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Presenting PROMIS Scores Correlate with Operative Status in Patients with De Quervain's Tenosynovitis
Gilbert S Smolyak, Medical Student, Courtney Jones, PhD, MPH, Bowen Qiu, MD and Constantinos Ketonis, MD, PhD, University of Rochester Medical Center, Rochester, NY

Introduction
De Quervain's Tenosynovitis (DQT) remains a common source of pain and loss of hand function. Treatment is largely empiric, but, PROMIS scores at time of diagnosis might provide insights into success of non-operative management and predict necessity for surgical release.
Materials & Methods
Patients presenting to a tertiary academic medical center from 2014-2019 with a sole diagnosis of DQT were identified. Patients <18 years old or that had other diagnoses were excluded. Patients were separated by treatment: physical therapy, injections, surgery or combinations thereof (Figure 1). Chi-square analysis was performed to identify confounding variables or demographic factors that affect treatment strategy. A two-sided t-test was performed to identify differences in presenting PROMIS scores (PPS) between initial and final operative status. Patient groups were then dichotomized by PROMIS score using predetermined cut-offs. A logistic regression was used to determine odds-ratio of surgical intervention. Patients without PPS were excluded from statistical tests involving PROMIS.
Results
Of the 1529 patients that met inclusion/exclusion criteria, 685 had PPS. Survey response rates were higher from patients choosing more invasive interventions. Older patients tended to choose more invasive treatments as their initial management. For initial treatment, 2.9% of patients chose PT, 84.8% chose injection, and 12.3% chose surgery. By the end of the follow-up period 87.0% of patients received an injection, with 29.9% of those patients requiring at least one additional injection, and 28.6% of the total cohort eventually undergoing surgery. There were no significant differences in PPS between patients of any initial treatment group. However, patients that had low PF (OR = 1.62 [1.062-2.47]) or high PI (OR = 1.62 [1.051-2.496]) had significantly increased odds of undergoing surgery. Age <40 or >60 and female gender also had an increased odds of undergoing surgery (Table 1).
Conclusions
PROMIS survey results could be used to identify patients that are likely to fail non-operative intervention for DQT. While there were no differences in PPS between patients choosing PT, injection or surgery as their initial management, patients who scored lower than 40 for PF or higher than 60 for PI had significantly increased odds of eventually undergoing surgery.


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