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Validation Of The PROMIS Questionnaires And Brief MHQ In Patients With Upper Extremity Illness At A Quaternary Hand Center
Pragna N. Shetty, MPH, Jessica Hawken, MD, Kavya K. Sanghavi, MPH, Aviram M. Giladi, MD, MS.
The Curtis National Hand Center, Baltimore, MD, USA.

Purpose: Health care is transitioning to value-based care, using patient-reported outcomes (PROs) as an indicator of care quality, affecting hospital ratings as well as reimbursement. The brief Michigan Hand Questionnaire (bMHQ) is a validated and widely used questionnaire; it assesses function, efficacy, and pain in patients with upper extremity illness. The Patient-Reported Outcomes Measurement Information System (PROMIS) instruments include measures of overall physical and mental health, as well as disease-specific measures, and are increasingly used. However, the correlation between PROMIS questionnaires and the bMHQ have not been investigated to validate the use of PROMIS in patients with upper extremity illness. We analyzed the relationship between the PROMIS Global Mental Health (GMH), Global Physical Health (GPH), Upper Extremity (UE), Pain Interference (PI), Self-Efficacy for Managing Chronic Conditions (SE) and bMHQ questionnaires in 5 common hand conditions: carpal tunnel syndrome (CTS), Dupuytrenís contracture, trigger finger (TF), thumb carpometacarpal (CMC) osteoarthritis (OA), and wrist ganglion cysts.
Methods: All patients over 18 years of age seen at our hand center between January 1, 2018 and May 31, 2019 with CTS, TF, thumb CMC OA, Dupuytrenís contracture, and wrist ganglion cysts were included. Patient demographics, PROMIS, and bMHQ were collected for all patients. Spearmanís rank correlation was used to evaluate the relationship between the different PROMIS and bMHQ questionnaire scores.
Results: Our cohort included 4,401 patients. Median age was 55.0 (40.3 - 64.5) years with 2414 (54.8) % females and 1987 (45.1) % males. Patients had a median of 2 (IQR 1 - 4) visits. Majority of patients had TF (N = 2200). The PROMIS GMH showed weak correlation with the bMHQ (ρ = 0.38, P <0.001). The PROMIS GPH showed moderate correlation with the bMHQ (ρ = 0.58, P <0.001). Both the PROMIS UE and PI questionnaires had strong correlations to the bMHQ (Figure 1). The PROMIS SE showed a very weak correlation to the bMHQ (ρ = 0.12, P <0.001). These correlation results for the overall group were consistent across subgroup analysis for each condition (Figure 1).
Conclusion: This study demonstrates how the PROMIS instruments compare with a previously validated and widely-used questionnaire in patients with common upper extremity illnesses. The PROMIS GPH, UE, and PI showed moderate to strong correlations with the bMHQ. The PROMIS SE and bMHQ were very weakly correlated as expected, as bMHQ does not gauge patientsí ability to manage their medication or treatments. Notably, the correlations between the PROMIS questionnaires and bMHQ were similar, regardless of condition. Given their moderate to strong correlations with the bMHQ and consistency across conditions, the PROMIS GPH, UE, and PI can be used for both clinical and research purposes in patients with these common upper extremity illnesses.


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