Foot & Ankle International - July 2018 - 763

765225
research-article2018

FAIXXX10.1177/1071100718765225Foot & Ankle InternationalAnderson et al

Article

Validation and Generalizability of
Preoperative PROMIS Scores to
Predict Postoperative Success in
Foot and Ankle Patients

Foot & Ankle International®
2018, Vol. 39(7) 763-770
© The Author(s) 2018
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https://doi.org/10.1177/1071100718765225
DOI: 10.1177/1071100718765225
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In-Depth

Michael R. Anderson, DO1, Jeff R. Houck, PT, PhD2, Charles L. Saltzman, MD3,
Man Hung, PhD3, Florian Nickisch, MD3, Alexej Barg, MD3, Timothy Beals, MD3,
and Judith F. Baumhauer, MD, MPH1

Abstract
Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation
System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and
ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation
and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold
t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically
unique patient population.
Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and ankle clinic were
obtained between January 2014 and November 2016. Patients undergoing elective foot and ankle surgery were identified
and PROMIS values obtained at initial and follow-up visits (average, 7.9 months). Analysis of variance was used to assess
differences in PROMIS scores before and after surgery. The distributive method was used to estimate a minimal clinically
important difference (MCID). Receiver operating characteristic curve analysis was used to determine thresholds for
achieving and failing to achieve MCID. To assess the validity and generalizability of these threshold values, they were
compared with previously published threshold values for accuracy using likelihood ratios and pre- and posttest probabilities,
2
and the percentages of patients identified as achieving and failing to achieve MCID were evaluated using χ analysis.
Results: There were significant improvements in PF (P < .001) and PI (P < .001) after surgery. The area under the curve for
PF (0.77) was significant (P < .01), and the thresholds for achieving MCID and not achieving MCID were similar to those in
the prior study. A significant proportion of patients (88.9%) identified as not likely to achieve MCID failed to achieve MCID
(P = .03). A significant proportion of patients (84.2%) identified as likely to achieve MCID did achieve MCID (P < .01). The
area under the curve for PROMIS PI was not significant.
Conclusions: PROMIS PF threshold scores from published data were successful in classifying patients from a different
patient and geographic population who would improve with surgery. If functional improvement is the goal, these thresholds
could be used to help identify patients who will benefit from surgery and, most important, those who will not, adding value
to foot and ankle health care.
Level of evidence: Level II, Prospective Comparative Study
Keywords: patient-reported outcomes, PROMIS, foot and ankle, pain, physical function
The utility of patient-reported outcomes (PROs) has begun
to expand beyond the scope of research by demonstrating
value in direct patient care, however, the adoption of PROs
in daily clinical practice is not widespread. Systematic barriers to PRO adoption are numerous and include technological, financial, and work flow challenges to realizing clinical
integration of PROs for physicians.1 Widespread adoption, therefore, will hinge upon the realization that PROs

1

University of Rochester, Rochester NY, USA
George Fox University, Newberg, OR, USA
3
University of Utah, Salt Lake City, UT, USA
2

Corresponding Author:
Judith F. Baumhauer, MD, MPH, University of Rochester, School of
Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY
14642, USA.
Email: judy_baumhauer@urmc.rochester.edu


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Table of Contents for the Digital Edition of Foot & Ankle International - July 2018

Contents
Foot & Ankle International - July 2018 - Intro
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