Clinical and Demographic Factors Associated With Baseline PROMIS Categorization in Shoulder and Elbow Patients

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) are commonly used in orthopaedics. While prior work has validated PROMIS domains in upper extremity populations, there is limited literature describing associations of clinical and demographic factors with baseline PROMIS score categorization in shoulder and elbow patients. Hypothesis: It was hypothesized that sex, operative status, body mass index (BMI), age, and injured body region would be associated with baseline PROMIS-Pain Interference (PI) and PROMIS-Physical Function (PF) categorization. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective analysis was performed between March 2022 and March 2025. Patients ≥18 years of age with a primary complaint of shoulder or elbow pain were included. PROMIS-PI and PROMIS-PF CATs were completed at the initial visit. Multinomial logistic regression was used to examine associations of impairment severity (mild, moderate, or severe), with the within normal limits group as the reference category. Independent variables included injured body part, sex, operative status, BMI, and age. A secondary analysis limited to shoulder patients incorporated primary encounter diagnosis as an additional factor. Results: The primary analysis included a cohort of 1324 patients (977 shoulder, 347 elbow; mean age, 53 ± 16 years; 43.7% female). Injured body part was not associated with impairment severity. Among this cohort, women were more likely to demonstrate all levels of PI (OR, 1.38-2.50) and moderate to severe PF impairment (OR, 1.90-3.24). Operative status was associated with greater odds of moderate to severe PI (OR, 2.00-3.78) and PF impairment (OR, 2.40-2.85). BMI ≥30 was associated with greater odds of moderate to severe PI (OR, 1.52-2.45) and all levels of PF impairment (OR, 1.50-2.76). Older age was modestly associated with severe PI and mild to severe PF impairment. In the shoulder-only cohort, rotator cuff pathology and arthritis were associated with lower likelihoods of severe impairment, while adhesive capsulitis was associated with mild to moderate PI but lower odds of severe PF impairment. Conclusion: Female sex, operative status, higher BMI, and advanced age were associated with worse baseline PROMIS-PI and PF categorization, while shoulder-specific diagnoses demonstrated variable associations.