The use of PROMIS CAT Physical Function Pre-surgical Scores to Predict Recovery and Establish Pre-surgical Cut-off Values

Objectives: There is a lack of standardized outcome measures or methods to study the effects of treatment and to effectively monitor and document patient outcomes. We have used Patient Reported Outcome Measurement Information System (PROMIS) computed adaptive testing questionnaires collected during routine office visits to describe the pre-surgical and postsurgical physical function scores and to assess the ability of pre-surgical scores to predict scores at 6 month after surgery. Methods: A retrospective analysis of 619 patients undergoing ACL reconstructive surgery at a large academic medical system was conducted to compare the predictive value of baseline PROMIS physical function scores to predict those scores after surgery. Patients with PROMIS physical Function scores within 1 standard deviation of the normal population at baseline were compare to those who fell below that score. Longitudinal comparisons of PROMIS scores between subsets was then made to identify any significant differences. PROMIS scores were assessed for discriminatory ability using receiver operating characteristic (ROC) curve analyses, with overall accuracy summarized using the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were used for each measurement at similar time points. Results: As shown in figure 1 average PROMIS physical function scores at later timepoints were comparable to those who had higher baseline scores. An ANOVA general linear (GROUP x TIME) model found statically significant (p0.826). Using the ROC analysis an “optimal” cut-off pre-surgical score was determined to be a T-Score of 42.6. Conclusion: If fully utilized, these outcome measures can help inform physicians in individual surgical cases, as well as be used to show overall practice trends. Early identification of potential poor outcomes after ACL reconstruction may result in ability to intervene earlier to prevent prolonged disability. This investigation into the use of PROMIS physical function assessment tools has shown some utility in the ability to discriminate between those individuals who go on to have a full recovery over a typical recovery timeline and those who go on to have slower recovery.