 8.4 years) who completed preoperative surveys were included (compliance: 91.7–96.2%). Preoperatively, age was significantly associated with both PROMIS PF (coefficient:  – 0.291, P = 0.005) and Pain scores (coefficient: 0.294, P = 0.002). PROMIS PF had a Very Good correlation with IKDC and PROMIS Pain had a Very Good correlation with KOOS JR. Other correlations ranged from Poor to Good. No significant floor or ceiling effects were observed for any PRO. On iterative question elimination Rasch modelling, only two questions from PROMIS PF remained after 6 rounds of elimination while PROMIS Pain had no questions remaining after 3 rounds of elimination.

Conclusion

Preoperative PROMIS PF and Pain provided only Fair to Good correlations with most legacy PROs. Although no significant floor and ceiling effects were observed, PROMIS PF and Pain did not perform well psychometrically in this population of patients undergoing MPFL reconstruction. These results suggest PROMIS questionnaires should be used with caution in this population, especially if used in isolation, when discussing clinical expectations with patients. The authors recommend continued use of legacy PROs specific to assessment of patellar instability and function that have established validity in patellar instability populations.

Level of evidence

Level IV.

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Data availability

Data not available.

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Funding

This study did not receive any funding from any source.

Author information

Authors and Affiliations

  1. Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA

    Hailey P. Huddleston, Ophelie Lavoie-Gagne, Nabil Mehta, Justin M. Walsh, Michael C. Fu, Brian Forsythe, Nikhil N. Verma, Brian J. Cole & Adam B. Yanke

  2. Hospital for special surgery, New York, NY, USA

    Hailey P. Huddleston

  3. Harvard, Cambridge, MA, USA

    Ophelie Lavoie-Gagne

  4. Houston Methodist, Houston, TX, USA

    Justin M. Walsh

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  1. Hailey P. Huddleston
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  2. Ophelie Lavoie-Gagne
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  5. Michael C. Fu
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Contributions

HPH—substantial contributions to study conception and design, acquisition, analysis, and interpretation of the data, drafting and revising, approved the final version, and agrees to be accountable for all aspects of the work. OLG—substantial contributions to study conception and design, acquisition and analysis of the data, drafting and revising, approved the final version, and agrees to be accountable for all aspects of the work. NM—substantial contributions to acquisition and analysis of the data, drafting and revising, approved the final version, and agrees to be accountable for all aspects of the work. JMW—substantial contributions to acquisition and analysis of the data, drafting and revising, approved the final version, and agrees to be accountable for all aspects of the work. MCF—substantial contributions to conception, design, and interpretation of data, drafting and revising of the work, approved the final version, and agrees to be accountable for all aspects of the work. BF—substantial contributions to conception and interpretation of data, drafting and revising of the work, approved the final version, and agrees to be accountable for all aspects of the work. NNV—substantial contributions to conception and interpretation of data, drafting and revising of the work, approved the final version, and agrees to be accountable for all aspects of the work. BJC—substantial contributions to conception and interpretation of data, drafting and revising of the work, approved the final version, and agrees to be accountable for all aspects of the work. ABY—substantial contributions to conception and interpretation of data, drafting and revising of the work, approved the final version, and agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Adam B. Yanke.

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Ethical approval

This study was performed and received Institutional Review Board approval at Rush University Medical Center. Due to the retrospective nature of this study, this study was granted a corresponding waiver of consent.

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Huddleston, H.P., Lavoie-Gagne, O., Mehta, N. et al. PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 31, 5067–5076 (2023). https://doi.org/10.1007/s00167-023-07535-4

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