Responsiveness and minimal important change of Dutch-Flemish Patient Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests for musculoskeletal disorders

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Objective To examine the responsiveness and minimal important change (MIC) of the Dutch-Flemish Patient Reported Outcomes Measurement Information System (DF-PROMIS) Physical Function (PF) v1.2, Upper Extremity (UE) v2.0, and Pain Interference (PI) v1.1 computerized adaptive tests (CATs) among patients with musculoskeletal conditions receiving physical therapy in primary care. Design Observational cohort study. Methods Participants with spinal or UE musculoskeletal disorders (n=314) were recruited from fourteen primary care physical therapy practices. Participants completed the DF-PROMIS CAT instruments at baseline and four to six weeks later. Responsiveness was assessed by testing predefined hypotheses on correlations of DF-PROMIS CAT change scores with validated comparative instruments, effect sizes, and the area under receiver operating characteristic curves. MIC values were determined using an improved adjusted predictive modelling approach. Results Data from 314 patients were analyzed. Ten out of twelve (83.3%) predefined hypotheses were confirmed. MIC values indicating minimal important improvement ranged from -3.6 to 1.5, with all 95% confidence intervals including zero. A subsequent sensitivity analysis, adjusting the MIC threshold, yielded MIC values between -4.4 and 5.1, with 95% confidence intervals excluding zero except for the DF-PROMIS PF CAT among patients with neck pain. Conclusion The responsiveness of DF-PROMIS-PF, DF-PROMIS-UE, and DF-PROMIS-PI CATs is sufficiently supported for patients with spinal and upper extremity musculoskeletal conditions. The findings also highlight the sensitivity of MIC estimates to adjustments of the MIC threshold and the differential performance of the DF-PROMIS-PF CAT in patients with neck pain. Impact statement This study adds robust evidence supporting the use of DF-PROMIS CATs in primary care physical therapy to facilitate accurate monitoring of patient reported outcomes. The nuanced understanding of responsiveness and MIC enhances clinical interpretation and applicability of DF-PROMIS CAT tools in musculoskeletal rehabilitation.