Patient-Reported Outcomes Measurement Information System Is Not as Responsive as Legacy Scores in Detecting Patient Outcomes in Hip Preservation: A Systematic Review


      To evaluate publication trends of Patient-Reported Outcomes Measurement Information System (PROMIS) in hip preservation literature, assess the usage of PROMIS as an outcome measure, and evaluate correlations of all available published PROMIS domains with legacy patient-reported outcomes (PROs).


      The PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar databases were queried for articles evaluating PROMIS scores among hip preservation populations. Inclusion criteria consisted of studies with Level IV evidence or above (per the Sackett et al. levels of evidence), such as case series and cohort studies, reporting on perioperative use of hip PROMIS scores. Exclusion criteria consisted of arthroplasty and trauma studies. Patient demographics, PROMIS usage, and PROMIS Pearson or Spearman correlation coefficients to historic PROs were recorded for each study.


      Fifteen articles published between 2017 and 2021 were included in the analysis, with the majority (75%) published between 2020 and 2021. Studies assessing postoperative outcomes had follow-up periods ranging from 6 months to 5 years. The most common PROMIS domain reported was Physical Function (PF), and there was varying usage of other domains including Pain Intensity, Anxiety, and Depression. PROMIS validity was most often assessed in comparison to the modified Harris Hip Score (mHHS) by calculating the Pearson coefficient, which assumes normal data distribution, or Spearman coefficient, which is rank-based and does not require normal data distribution. Studies comparing PROMIS-PF with mHHS reported Pearson coefficients ranging from 0.49 to 0.72 and Spearman coefficients ranging from 0.67 to 0.71.


      There has been a chronologic increase in PROMIS usage in hip preservation literature. PROMIS demonstrates moderate-to-strong correlations with legacy PROs, but there is substantial heterogeneity in follow-up periods, PROMIS domains used, and statistical methodology. The current data show that PROMIS is not as responsive as historically used, validated PROs in quantitatively assessing function and pain in hip preservation patients.

      Clinical Relevance

      Surgeons using PROMIS solely should be aware that the score may not be as responsive as legacy PROs in closely assessing improvements or deterioration in patient performance after hip preservation surgery. Rather than being used alone, PROMIS may be useful as a replacement for a group of legacy PROs. Thus, when used alongside select legacy PROs, overall questionnaire burden can be reduced while maintaining a high level of accuracy in assessing health status.
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