Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Different patient reported outcome [PRO] measures are used for rheumatic diseases [RD], and there is lack of uniform generic illness measures across the disease spectrum. The aims of this study are – (1) Identify PROMISÒ health domains most relevant to care of patients with RD, (2) Collect T-Score metrics for these domains, (3) Identify clinically meaningful cut-points for these domains.
Methods: A convenience sample of RD patients aged 18 and over, were recruited consecutively at the time of routine clinic visits, to complete computer-adaptive tests on thirteen Patient-Reported Outcomes Measurement Information System (PROMIS®) instruments as part of an approved IRB. Based on the severity of the T-score metrics and discussion with clinical providers, four measures were chosen to be relevant to RD patients. A common educational method for establishing “proficiency” was borrowed to determine severity of the domains. Data from these patients were used to develop clinical vignettes across a range of symptom severity. Vignettes were created based on most likely item responses at different levels on the T-score metric (mean = 50; SD = 10). Vignettes were anchored at 5-point intervals (0.5 SDs). Patients with RD (N=9) and clinical providers (N=10) participated as expert panelists in separate one-day meetings. Vignettes were ordered and placed on cards. Panelists identified adjacent vignettes considered to represent upper and lower boundaries separating category cut points. In other words, for each domain these cut-points were used to classify the severity of symptoms – no symptoms, mild symptoms, moderate symptoms, and severe symptoms. Cut scores were defined as mean score for boundary vignettes.
Results: Four domains (physical function, pain interference, sleep disturbance, depression) were selected for their importance in RD, and that are actionable at the point of care, as determined in previous focus groups with clinical providers1. For all domains, patients set lower cut points for severity than clinical providers, by 0.5 to 1 SD (Table1). Patient and providers had the most overlap in their cut-scores for the pain interference domain.
Conclusion: We used a modified educational standard setting method to estimate clinically relevant cut points to classify severity for PROMIS measures of physical function, pain interference, sleep disturbance, and depression in patients with RD. Parallel exercises identified the cut points from the perspectives of patients with RD, and clinical providers who treat rheumatic diseases. This allows for meaningful interpretation of PROMIS® measures in a clinical setting in RD populations. Further work is focused on incorporating these cut points in clinical practice and assessing their impact on clinical care. Table 1: Consensus cut-scores by domains and expert panel
|Domain||Severity categories||T-score cut points|
|Patient classification||Provider classification|
|Physical function*||No symptoms||>65||>60|
|Pain interference**||No symptoms||<50||<50|
|Sleep disturbance**||No symptoms||<35||<45|
*Higher score denotes better physical function ** Higher scores denote more [or worse] symptoms
To cite this abstract in AMA style:Nagaraja V, Mara C, Dodge CV, Fox D, Khanna P, Laing T, McCune WJ, Namas R, Bancroft Rizzo D, Vanoverbeke K, Young A, Almackenzie M, Khanna D. Establishing Clinical Severity for Patient Reported Outcomes Measurement Information System Measures in Adult Patients with Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/establishing-clinical-severity-for-patient-reported-outcomes-measurement-information-system-measures-in-adult-patients-with-rheumatic-diseases/. Accessed December 2, 2020.
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