Do Patient Reported Outcome Measurement Information System (PROMIS) Computer Adaptive Tests Correlate with Disease Activity in Juvenile Idiopathic Arthritis?

Rebecca Trachtman¹, Elizabeth T. Murray², Jackie Szymonifka³, Alexa Adams⁴, Nancy Pan⁴, Sarah Taber⁴, Thomas J. A. Lehman⁴, Karen Onel⁴ and Lisa A. Mandl⁵, ¹Pediatric Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, NY, NY, ²Hospital for Special Surgery, New York, NY, ³Rheumatology, Hospital for Special Surgery, New York, NY, ⁴Pediatric Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, NY, ⁵Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, NY

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: juvenile idiopathic arthritis (JIA), patient outcomes and pediatric rheumatology

Session Information

Date: Monday, November 6, 2017

Title: Measures and Measurement of Healthcare Quality

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: The importance of patient-reported outcomes is increasingly recognized both in clinical care and in research. PROMIS is an NIH-supported collection of patient-reported outcome measures, covering a variety of domains that are designed without disease specificity. While ‘short forms’ have been studied in juvenile idiopathic arthritis (JIA), PROMIS computer adaptive tests (CATs) have not. This study evaluates whether PROMIS CATs correlate with disease activity in patients with JIA.

Methods: A convenience sample of patients with JIA (N = 21) were recruited from a single center. Patients aged 10-17 years completed all available pediatric PROMIS CATs, and parents of patients aged 2-9 years completed all available parent proxy PROMIS CATs (fatigue, pain interference, peer relations, anxiety, depressive symptoms, and mobility). Correlation of the CATs t-scores with disease activity, as measured by the Juvenile Disease Activity Score-71 (JADAS-71), (0-101, higher being worse) was evaluated using Spearman correlation coefficients.

Results: All families approached completed the PROMIS CATs: 13 patients and 8 parents (Table 1). Median age was 12.7 years (range 1.3 – 18.6 years), and mean JADAS-71 score was 9.58 (SD 2.07). 69% of patients completed PROMIS CATs remotely via smartphone. Anxiety (r = 0.74, p = 0.006), depressive symptoms (r = 0.84, p < 0.001), and pain interference (r = 0.64, p = 0.018) CATs correlated strongly with JIA disease activity (Table 2). Among parent proxy CATs, only anxiety correlated with disease activity (r = 0.71); however the association was not statistically significant.

Conclusion: Our results demonstrate that the PROMIS CATs are feasible to administer in an outpatient pediatric rheumatology setting. Anxiety, depressive symptoms, and pain interference were significantly correlated with disease activity, even though mean disease activity was relatively low. This underscores the negative effect on quality of life of even mild disease. Parent proxy CATs showed poor correlations with disease activity, suggesting parents are inaccurate in assessing important aspects of their child’s health. Larger prospective studies are needed to evaluate the sensitivity of PROMIS CATS to change in disease activity over time.

Table 1. Patient characteristics

Characteristic	N=26 patients
Age, years, median [interquartile range]	12.7 [6.0, 14.5]
Sex
Male	8 (30.8%)
Female	18 (69.2%)
Race
White or Caucasian	20 (76.9%)
Black or African American	1 (3.9%)
American Indian or Alaska Native	1 (3.9%)
Asian	4 (15.4%)
Ethnicity
Hispanic	4 (15.4%)
Non-hispanic	22 (84.6%)
Insurance
Medicaid	6 (23.1%)
Private insurance	20 (76.9%)
Device
Smartphone	18 (69.2%)
iPad	3 (11.5%)
Computer	5 (19.2%)
Location
In hospital	8 (30.8%)
Remotely	18 (69.2%)

Table 2. Spearman correlation coefficients for PROMIS domains and JADAS71 score

PROMIS domain	JADAS71 score Spearman correlation coefficient	p-value
PATIENT SCORES
Fatigue T-score	0.488	0.090
Pain Interference T-score	0.640	0.018
Peer Relations T-score	-0.345	0.248
Anxiety T-score	0.738	0.006
Depressive Symptoms T-score	0.840	<0.001
Mobility T-score	-0.671	0.017
PARENT PROXY SCORES
Fatigue T-score	-0.024	0.955
Pain Interference T-score	0.048	0.911
Peer Relations T-score	0.037	0.937
Anxiety T-score	0.714	0.071
Depressive Symptoms T-score	0.074	0.875
Mobility T-score	-0.464	0.294

Disclosure: R. Trachtman, None; E. T. Murray, None; J. Szymonifka, None; A. Adams, None; N. Pan, None; S. Taber, None; T. J. A. Lehman, None; K. Onel, None; L. A. Mandl, Boehringer Ingelheim, 2,American College of Physicians, 3,Up To Date, 7.

To cite this abstract in AMA style:

Trachtman R, Murray ET, Szymonifka J, Adams A, Pan N, Taber S, Lehman TJA, Onel K, Mandl LA. Do Patient Reported Outcome Measurement Information System (PROMIS) Computer Adaptive Tests Correlate with Disease Activity in Juvenile Idiopathic Arthritis? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/do-patient-reported-outcome-measurement-information-system-promis-computer-adaptive-tests-correlate-with-disease-activity-in-juvenile-idiopathic-arthritis/. Accessed .

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