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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Comparison of Pediatric PROMIS Computer Adaptive Tests between Parent-Proxy and Patient Report Populations with Upper Extremity Fractures
William D. Gerull, BS; Ugochi Okoroafor, MD; Jason Guattery, MS; Charles A. Goldfarb, MD; Lindley B. Wall, MD MSc; Ryan P. Calfee, MD MSc; Washington University in St. Louis School of Medicine, St. Louis, MO

Introduction: The NIHs Patient-Reported Outcomes Measurement Information System (PROMIS) offers pediatric specific assessments of musculoskeletal function.  Pediatric PROMIS assessments are offered as either a parent-proxy (5-7 year olds) or patient self-administered (8-17 year olds) version.  Pediatric Physical Function assessment also distinguishes between Upper Extremity (UE) and Mobility scores.  Although validated during development, the performance of pediatric PROMIS assessments following upper extremity injury is untested. 

Materials & Methods: This cross-sectional study analyzed 1924 pediatric patients presenting to the offices of a tertiary center with an upper extremity (UE) fracture between June 1, 2016 and June 1, 2017. All patients completed PROMIS Pain Interference, Peer Relationships, UE Function, and Mobility computer adaptive tests at initial registration. Patients were grouped according to PROMIS being completed by parent-proxy (n=418) or self-administration (n=1506).  For each group, PROMIS score distributions were examined and Pearson correlations assessed the degree of inter-relation between PROMIS domains.  To assess the impact of parent-proxy completion versus self-administration on absolute PROMIS scores, each 5-7 year old patient was matched by fracture location with 2 patients in the 8-17 year old group with students t-tests to compare mean PROMIS scores between the groups. 

Results: Consistent for both parent-proxy and self-administered surveys, UE function scores indicated the greatest average impairment of all PROMIS domains (Table 1). At presentation though, 11% of patients (4.9% parent-proxy, 12.8% self-administered) reached the ceiling UE score indicating maximal UE function. However, in both groups UE scores were strongly correlated with Mobility (r=0.61 to 0.64), and moderately correlated with Pain Interference (r=-0.41 to -0.43) scores. In all patients, Peer Relationships was, at most, very weakly correlated with any other PROMIS domain (r<0.15). After matching by fracture type, parent-proxy completion estimated worse UE function (-5.8 points, p<0.01) and more Pain Interference (5.3 points, p<0.01) but comparable Mobility and Peer Relationship scores.  

Conclusions:

-Pediatric PROMIS Upper Extremity function scores capture impairment from fracture but are limited by ceiling effect.

-Pediatric PROMIS Upper Extremity function and Mobility components of Physical Function are strongly correlated indicating that these are not independent domains.

-Among children with upper extremity fractures, parent-proxy completion of pediatric PROMIS may magnify perceived physical impairment and pain.

-Pediatric Peer Relationships is not related to either Physical Function or Pain Interference scores after fracture.

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