Outcomes Analysis of Patients Undergoing Non-Operative Treatment of Distal Biceps Ruptures Using PROMIS
Thomas John Carroll, MD1; Jonathan Minto, MD1; Akhil Dondapati, 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-injury outcomes of patients with traumatic distal biceps ruptures treated non-operatively using PROMIS. Our hypothesis is that PROMIS Upper Extremity (UE) and Physical Function (PF) scores will improve throughout treatment and 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 561 consecutive patients with traumatic distal biceps ruptures presenting to a large academic institution. Demographic information, treatment method, strength, range of motion, PROMIS UE, PROMIS PF, PROMIS pain interference (PI), PROMIS depression, and PASS were recorded for each patient at the time of injury, 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 561 patient cohort, the patients were 86% male and had an average age of 45 years old. The dominant side was affected in 53% of cases and 51% of patients reported nicotine use. There was an average follow up of 4.7 months. At time of injury, 328 patients completed the questionnaire with mean PROMIS scores of PF 41.01 (SD 9.82), UE 37.10 (SD 8.12), PI 58.84 (SD 9.95) and Depression 47.19 (SD 11.82). At 12-months, 118 patients completed the questionnaire with mean PROMIS scores of PF 44.60 (SD 8.94), UE 42.2 (SD 9.39), PI 57.65 (SD 8.82) and Depression 46.93 (SD 10.78). The overall change in PROMIS scores were PF +3.60 (p<0.001), UE +5.10 (p<0.001), PI -1.19 (p=0.03) and Depression -0.26 (p=0.6). At 12 month follow-up, 43% reported satisfactory symptom resolution on the PASS questionnaire. Satisfactory symptom state on PASS was correlated with final PROMIS PF score of 42.8 (difference of +2.3) and PROMIS UE score of 39.1 (difference of +3.1).
Conclusion: For patients with distal biceps ruptures treated non-operatively, there was a significant improvement in PROMIS PI, UE and PF scores between time of injury, 6 month and 12 month follow-up. Scores improved through the 12 week and 6 month visits then plateaued. PASS correlated with PROMIS PF and UE scores at final visit. There was no significant difference in PROMIS depression over time. Future work will establish a minimum clinically important difference (MCID) for PROMIS PF and UE scores, correlate PROMIS with objective exam measures, and determine predictors of post-injury treatment success.
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