Psychometric Properties and Feasibility of PROMIS Computerized Adaptive Tests Compared with Disease-Specific Measures in Knee Arthroplasty

The efficient assessment of health outcomes in knee arthroplasty may benefit from universally applicable Patient-Reported Outcomes Measurement Information System computerized adaptive tests (PROMIS CATs), rather than disease-specific measures. This study aimed to evaluate and compare some psychometric properties and the feasibility of various PROMIS CATs (Pain Interference PROMIS-PI-CAT, v1.1, Physical Function PROMIS-PF-CAT, v2.0, Mobility PROMIS-Mob-CAT, v2.0, Ability to Participate in Social Roles and Activities PROMIS-AS-CAT, v2.0, and Satisfaction with Social Roles and Activities PROMIS-SS-CAT, v2.0), with the Knee Injury and Osteoarthritis Outcome Score (KOOS) scales, including the KOOS Physical Function Shortform KOOS-PS and KOOS for Joint Replacement KOOS-JR, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales. Patients (n = 193; mean age and standard deviation, 64.4 ± 10.1 years; 56% female; mean body mass index, 29.6 ± 5.2 kg/m2) undergoing unilateral or bilateral primary or revision knee arthroplasty at AZ Alma (Eeklo, Belgium) completed the measures 6 weeks before and 6 weeks and 3, 6, and 12 months after surgery. The study evaluated precision (standard error as a percentage of scale range SE%), responsiveness (hypothesized correlations and standardized response mean SRM), floor and ceiling effects (percentage with the worst and the best scores), and feasibility (completion time and number of items). The PROMIS-PI-CAT and PROMIS-PF-CAT showed better precision at baseline compared with corresponding KOOS/WOMAC scales (SE%, 4.6 versus 7.1/9.3 and 3.6 versus 4.4/4.4), but less precision at 12 months of follow-up (SE%, 6.8 versus 4.8/5.5 and 3.6 versus 3.0/3.0). All PROMIS CATs had good responsiveness (75% to 100% of hypotheses not rejected; SRMs at 12 months: PROMIS-PI-CAT = -1.35 versus KOOS Pain = 1.78 and WOMAC Pain = -1.59; PROMIS-PF-CAT = 1.14 versus KOOS-ADL/WOMAC-PF = 1.43/-1.44; PROMIS-AS-CAT = 0.93 and PROMIS-SS-CAT = 0.93). The PROMIS-PF-CAT did not show ceiling effects at 12 months, unlike the KOOS-ADL/WOMAC-PF (17.5%). PROMIS CATs were more feasible at baseline and follow-ups compared with KOOS and WOMAC scales. PROMIS-CATs effectively assess health outcomes in knee arthroplasty patients, showing strong psychometric properties and favorable feasibility, supporting their role in value-based health care. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.