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Study suggests PROMIS scores of elite athletes and average patients differ
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BOSTON — Baseline patient-reported outcome measurement information system scores of elite athletes differed significantly from NIH baseline scores for the general population, according to a study presented here.
“Our athletes were different in every domain and in several domains, were nearly a standard deviation different. The mean in the NIH [patient-reported outcome measurement information system] PROMIS system didn’t necessarily apply to our elite athlete population,” Kenneth Hunt, MD, said at the American Orthopaedic Foot & Ankle Society Annual Meeting. According to Hunt, the NIH developed the normal PROMIS scores with a mean of 50 based on internet surveys of adults, modelled after the US census, to achieve a score that reflected the average American patient.
The IRB-approved prospective cohort study collected data from 206 college students from May to November 2017. Researchers categorized participants as elite athletes or healthy non-athletes. There were 39 elite athletes, defined as older than 18 years of age and participating in a NCAA Division I sport. The remaining 167 participants were healthy non-athletes, aged 18 to 35 years and who did not participate in a NCAA Division I sport. All participants completed a survey, which included demographic questions and the following six PROMIS domains: pain interference computerized adaptive testing (CAT), physical functioning CAT, mobility CAT, social functioning CAT, depression CAT and global health short form.
Researchers found elite athlete scores in all six domains showed statistically significant differences compared to NIH average PROMIS scores. Additionally, elite athletes’ scores were significantly different compared to healthy non-athletes’ scores, except for the PROMIS social functioning CAT and PROMIS global health short-form physical functioning t-score.
“[The result] highlights the need to interpret these scores carefully. We need to understand that we may not be trying to get these patients back to 50, we may be trying to get them to 60 or for the pain scales, back to 40. It underscores the necessity for us to understand this further,” Hunt commented. – Laura Kincaid
References:
Hunt K, et al. Application of patient-reported outcome measurement information system (PROMIS) in elite athletes. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 11-14, 2018; Boston.
Disclosure: Hunt reports no relevant financial disclosures.
Perspective
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John T. Campbell, MD
Patient-reported outcomes have received greater emphasis in clinical research as a more valid measure of the result of treatment. The NIH PROMIS outcome instrument has been increasingly adopted in orthopedic surgery, including in the foot and ankle setting. Critical to the use of such instruments is sufficiently developed benchmark data on different populations to make comparisons meaningful. This study investigated PROMIS measures in elite NCAA Division I college athletes compared to NIH population norms and a control group comprised of healthy young individuals, including a subgroup of non-athlete college students. Elite athletes were found to have significantly different baseline measures across multiple PROMIS domains compared to NIH population norms and compared to the young non-athlete cohort. No differences were found in physical domains vs. the non-athlete college students. Further breakdown of athletes by sport, gender, level of experience, in-season vs. off-season and sports participation hours per week could be helpful subsets to examine. The authors are to be congratulated on this initial study, highlighting the need for further specific data on athletes to better interpret future results in this specialized population.
Mercy Medical Center
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