PROMIS (Patient-Reported Outcomes Measurement Information System) has proven to be a reliable and efficient gathering of data in patients with rotator cuff injuries. This study aimed to establish threshold score changes in PROMIS computer adaptive test (CAT) scores following rotator cuff reconstruction (RCR) to define the minimal clinically relevant difference (MCID) and substantial clinical benefit (SCB). Researchers wanted to see any risk factors for not achieving MCID and SCB. During 24 months, patients undergoing arthroscopic RCR were identified. This sample only included individuals who completed preoperative and postoperative PROMIS CAT assessments. With a minimum of 1.5-year follow-up, PROMIS CAT forms for upper extremity physical function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) were used by Researchers. Statistical analysis was used to assess threshold score changes, anchor-based MCID and SCB, and risk variables for failure to achieve significant clinical improvement following surgery.
Only 168 (84.8%) of the 198 eligible patients were included in the study. Delta PROMIS-UE values of 5.8 and 9.7 (AUC=0.906 and 0.949, respectively) were identified as threshold predictors of MCID and SCB attainment, as were delta PROMIS-PI values of -11.4 and -12.9 (AUC=0.875 and 0.938, respectively). For PROMIS-UE, PROMIS-PI, and PROMIS-D, on average, 81%, 65%, and 55% of patients reached MCID, while 71%, 61%, and 38% of patients in the cohort achieved SCB. Smoking status (LR: 9.8, p=0.037), tear size (LR: 10.4, p=0.001), a distal gathering of p=0.005), and prior shoulder surgery (LR: 19.2, p=0.001) all had a substantial impact on MCID accomplishment in PROMIS-UE. Smoking status (LR: 9.3, p=0.022), tear size (LR: 8.0, p=0.039), and past shoulder surgery (11.9, p<0.001) were all factors that influenced SCB accomplishment for PROMIS-UE. Smoking status (LR: 7.0, p=0.030 and LR: 5.2, p=0.045) and past shoulder surgery (LR: 9.1, p=0.002 and LR: 7.4, p=0.006) were also significantly different rates of MCID and SCB attainment in PROMIS-PI. Following RCR, most patients showed clinically meaningful improvements in PROMIS-UE and PROMIS-PI that exceeded the specified MCID. In PROMIS-UE, patients with larger tear sizes, a history of prior shoulder surgery, cigarette users, and those who got concomitant distal clavicle excision were more likely to fail to reach MCID. Additionally, smokers and patients who had previously undergone shoulder surgery had much poorer pain relief after surgery.
Reference:www.jshoulderelbow.org/article/S1058-2746(22)00221-X/fulltext
