Minimal Clinically Important Difference for PROMIS Physical Function in Patients with Distal Radius Fractures
Ugochi C. Okoroafor, MD; Brinkley K. Sandvall, MD; William D. Gerull, BS; Jason Guattery, MS; Ryan P. Calfee, MD MSc
Washington University in St. Louis School of Medicine, St. Louis, MO
This study was conducted to determine the minimal clinically important difference of the Patient-Reported Outcomes Information System (PROMIS) Physical Function computer adaptive test (CAT) after distal radius fracture.
This study retrospectively analyzed data from 187 adults receiving nonoperative care for a unilateral distal radius fractures at a single institution between February 2016 and November 2017. All patients completed PROMIS Physical Function v1.2/2.0 CAT at each visit. At follow-up, patients also completed two multiple choice clinical anchor questions querying their overall response to treatment (Table 1). Statistical testing assessed ability of the clinical anchor to distinguish levels of improvement, and mean PROMIS Physical Function score change for the group reporting mild improvement was interpreted as the MCID value. The MCID estimate was examined for the influence of patient age, follow-up interval, and initial PROMIS score.
Change in PROMIS Physical Function scores between visits was significantly different between patients reporting no change (0.8), mild improvement (3.6), and much improvement (6.4) compared to their prior visits. The MCID estimate for PROMIS Physical Function was 3.5 points (95% Confidence Interval 2.2-5.0). Individual MCID values were not correlated with patient age or time between visits but were moderately negatively correlated with the initial absolute PROMIS Physical Function score. Initial PROMIS Physical Function scores were significantly associated with the likelihood of patients demonstrating clinically relevant change on the PROMIS CAT, but these initial scores did not affect the percentage of patients reporting clinical improvement on an independent anchor question.
The estimated MCID value for PROMIS Physical Function is 3.6 points in patients treated nonoperatively for distal radius fractures. Initial Physical Function scores influence the chance of a patient exceeding this level of improvement on the PROMIS CAT; however, they do not influence the chance of a patient reporting improvement with treatment.
Figure 1. Flow Diagram of Study Enrollment
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