The promise of computer adaptive testing in collection of orthopaedic outcomes: an evaluation of PROMIS utilization

Background A crucial component to improving patient care is better clinician understanding of patients’ health-related quality of life (HRQoL). In orthopaedic surgery, HRQoL assessment instruments such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), provide surgeons with a framework to assess how a treatment or medical condition is affecting each patient’s HRQoL. PROMIS has been demonstrated as a valuable instrument in many diseases; however, the extent to which orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research is unclear. Methods Systematic scoping methodology was used to investigate the characteristics of studies using PROMIS to assess HRQoL measures as orthopaedic surgical outcomes as well as studies validating computerized adaptive test (CAT) PROMIS physical health (PH) domains including: Physical Function (PF), Upper Extremity (UE), Lower Extremity (LE). Results A systematic search of PubMed identified 391 publications utilizing PROMIS in orthopaedics; 153 (39%) were PROMIS PH CAT validation publications. One-hundred publications were in Hand and Upper Extremity, 69 in Spine, 44 in Adult Reconstruction, 43 in Foot and Ankle, 43 in Sports, 37 in Trauma, 31 in General orthopaedics, and 24 in Tumor. From 2011 through 2020 there was an upward trend in orthopaedic PROMIS publications each year (range, 1–153) and an increase in studies investigating or utilizing PROMIS PH CAT domains (range, 1–105). Eighty-five percent (n = 130) of orthopaedic surgery PROMIS PH CAT validation publications (n = 153) analyzed PF; 30% (n = 46) analyzed UE; 3% (n = 4) analyzed LE. Conclusions PROMIS utilization within orthopaedics as a whole has significantly increased within the past decade, particularly within PROMIS CAT domains. The existing literature reviewed in this scoping study demonstrates that PROMIS PH CAT domains (PF, UE, and LE) are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. The expanded use of PROMIS CATs in orthopaedic surgery highlights the potential for improved quality of patient care. While challenges of integrating PROMIS into electronic medical records exist, expanded use of PROMIS CAT measurement instruments throughout orthopaedic surgery should be performed. Plain english summary In orthopaedic surgery, health-related quality of life tools such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), offer patients an opportunity to better understand their medical condition and be involved in their own care. Additionally, PROMIS provides surgeons with a framework to assess how a treatment or medical condition is affecting each patient’s functional status and quality of life. The efficacy of PROMIS has been demonstrated in many diseases; however, its application throughout orthopaedic care has yet to be depicted. This study sought to identify the extent to which all orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research in order to identify its potential as an applicable and valuable tool across specialties. We determined that PROMIS utilization has significantly increased within the past decade. The existing literature reviewed in this scoping study demonstrates that the PROMIS computerized adaptive test domains evaluating physical function status are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. Based on these results, this study recommends the expanded and more uniform use of PROMIS computerized adaptive test measurement instruments in the clinical care of orthopaedic patients.

THE ROLE OF INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING TO ENHANCE SUCCESSFUL ORTHOPEDIC SURGERY

One of the main advance in orthopaedic surgery domain has a goal to investigates the safest and harmless method in surgical procedures. Less complications means a better outcome of surgery. One of the commonest risks at orthopaedic surgery is central and peripheral nerve injury. The modality of Intraoperative Neurophysiologic Monitoring (IONM) which act to limit the risk of nerve injury during operative procedure through the evaluation of nerve integrity and function enable the surgeon to decrease injury to the nerve associated with orthopaedic surgical procedure in the operating room. This article aims to explain and describe the latest modality of IONM, its basic concept and its function at surgery. The last part of the article discussed about orthopaedic surgical techniques which use IONM. The authors hope that this article will enhance the knowledge of all the readers about IONM. This article was written based on literature study searched at Google Scholar, Medline and PubMed. The references were taken from a relatively up to date study ranging from 2013-2018. The article was selected according to the authors inclusion criteria and six articles was chosen as the references for this review. As a conclusion, IONM has an important role to increase successful rate of surgery through minimizing nerve injury risk during surgical procedure.