Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 5;4(4):e0015.
doi: 10.2106/JBJS.OA.19.00015. eCollection 2019 Oct-Dec.

Floor and Ceiling Effects, Time to Completion, and Question Burden of PROMIS CAT Domains Among Shoulder and Knee Patients Undergoing Nonoperative and Operative Treatment

Caleb M Gulledge  1 , D Grace Smith  1 , Alexander Ziedas  1 , Stephanie J Muh  1 , Vasilios Moutzouros  1 , Eric C Makhni  1
Affiliations

Floor and Ceiling Effects, Time to Completion, and Question Burden of PROMIS CAT Domains Among Shoulder and Knee Patients Undergoing Nonoperative and Operative Treatment

Caleb M Gulledge et al. JB JS Open Access. .

Abstract

The Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) have emerged as an efficient technique for measuring patient-reported outcomes among orthopaedic patients. The purpose of this study was to investigate the floor and ceiling (F/C) effects, time to completion (TTC), and question burden of PROMIS CATs administered to patients presenting to a shoulder and sports medicine orthopaedic clinic.

Methods: Patients prospectively completed PROMIS CATs including the physical function (PROMIS-PF) or upper-extremity function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) domains at their initial encounter and were retrospectively included in this study. Adult patients indicating a single problem involving either the shoulder or knee were included. Patients were also grouped as either preoperative or nonoperative. F/C effects were defined as the proportion of respondents scoring the highest (ceiling) or lowest (floor) possible score across a given domain.

Results: Included were 2,952 patients (average age, 51.0 ± 16.9 years). The PROMIS-UE, PROMIS-PF, and PROMIS-PI demonstrated negligible F/C effects across all shoulder and knee patients (<2%). The PROMIS-D displayed moderate to significant floor effects (13.9% to 18.9%) and a 0% ceiling effect in all main patient groups. The mean TTC and mean question burden of the PROMIS-UE, PROMIS-PF, and PROMIS-PI ranged from 45.3 to 54.4 seconds and 4.1 to 4.9 questions for all patient groups, while the PROMIS-D exhibited a TTC ranging from 20.9 to 38.6 seconds for all groups and a question burden that ranged from 6.2 to 6.7 questions.

Conclusions: The PROMIS-PF, PROMIS-UE, and PROMIS-PI demonstrated favorable F/C effects, TTC, and question burden among both nonoperative and preoperative patients. These findings justify consideration of the PROMIS-PF, PROMIS-UE, and PROMIS-PI for clinical and research applications involving shoulder and knee sports medicine patients. Additionally, we found moderate to significant floor effects for the PROMIS-D in all patient groups, which may be multifactorial in nature and may not be unexpected in patients with an isolated joint concern.

Clinical relevance: This study highlights the psychometric properties of PROMIS CAT forms for knee and shoulder patients. Understanding these basic properties is important in considering the adoption of PROMIS CAT forms for patients with musculoskeletal conditions.

PubMed Disclaimer

References

    1. Kadri O, Jildeh TR, Meldau JE, Blanchett J, Borowsky P, Muh S, Moutzouros V, Makhni EC. How long does it take for patients to complete PROMIS scores?: an assessment of PROMIS CAT questionnaires administered at an ambulatory sports medicine clinic. Orthop J Sports Med. 2018. Aug 14;6(8):2325967118791180. - PMC - PubMed
    1. Hancock KJ, Glass N, Anthony CA, Wolf BR, Hettrich CM, Albright J, Bollier M, Amendola A. PROMIS: a valid and efficient outcomes instrument for patients with ACL tears. Knee Surg Sports Traumatol Arthrosc. 2019. Jan;27(1):100-4. Epub 2018 Jul 4. - PubMed
    1. Rose M, Bjorner JB, Gandek B, Bruce B, Fries JF, Ware JE, Jr. The PROMIS physical function item bank was calibrated to a standardized metric and shown to improve measurement efficiency. J Clin Epidemiol. 2014. May;67(5):516-26. - PMC - PubMed
    1. Hung M, Stuart AR, Higgins TF, Saltzman CL, Kubiak EN. Computerized adaptive testing using the PROMIS physical function item bank reduces test burden with less ceiling effects compared with the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma. 2014. Aug;28(8):439-43. - PubMed
    1. Strong B, Maloney M, Baumhauer J, Schaffer J, Houck JR, Hung M, Bounsanga J, Voss MW, Gu Y, Voloshin I. Psychometric evaluation of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and pain interference computer adaptive test for subacromial impingement syndrome. J Shoulder Elbow Surg. 2019. Feb;28(2):324-9. Epub 2018 Oct 18. - PubMed