Abstract
Objective
To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS)
pain interference items for use in a quality measure and to compare the resulting
quality score, along with internal reliability and validity, to a similar item set
in the Minimum Data Set Version 3.0 (MDS).
Design
Cross-sectional, observational study.
Setting
One freestanding inpatient rehabilitation facility (IRF) and one large hospital-based
IRF.
Participants
Patients with neurologic disorders. Of 1055 consecutive admissions, 26% were excluded
based on clinician-determined cognitive impairment or emotional distress. Of the remainder,
50% consented and completed the survey near the end of their IRF stay (N = 391). Of
these, more than half (57%) reported pain over the last day (n = 224).
Measurements
Psychometric statistics and quality scores were computed from a 55-question survey,
including the MDS and PROMIS pain interference items.
Results
Estimates for internal reliability were higher for the PROMIS 2-item scale compared
to the MDS: Cronbach α (0.86 vs 0.48) and interitem correlations (0.75 vs 0.31). The
PROMIS-2 items were better able to detect differences in patients with mild and severe
pain intensity (Cohen d = 1.57) relative to the corresponding MDS items (Cohen d = 0.81). Two quality scores based on the PROMIS-2 items, reflecting low and high
levels of pain interference, showed 46% or 12% of patients meeting these thresholds.
This compared to a 30% rate when patients were classified by the MDS as experiencing
pain interference.
Conclusions
PROMIS pain interference items appear to be more internally consistent than similar
MDS items. The graded PROMIS items permit the creation of multiple quality scores,
showing predictable overlap with corresponding MDS quality scores. Because PROMIS
items provide finer distinctions, they allow greater latitude in reporting quality
scores. We recommend further study of pain interference scores across IRFs to improve
their reliability and validity.
Keywords
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Article info
Publication history
Published online: May 24, 2018
Footnotes
D. Cella is an unpaid member of the board of directors and officer of the PROMIS Health Organization. K. F. Cook is an unpaid officer of the PROMIS Health Organization. The remaining authors have no conflicts of interest to report.
This work was supported by a grant from the Patient-Centered Outcomes Research Institute (CD-12-11-4201) and by grant from the National Institutes of Health (U2C CA186878).
Identification
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
