Maren W. Voss

PROMIS® PF CAT Outperforms the ODI and SF-36 Physical Function Domain in Spine Patients.

Study Design. The Oswestry Disability Index v2.0 (ODI), SF36 Physical Function Domain (SF-36 PFD), and PROMIS Physical Function CAT v1.2 (PF CAT) questionnaires were prospectively collected from 1607 patients complaining of back or leg pain, visiting a university-based spine clinic. All questionnaires were collected electronically, using a tablet computer. Objective. The aim of this study was to compare the psychometric properties of the PROMIS PF CAT with the ODI and SF36 Physical Function Domain in the same patient population. Summary of Background Data. Evidence-based decision-making is improved by using high-quality patient-reported outcomes measures. Prior studies have revealed the shortcomings of the ODI and SF36, commonly used in spine patients. The PROMIS Network has developed measures with excellent psychometric properties. The Physical Function domain, delivered by Computerized Adaptive Testing (PF CAT), performs well in the spine patient population, though to-date direct comparisons with common measures have not been performed. Methods. Standard Rasch analysis was performed to directly compare the psychometrics of the PF CAT, ODI, and SF36 PFD. Spearman correlations were computed to examine the correlations of the three instruments. Time required for administration was also recorded. Results. One thousand six hundred seven patients were administered all assessments. The time required to answer all items in the PF CAT, ODI, and SF-36 PFD was 44, 169, and 99 seconds. The ceiling and floor effects were excellent for the PF CAT (0.81%, 3.86%), while the ceiling effects were marginal and floor effects quite poor for the ODI (6.91% and 44.24%) and SF-36 PFD (5.97% and 23.65%). All instruments significantly correlated with each other. Conclusion. The PROMIS PF CAT outperforms the ODI and SF-36 PFD in the spine patient population and is highly correlated. It has better coverage, while taking less time to administer with fewer questions to answer. Level of Evidence: 2

Examination of the PROMIS upper extremity item bank

STUDY DESIGN Clinical measurement. INTRODUCTION The psychometric properties of the PROMIS v1.2 UE item bank were tested on various samples prior to its release, but have not been fully evaluated among the orthopaedic population. PURPOSE OF THE STUDY This study assesses the performance of the UE item bank within the UE orthopaedic patient population. METHODS The UE item bank was administered to 1197 adult patients presenting to a tertiary orthopaedic clinic specializing in hand and UE conditions and was examined using traditional statistics and Rasch analysis. RESULTS The UE item bank fits a unidimensional model (outfit MNSQ range from 0.64 to 1.70) and has adequate reliabilities (person = 0.84; item = 0.82) and local independence (item residual correlations range from -0.37 to 0.34). Only one item exhibits gender differential item functioning. Most items target low levels of function. DISCUSSION The UE item bank is a useful clinical assessment tool. Additional items covering higher functions are needed to enhance validity. CONCLUSIONS Supplemental testing is recommended for patients at higher levels of function until more high function UE items are developed. LEVEL OF EVIDENCE 2c.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

Interpretation of correlations in clinical research

ABSTRACT Background: Critically analyzing research is a key skill in evidence-based practice and requires knowledge of research methods, results interpretation, and applications, all of which rely on a foundation based in statistics. Evidence-based practice makes high demands on trained medical professionals to interpret an ever-expanding array of research evidence. Objective: As clinical training emphasizes medical care rather than statistics, it is useful to review the basics of statistical methods and what they mean for interpreting clinical studies. Methods: We reviewed the basic concepts of correlational associations, violations of normality, unobserved variable bias, sample size, and alpha inflation. The foundations of causal inference were discussed and sound statistical analyses were examined. We discuss four ways in which correlational analysis is misused, including causal inference overreach, over-reliance on significance, alpha inflation, and sample size bias. Results: Recent published studies in the medical field provide evidence of causal assertion overreach drawn from correlational findings. The findings present a primer on the assumptions and nature of correlational methods of analysis and urge clinicians to exercise appropriate caution as they critically analyze the evidence before them and evaluate evidence that supports practice. Conclusion: Critically analyzing new evidence requires statistical knowledge in addition to clinical knowledge. Studies can overstate relationships, expressing causal assertions when only correlational evidence is available. Failure to account for the effect of sample size in the analyses tends to overstate the importance of predictive variables. It is important not to overemphasize the statistical significance without consideration of effect size and whether differences could be considered clinically meaningful.

The relationship between family support; pain and depression in elderly with arthritis

Abstract The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

Evaluating instrument responsiveness in joint function: The HOOS JR, the KOOS JR, and the PROMIS PF CAT†

12345Responsiveness is the ability to detect change over time and is an important aspect of measures used to detect treatment effects. The purpose of this study was to assess the responsiveness of the HOOS JR, the KOOS JR, and the PROMIS Physical Function (PF) computerized adaptive test (CAT) in a joint reconstruction practice. 983 patients were evaluated for joint conditions between 2014 and 2017 in an orthopaedic clinic and completed the three instruments at baseline and 3 and/or 6‐month follow‐up visits. Average age was 61.03 years (SD = 12.33, Range = 18–90 years) and the majority of the patients were White (n = 875, 89.0%). Three‐month responsiveness was calculated two ways, as between 80 and 100 days and as 90 days and beyond. Six‐month responsiveness was calculated as 170–190 days and as 180 days and beyond. All changes from baseline scores were significant at the 3‐, >3‐, and >6‐month follow‐up (p < 0.05). All three measures showed large effect sizes, ranging from 0.80–1.20 at each time‐point. The standardized response mean was large for each measure and at each time‐point (Range = 1.06–1.53). This study demonstrated the responsiveness of the HOOS JR, KOOS JR, and the PROMIS PF in adult reconstruction patients. The PROMIS PF was consistently the most responsive instrument in this analysis. Clinical significance: The HOOS JR, KOOS JR, and PROMIS PF are useful clinical instruments for assessing treatment change and may be selected as relevant to the specific needs and conditions of the adult joint reconstruction patient population.

Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement?

Objective: Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes. Methods: A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status. Results: Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status. Conclusions: Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.

The Association Between Perceived Health Status and Health Information Communication Channels

Varying types of health information sources may influence health outcomes, but not much is known about their impact. The purpose of our study was to explore the association between health information sources and individuals’ health status. A total of 14,966 participants who responded to the Annenberg National Health Communication Survey between 2005 and 2012 were included. Controlling for demographics, comorbidities, communication patterns, and socioeconomic status, we utilized regression analysis to examine the relationship between sources of health information and perceived health status. Included in the study were a total of 8,103 females and 6,863 males between 18 and 101 years old (M = 49.14, SD = 16.13). Health information from the Internet and pharmaceutical companies was significantly associated with better health status (p < .05), whereas information from social media, health care apps, news outlets, and health care companies was not. Information from the Internet was significantly associated with better health status, suggesting that health information from the Internet may have benefits. However, use of social media and health care apps did not relate to better health status, which may indicate that these sources are not as useful to consumers or that these sources have not yet saturated the health information marketplace.

Profiling arthritis pain with decision tree

Arthritis is the leading cause of work disability and contributes to lost productivity. Previous studies showed that various factors predict pain, but they were limited in sample size and scope from a data analytics perspective.

Late-career unemployment has mixed effects in retirement

ABSTRACT Paid work forms a pattern of occupational engagement that shifts during both unemployment and retirement. Similar to unemployment, the occupational disruption associated with involuntary retirement has been linked to poorer physical and mental health outcomes. To better understand the health impact of work transitions during the pre- and post-retirement years, 24 retired individuals with late-career unemployment were interviewed at the Huntsman World Senior Games in October 2016. Demographic data were collected. Braun and Clarke’s (2006) approach was utilized to thematically analyse the interview data and interpretations were evaluated against existing theory. Themes identified included struggle, freedom, and transition, followed by resilience and a return to well-being, with mental health levels reported at national averages for the age group. Choice and autonomy in the retirement years contributed to resilience. Concepts of productivity and meaningful engagement shift during the retirement years toward wellness derived from purposeful occupation, suggesting that occupational models may need to reconsider concepts of productivity and purpose for this age group.