Addition of PROMIS Pain Instruments to PROMIS Upper Extremity Physical Function Improves the Responsiveness of PROMIS scores compared to Legacy scores in patients undergoing Total Shoulder Arthroplasty: A Prospective Study.

Introduction: Patient Reported Outcome Measurement Information Systems (PROMIS) is increasingly being utilized across the United States as a patient reported outcome evaluation tool for a wide variety of musculoskeletal conditions. However, PROMIS Upper Extremity physical function (P-UE) has demonstrated limited responsiveness in the early postoperative period after total shoulder arthroplasty (TSA). The aim of this study is to determine if addition of PROMIS Pain Interference (P-Interference) or Pain Intensity (P-Intensity) scores improve the ability to detect postoperative changes in the one-year postoperative period following TSA.

Methods: Patients who were indicated for and elected to undergo TSA between 2020-2022 were prospectively enrolled. Prospective data was collected for patient surveys (ASES, SST, WOOS, P-UE, P-Interference and P-Intensity) at the 2-week, 6-week, 3-month, 6-month and 12-month timepoints. Instrument responsiveness for each PROM was evaluated using the effect size (ES; Cohen d). Responsiveness was defined by the absolute values of each measurement, previously reported as small (0.2), medium (0.5), or large (0.8). Statistical analysis (two sample t-tests and Fisher's tests) was performed using R studio version 4.2.3 (Boston, MA, USA).

Results: A total of 127 subjects were enrolled in this study. All survey instruments demonstrated large responsiveness (>0.8) at 3, 6 and 12-months. P-Intensity was the only instrument to demonstrate large responsiveness at 2-weeks with its addition to P-UE showing an improved responsiveness at all time points. Moreover, the addition of P-Intensity had a lower response burden at all time points when compared to the legacy measures (ASES, SST and OSS) at all time points albeit no difference to ASES (p=0.55) at 12-months after surgery. P-Interference, and other legacy scores demonstrated large responsiveness starting at 6-weeks postoperatively.

Conclusion: The responsiveness of PROMIS UE can be improved by coupling the outcome measure to P-Intensity scores with a significantly lower response burden when compared to the legacy measures evaluated at nearly all time points.