PROMIS 4-item measures and numeric rating scales efficiently assess SPADE symptoms compared with legacy measures

Kurt Kroenke; Timothy E Stump; Jacob Kean; Tasneem L Talib; David A Haggstrom; Patrick O Monahan

doi:10.1016/j.jclinepi.2019.06.018

PROMIS 4-item measures and numeric rating scales efficiently assess SPADE symptoms compared with legacy measures

J Clin Epidemiol. 2019 Nov:115:116-124. doi: 10.1016/j.jclinepi.2019.06.018. Epub 2019 Jul 19.

Authors

Kurt Kroenke¹, Timothy E Stump², Jacob Kean³, Tasneem L Talib⁴, David A Haggstrom⁵, Patrick O Monahan²

Affiliations

¹ Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA. Electronic address: kkroenke@regenstrief.org.
² Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA.
³ Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁴ Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁵ Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; VA Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.

PMID: 31330252
DOI: 10.1016/j.jclinepi.2019.06.018

Abstract

Objective: The 5 SPADE (sleep, pain, anxiety, depression, and low energy/fatigue) symptoms are among the most prevalent and disabling symptoms in clinical practice. This study evaluates the minimally important difference (MID) of Patient-Reported Outcomes Measurement Information System (PROMIS) measures and their correspondence with other brief measures to assess SPADE symptoms.

Study design and setting: Three hundred primary care patients completed a 4-item PROMIS scale, a numeric rating scale (NRS), and a non-PROMIS legacy scale for each of the 5 SPADE symptoms. Optimal NRS cutpoints were examined, and cross-walk units for converting legacy measure scores to PROMIS scores were determined. PROMIS scores corresponding to standard deviation (SD) and standard error of measurement (SEM) changes in legacy scores were used to estimate MID.

Results: At an NRS ≥5, the mean PROMIS T-score exceeded 55 (the operational threshold for a clinically meaningful symptom) for each SPADE symptom. Correlations were high (0.70-0.86) between each PROMIS scale and its corresponding non-PROMIS legacy scale. Changes in non-PROMIS legacy scale scores of 0.35 SD and 1 SEM corresponded to mean PROMIS T-scores of 2.92 and 3.05 across the 5 SPADE symptoms, with changes in 0.2 and 0.5 SD corresponding to mean PROMIS T-scores of 1.67 and 4.16.

Conclusion: A 2-step screening process for SPADE symptoms might use single-item NRS scores, proceeding to PROMIS scales for NRS scores ≥5. A PROMIS T-score change of three points represents a reasonable MID estimate, with two to four points approximating lower and upper bounds.

Trial registration: ClinicalTrials.gov NCT02383862.

Keywords: Anxiety; Depression; Fatigue; Pain; Psychometrics; Sleep.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety / diagnosis*
Depression / diagnosis*
Fatigue / diagnosis*
Female
Humans
Male
Middle Aged
Pain / diagnosis*
Patient Reported Outcome Measures
Prospective Studies
Severity of Illness Index
Sleep Wake Disorders / diagnosis*
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT02383862

Grants and funding

IK2 RX000879/RX/RRD VA/United States