Elsevier

The Journal of Hand Surgery

Volume 39, Issue 10, October 2014, Pages 2047-2051.e4
The Journal of Hand Surgery

Scientific article
Evaluation of the PROMIS Physical Function Computer Adaptive Test in the Upper Extremity

https://doi.org/10.1016/j.jhsa.2014.06.130Get rights and content

Purpose

To compare psychometric and responder burden characteristics between the Patient-Reported Outcomes Measurement Information System Physical Function Computer Adaptive Test (PF CAT) and the Disabilities of Arm, Shoulder, and Hand (DASH) instruments in a tertiary hand and upper extremity practice.

Methods

Adult patients who presented to the clinic of 2 hand and upper extremity surgeons in a university-based tertiary care center were enrolled in this study. Participants received the DASH and PF CAT administered via tablet computer. Time to completion was recorded for both the DASH and PF CAT. We conducted statistical analyses to calculate Pearson correlation coefficients between the 2 instruments and performed a Rasch item response theory analysis to determine dimensionality, reliability, ceiling and floor effects, and item bias for each instrument.

Results

A total of 134 patients were included. Time to completion for the DASH was 262 seconds, and for the PF CAT 57 seconds. The instruments had strong correlation (r = 0.726). The item and Pearson reliability were 0.97 and 0.94, respectively, for the DASH and 0.99 and 0.96 for the PF CAT. The DASH and PF CAT had 5% and 5% of unexplained variance, respectively. The DASH exhibited 5% of ceiling effect and 1% floor effect whereas the PF CAT had no ceiling or floor effects.

Conclusions

The psychometric characteristics of the Patient-Reported Outcomes Measurement Information System PF CAT instrument compared favorably with the DASH in a tertiary upper extremity practice. Patient time burden was significantly reduced with the PF CAT compared with the DASH.

Type of study/level of evidence

Diagnostic III.

Section snippets

Materials and Methods

We collected data from new and returning patients over 18 years of age seen in a university clinic for any upper extremity problem excluding the shoulder between March 2013 and June 2013. We obtained institutional review board exemption to analyze data from our institution’s musculoskeletal outcomes registry. Patients were given a handheld tablet computer and prompted to complete the DASH (Appendix A, available on the Journal’s Web site at http://www.jhandsurg.org) and PROMIS PF CAT (Appendix B

Results

A total of 134 nonconsecutive patients (74 men and 60 women) made up the final analysis. Table 1 contains information on patient characteristics.

The average number of questions needed to complete a scoreable PF CAT was 5 (range, 4–12) compared with the 30 (range, 27–30) needed to complete a scoreable DASH. Average time to complete the PF CAT was 57 seconds compared with 262 seconds for the DASH (P < .001).

The instruments were highly correlated (r = 0.726; P < .001) (Fig. 1) and both

Discussion

The main strength of this study was that it demonstrated the viability of using CAT as a fast, accurate, and precise alternative to more commonly used questionnaires that evaluate patient outcomes in a hand and upper extremity clinic. A, over 75% reduction in time to complete the PF CAT compared with the DASH was not associated with a loss of reliability, precision, or targeting of the chosen metric.

The noted reduction in time to complete the PF CAT is likely because of the fewer number of

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