Validation of PROMIS Physical Function for Evaluating Outcome After Acute Achilles Tendon Rupture

Orthopaedic Journal of Sports Medicine, vol. 9, pp. 23259671211022686

Abstract

Background: There is increased demand for valid, reliable, and responsive patient-reported outcome measures (PROMs) to evaluate treatment for Achilles tendon rupture, but not all PROMs currently in use are reliable and responsive for this condition. Purpose: To evaluate the measurement properties of the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) compared with other PROMs used after treatment for acute Achilles tendon rupture. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A retrospective cohort study with a follow-up questionnaire was performed. All adult patients with an acute Achilles tendon rupture between June 2016 and June 2018 with a minimum 12-month follow-up were eligible for inclusion. Functional outcome was assessed using the PROMIS PF computerized adaptive test (CAT), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), FAAM–Sports, and Achilles Tendon Total Rupture Score (ATRS). Pearson correlation ( r) was used to assess the correlations between PROMs. Absolute and relative floor and ceiling effects were calculated. Results: In total, 103 patients were included (mean age, 44.7 years; 74% male); 82 patients (79.6%) underwent operative repair, while 21 patients (20.4%) underwent nonoperative management. The mean time between treatment and collection of PROMs was 25.3 months (range, 15-36 months). The mean scores were 55.4 ± 9.2 (PROMIS PF), 92.9 ± 12.2 (FAAM-ADL), 77.7 ± 22.9 (FAAM–Sports), and 83.0 ± 19.4 (ATRS). The ATRS was correlated with FAAM-ADL ( r = 0.80; 95% CI, 0.72-0.86; P < .001) and FAAM–Sports ( r = 0.86; 95% CI, 0.80-0.90; P < .001). The PROMIS PF was correlated with the FAAM-ADL ( r = 0.66; 95% CI, 0.53-0.75; P < .001), FAAM–Sports ( r = 0.65; 95% CI, 0.53-0.75; P < .001), and ATRS ( r = 0.69; 95% CI, 0.58-0.78; P < .001). The PROMIS PF did not show absolute floor or ceiling effects (0%). The FAAM-ADL (35.9%), FAAM–Sports (15.8%), and ATRS (20.4%) had substantial absolute ceiling effects. Conclusion: The PROMIS PF, FAAM-ADL, and FAAM–Sports all showed a moderate to high mutual correlation with the ATRS. Only the PROMIS PF avoided substantial floor and ceiling effects. The results suggest that the PROMIS PF CAT is a valid, reliable, and perhaps the most responsive tool to evaluate patient outcomes after treatment for an Achilles tendon rupture.

Authors 7

1. Yassine Ochen corresponding Aachen Department of Clinical Epidemiology Department of Biomedical Data Sciences

   Harvard University · Leiden University Medical Center · University Medical Center Utrecht · Massachusetts General Hospital

   Affiliation as printed

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

   Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA

   Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

2. Daniel Guss

   Harvard University · Newton Wellesley Hospital · Massachusetts General Hospital

   Affiliation as printed

   Department of Orthopedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

   Department of Orthopedic Surgery, Foot and Ankle Service, Newton-Wellesley Hospital, Newton, Massachusetts, USA

3. Roderick Marijn Houwert

   University Medical Center Utrecht

   Affiliation as printed

   Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands

4. Jeremy T. Smith

   Brigham and Women's Hospital · Harvard University

   Affiliation as printed

   Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

   Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massa-chusetts, USA

5. Christopher William DiGiovanni

   Harvard University · Newton Wellesley Hospital · Massachusetts General Hospital

   Affiliation as printed

   Department of Orthopedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

   Department of Orthopedic Surgery, Foot and Ankle Service, Newton-Wellesley Hospital, Newton, Massachusetts, USA

6. Rolf H. H. Groenwold Aachen Department of Biomedical Data Sciences Department of Clinical Epidemiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

7. Marilyn M. Heng Aachen Department of Biomedical Data Sciences

   Brigham and Women's Hospital · Harvard University · Leiden University Medical Center · Massachusetts General Hospital

   Affiliation as printed

   Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA

   #Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

   **Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands