Responsiveness of PROMIS Instruments for Trigger Digit After Corticosteroid Injection or A-1 Pulley Release
Amy Phan, BS1, Thais Calderon, MD1 and Warren C. Hammert, MD2, (1)University of Rochester, Rochester, NY, (2)Department of Orthopaedics, University of Rochester, Rochester, NY
Introduction: Health care payers are considering outcome data to assign value to interventions and to determine reimbursement rates, but there is still uncertainty if the Patient Reported Outcomes Measurement Information System (PROMIS) is sufficiently sensitive to detect improvement after treatment of common hand conditions such as trigger digits. Our null hypothesis is that there is not significant improvement in PROMIS domains in the initial recovery period after corticosteroid injection or A-1 pulley release.
Methods and Materials: This is a retrospective cohort study including 72 patients in the injection group and 51 patients in the A-1 pulley release group. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) scores were collected at baseline and 6-weeks post-injection. For A-1 pulley release patients, they were collected at baseline, and 1-week, 6-weeks, and 3-months postoperatively. Descriptive statistics and paired t-tests were used to compare PROMIS scores within each cohort. Standardized response means (SRMs) were calculated for each PROMIS domain to gauge instrument responsiveness.
Results: For the steroid injection cohort, the average age was 62.4 years old, 65.3% were female, and 86.1% were Caucasian. For the A-1 pulley release cohort, the average age was 59.7 years old, 70.6% were female, and 88.2% were Caucasian. On average, PROMIS PI and UE scores improved significantly from baseline to 6-weeks post-injection (p < 0.001 and SRM = -0.63; p < 0.001 and SRM=0.54). Meanwhile, PI and UE scores for A-1 pulley release patients worsen from baseline to 1-week postoperatively (p = 0.38; p = 0.13), significantly improve 1-week to 6-weeks postoperatively (p = 0.002; p < 0.001) and continue to improve to 3 months (p = 0.39; p = 0.60). Moreover, A-1 pulley release patients improved significantly at 3-months compared to baseline in mean PI scores (p < 0.001; SRM = -0.53) and in mean UE scores (p = 0.03; SRM=0.67).
Conclusions: PROMIS PI and UE have moderate responsiveness in capturing improvement for trigger digit 6 weeks after steroid injection and 3 months after A-1 pulley release. PROMIS PF and Depression have only mild responsiveness in outcomes after trigger digit treatments. PROMIS PI and UE can be used in the immediate post-treatment period for trigger digit to capture improvement after corticosteroid injection or A-1 pulley release.
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