The Use of Patient-Reported Outcomes Measurement Information System in Spine: A Systematic Review

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide an easily administered patient-outcome questionnaire that was adaptable to a variety of medical and surgical subspecialties. Numerous authors have examined the effectiveness of PROMIS in various areas of spine surgery. Our goal was to systematically review PROMIS scores compared with legacy patient-reported outcomes measures (PROMs) in spinal surgery and spine pathology.

Methods: A systematic search of the PubMed, EMBASE, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed, yielding 254 unique studies reporting on “PROMIS” in “spine.” Each study was independently reviewed. A total of 16 studies were selected for inclusion.

Results: The pooled sample size yielded a total of 4268 patients. In the cervical population, PROMIS physical function (PF; |r| = .47–.87, pain intensity (PIn; |r| = .61–.74), pain interference (PIf; |r| = .65–.88), and pain behavior (PB; |r| = .59–.74) correlated with the Neck Disability Index (NDI). PROMIS PF also strongly correlated with the modified Japanese Orthopaedic Association scale (mJOA; |r| = .61–.72). Among patients with lumbar pathology and adult spinal deformities, PROMIS PF (|r| = .53–.85), PIn (|r| = .73–.78), PIf (|r| = .59–.89), and PB (|r| = .58–.82) strongly correlated with the Oswestry Disability Index (ODI). PF (|r| = .51–.78), PIf (|r| = .60–.70), and anxiety (|r| = .73) also strongly correlated with the Scoliosis Research Society (SRS)-22 and SRS-30. When comparing measures of global health, PROMIS PF was strongly correlated with the Short Form (SF)-12 and SF-36 (|r| = .50–.85). On average, all PROMIS domains required less time to complete (49.6–56 seconds) than the ODI (176 seconds), NDI (190.3 seconds), SF-12 (214 seconds), and SF-36 physical function domains (99 seconds). The responsiveness of the PROMIS PF, PIf, and PB was comparable to that of legacy measures ODI, NDI, and SF-12.

Conclusions: The PROMIS PF, PIn, PIf, and PB demonstrated moderate to strong correlations with NDI, mJOA, ODI, SRS, and SF-12 measures in various populations of spine patients. All PROMIS domains had decreased time to completion and similar responsiveness compared with legacy measures.

Level of Evidence: 2.

Clinical Relevance: These results highlight the potential of PROMIS as a valid and reliable tool to assess patient-reported outcomes in spinal surgery patients and support more widespread use of PROMIS in spine.