Background/Purpose

Assessing clinical status in musculoskeletal pain syndromes requires self-report of pain and function. Yet, the field suffers from a lack of psychometrically sound, consistently applied measurement tools, limiting clinical practice and research. In this study, we used longitudinal data to evaluate the validity and responsiveness of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric item banks (physical function (PF), pain impact, fatigue, emotional distress, social role) among children receiving treatment for chronic musculoskeletal pain at two clinics. We expected each domain to improve across time, but we expected domains most closely aligned with treatment (i.e., pain and fatigue) to improve more and domains more distally related (i.e., peer relationships) to improve less. Additionally, we expected scores to improve more quickly among children receiving intensive, inpatient treatment vs. those receiving treatment at an outpatient clinic.  

Methods

Across 2 multi-disciplinary pediatric pain clinics, we collected data from patients receiving treatment for a chronic painful condition (n= 145: aged 8-18 years). Across 3 visits, patients completed PROMIS self-report short form measures (~7 items each) that assessed: pain impact, PF-upper extremity, PF-mobility, fatigue, anger, anxiety, depressive symptoms, and peer relationships. PROMIS measures are normed in the general population and have a mean of 0 and standard deviation (SD) of 1. For each measure, higher values reflect more of the measured domain (e.g., higher pain impact scores reflect more pain impact, higher PF-mobility scores reflect better mobility). We used longitudinal growth models (LGM) to examine change across time. 

Results

At study’s start, mean domain levels ranged from -1.26 SDs below the general population (mobility) to 0.97 SDs above (pain), indicating more pain and poorer function. LGM revealed that each domain demonstrated statistically significant improvement across time. The average monthly change ranged from 0.014 (peer relationships) to -0.074 (pain). Fatigue, PF-mobility and showed changed at rates similar pain impact’s. PF-upper extremity’s, anxiety’s, and depression’s changed at rates similar to peer relationships’. In all models, rates of change showed statistically significantly differences across site in the expected directions.  

Conclusion

We tested responsiveness to change of PROMIS pediatric domains in youth with chronic musculoskeletal pain. Consistent with expectations, 1) children in the pain clinics reported poorer quality than general population; 2) domains most closely related to treatment (pain impact, fatigue, and mobility) demonstrated the most change, 3) domains more distally related to treatment (e.g., peer relationships) showed the least improvement, and 4) across domains, the measures indicated intensive, inpatient treatment resulted in more rapid improvement than outpatient treatment. Results support the construct validity and responsiveness of PROMIS instruments. Future clinical research in pediatric pain should consider utilizing the PROMIS pediatric items banks.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/longitudinal-assessment-of-promis-pediatric-item-banks-in-children-with-chronic-musculoskeletal-pain/