Responsiveness of PROMIS Instruments for Trigger Digit After Corticosteroid Injection or A1 Pulley Release

Amy Phan; Thais Calderon; Warren Hammert

doi:10.1016/j.jhsa.2022.03.015

Responsiveness of PROMIS Instruments for Trigger Digit After Corticosteroid Injection or A1 Pulley Release

J Hand Surg Am. 2023 Oct;48(10):1064.e1-1064.e7. doi: 10.1016/j.jhsa.2022.03.015. Epub 2022 May 14.

Authors

Amy Phan¹, Thais Calderon¹, Warren Hammert²

Affiliations

¹ Department of Orthopedics and Physical Performance, University of Rochester School of Medicine and Dentistry, Rochester, New York.
² Department of Orthopedics and Physical Performance, University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address: warren_hammert@urmc.rochester.edu.

PMID: 35581043
DOI: 10.1016/j.jhsa.2022.03.015

Abstract

Purpose: The purpose of the study was to determine if the patient-reported outcomes measurement information system (PROMIS) is sufficiently sensitive to detect improvement after 2 common treatments of trigger finger: corticosteroid injection or A1 pulley release.

Methods: This retrospective cohort study included 72 patients in the injection group and 51 in the A1 pulley release group. PROMIS physical function (PF), pain interference (PI), and upper extremity (UE) scores were collected at baseline and 6 weeks after injection for the injection group and at baseline, and 1 week, 6 weeks, and 3 months after surgery for A1 pulley release patients. Descriptive statistics and paired t tests were used to compare PROMIS scores within each cohort. Standardized response means (SRMs) were calculated for each PROMIS domain to gauge instrument responsiveness.

Results: Average age was 62 years, 65% were female patients, and 86% were White for the steroid injection cohort, compared to 60 years, 71%, and 88%, respectively, for the A1 pulley release cohort. For the steroid injection group, mean PROMIS PI scores (-4.0 points; SRM = -0.6) and PROMIS UE scores (+3.3 points; SRM = 0.5) improved significantly at 6 weeks after injection compared to baseline. Meanwhile, A1 pulley release patients improved significantly in mean PI scores (-3.7 points; SRM = -0.5) and in UE scores (+4.9 points; SRM = 0.7) at 3 months after surgery compared to baseline.

Conclusions: Clinical improvements after trigger digit treatments are reflected in improved PROMIS PI and UE scores that reach previously accepted minimum clinically important difference values for hand patients. PROMIS PI and UE also are more responsive than PROMIS PF in capturing improvement for trigger digit treatments.

Clinical relevance: As health care payers continue to emphasize patient-reported outcomes to determine treatment value and set reimbursement rates, this study helps establish that clinical improvement after trigger digit treatments are reflected in PROMIS PI and UE domains by reaching previously established minimum clinically important difference values for hand patients.

Keywords: A1 pulley release; PROMIS; patient-reported outcomes; trigger finger; value-based health care.

MeSH terms

Disability Evaluation
Female
Hand
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Retrospective Studies
Steroids
Trigger Finger Disorder* / drug therapy
Trigger Finger Disorder* / surgery
Upper Extremity

Substances

Steroids