Outcomes Analysis of Patients Undergoing Distal Biceps Repair Using PROMIS
Thomas John Carroll, MD1; Akhil Dondapati, MD1; Jonathan Minto, MD1; Samantha Hoffman, BA1; Warren C. Hammert, MD2; Bilal Mahmood, MD1
1University of Rochester, Rochester, NY; 2Duke University, Durham, NC
Introduction: The purpose of our study is to analyze the risk factors and post-operative outcomes of patients with traumatic distal biceps ruptures undergoing operative repair using PROMIS. Our hypothesis is that PROMIS Upper Extremity (UE), Physical Function (PF) and Pain Interference (PI) scores will improve and be significantly different between pre-op and 12 month follow up. Patient Acceptable Symptom State (PASS) will change from not acceptable to acceptable and PROMIS scores will continue to improve even when symptoms are acceptable.
Methods: This is a 7-year retrospective study of 461 consecutive patients with traumatic distal biceps ruptures who underwent primary operative repair. Demographic information, treatment method, strength, range of motion, PROMIS upper extremity (UE), PROMIS physical function (PF), PROMIS pain interference (PI), PROMIS depression, and PASS were recorded for each patient at the preoperative, 2 week, 6 week, 12 week, 6 month, and 1 year visits. Statistical analysis was completed using unpaired T-test and Chi-square analysis.
Results: Within the 461 patient cohort, the patients were 93% male and had an average age of 37. The dominant side was affected in 78% of cases and 43% of patients reported nicotine use. There was an average follow up of 6.3 months. Pre-operatively, 290 patients completed the questionnaire with mean PROMIS scores of PF 44.11 (SD 10.39), UE 37.39 (SD 10.94), PI 58.37 (SD 8.35) and Depression 46.21 (SD 9.74). At 12 months, 173 patients completed the questionnaire with mean PROMIS scores of PF 44.12 (SD 7.66), UE 41.58 (SD 10.94), PI 55.13 (SD 8.89) and Depression 46.89 (SD 8.98). The overall change in PROMIS scores were PF +0.01 (p=0.98), UE +4.18 (p<0.0001), PI -3.24 (p<0.0001) and Depression +0.69 (p=0.2). At 12 month follow-up, 65% reported satisfactory symptom resolution on the PASS questionnaire. Satisfactory symptom state on PASS was correlated with final PROMIS PI score of 56.4 (difference of -1.8) and PROMIS UE score of 39.4 (difference of +2.9).
Conclusion: Among patients with distal biceps ruptures treated with primary operative repair, there was a significant improvement in PROMIS PI and UE scores between pre-operative, 12 week, 6 month and 12 month follow up, with the UE domain detecting the greatest change. PASS correlated with PROMIS PI and UE scores at final visit. There was no significant difference in PROMIS PF or depression over time. Future work will establish a minimum clinically important difference (MCID) for PROMIS PI and UE, correlate PROMIS with objective outcomes.
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