Purpose
The purpose of the study was to define the minimal clinically important difference
(MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state
(PASS) thresholds for the Patient-Reported Outcomes Measurement Information System
(PROMIS) Physical Function (PF) computerized adaptive test (CAT) instrument in patients
undergoing arthroscopic meniscal surgery.
Methods
The PROMIS PF CAT was administered preoperatively and postoperatively to patients
undergoing arthroscopic meniscal surgery. At 6 months postoperatively, patients graded
their knee function based on a domain-specific anchor question. A satisfaction anchor
question was used to indicate achievement of the PASS. Receiver operating characteristic
analysis determined the relevant psychometric values. Cutoff analysis was performed
to find preoperative patient-reported outcome scores predicting achievement of clinically
significant outcomes (CSOs).
Results
A total of 73 patients (41.1% female patients) were included, with a mean age of 44.9
± 12.8.0 years and average follow-up period of 24.0 ± 1.2 weeks. The MCID on the PROMIS
PF CAT was calculated to be 2.09 (area under the curve [AUC], 0.75; 95% CI, 0.57-0.94).
Net score improvement equivalent to achievement of SCB was found to be 6.50 (AUC,
0.77; 95% CI, 0.55-0.99). The PASS was found to be 46.1 (AUC, 0.86; 95% CI, 0.76-0.96).
A preoperative score below 37.6 on the PROMIS PF CAT predicted achievement of the
MCID (AUC, 0.76; 95% CI, 0.62-0.87), whereas scores above 41.9 predicted achievement
of the PASS (AUC, 0.77; 95% CI, 0.65-0.90). Higher baseline functional status and
the absence of pre-existing arthritis were also found to be statistically significant
predictors of achieving CSOs.
Conclusions
Our study defined the MCID, SCB, and PASS for the PROMIS PF CAT. We found that a preoperative
score below 37.6 was predictive of achieving a meaningful clinical change with surgery
whereas a preoperative score above 41.9 was predictive of patients who would attain
an acceptable postoperative health state. In addition, exercising more days per week
and the absence of arthritis increased the likelihood of achieving postoperative CSOs.
Level of Evidence
Level III, retrospective cohort.
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Article info
Publication history
Accepted:
July 28,
2019
Received:
April 15,
2019
Footnotes
See commentary on page 251
The authors report the following potential conflicts of interest or sources of funding: N.V. receives financial support for this study from Smith & Nephew; research support from Arthrex and DJ Orthopaedics; publishing royalties and material support from Arthroscopy; and publishing royalties from Vindico Medical-Orthopedics Hyperguide. B.C. receives research support from Aesculap/B.Braun, Geistlich, National Institutes of Health, and sanofi-aventis; is on the editorial or governing board of the American Journal of Orthopedics, American Journal of Sports Medicine, Arthroscopy, Cartilage, Journal of Bone and Joint Surgery–American, and Journal of Shoulder and Elbow Surgery; receives stock or stock options from Aqua Boom, Biomerix, Giteliscope, and Ossio; receives IP royalties and research support from and is a paid consultant for Arthrex; is a board or committee member of the Arthroscopy Association of North America and International Cartilage Repair Society; receives other financial or material support from Athletico, JRF Ortho, and Tornier; receives IP royalties from DJ Orthopaedics and Elsevier Publishing; is a paid consultant for Flexion; receives publishing royalties and financial or material support from Operative Techniques in Sports Medicine; is a paid consultant for and receives stock or stock options from Regentis; receives other financial or material support from and is a paid consultant for Smith & Nephew; and is a paid consultant for and receives research support from Zimmer. B.F. receives paid royalties from Elsevier; receives research support from Arthrex; receives stock or stock options from Jace Medical; receives fellowship support from Smith & Nephew and Ossur; and is a consultant for and receives research support from Stryker. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
