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Spine (Phila Pa 1976). 2019 Sep 6. doi: 10.1097/BRS.0000000000003232. [Epub ahead of print]

Validation of PROMIS CATs and PROMIS Global Health in an Interdisciplinary Pain Program for Patients with Chronic Low Back Pain.

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Neurological Institute, Cleveland Clinic, Cleveland, OH 44195.



Retrospective cohort study OBJECTIVE.: To (1) confirm validity of PROMIS physical function and pain interference computer adaptive tests (CATs) and (2) assess the validity of PROMIS Global Health (GH) and five additional PROMIS CATs: social role satisfaction, fatigue, anxiety, depression, and sleep disturbance in a population of chronic low back pain (cLBP) patients who completed a 3-month Interdisciplinary Pain Program (IPP).


Recent recommendations for assessing outcomes in cLBP patients have included PROMIS scales, however there is a need for further evaluation, and PROMIS GH has not been studied in this population.


The study cohort included cLBP patients who completed the entirety of a 3-month IPP between 8/2016-12/2018. PROMs were analyzed prior to the start of the IPP and at graduation. Convergent and discriminant validity were evaluated using Pearson correlation coefficients. Known groups validity assessed the change in PROMIS scores stratified by improvement on the Modified LBP Disability Questionnaire (MDQ). Responsiveness was evaluated with standardized response means (SRM) based on global impression of change.


IPP was completed by 217 patients (67.7% female, age 53.8 ± 12.8). Convergent validity was supported (p < 0.01 for all pairwise PROMs comparisons). All PROMs improved significantly by graduation, with the largest improvement for PROMIS pain interference, physical function, social role satisfaction, and MDQ. Known groups validity demonstrated the greatest change on PROMIS physical function, social role satisfaction, pain interference, and depression. Responsiveness was supported for all PROMs in 170 (78.3%) patients who indicated at least minimal improvement (SRMs 0.43-1.06).


Our study provides support of PROMIS CATs, highlights the importance of including other meaningful outcome measures, such as social role satisfaction, and provides the first validation of PROMIS GH, in cLBP patients. PROMs collection can be streamlined through the use of PROMIS CATs which offer advantages over legacy measures.



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