Computerized Adaptive Testing Using the PROMIS Physical Function Item Bank Reduces Test Burden With Less Ceiling Effects Compared With the Short Musculoskeletal Function Assessment in Orthopaedic Trauma Patients

Purpose: Patient-reported outcomes are important to assess effectiveness of clinical interventions. For orthopaedic trauma patients, the short Musculoskeletal Function Assessment (sMFA) is a commonly used questionnaire. Recently, the Patient-Reported Outcome Measurement Information System (PROMIS) PF Function Computer Adaptive Test (PF CAT) was developed using item response theory to efficiently administer questions from a calibrated bank of 124 PF questions using computerized adaptive testing. In this study, we compared the sMFA versus the PROMIS PF CAT for trauma patients. Methods: Orthopaedic trauma patients completed the sMFA and the PROMIS PF CAT on a tablet wirelessly connected to the PROMIS Assessment Center. The time for each test administration was recorded. A 1-parameter item response theory model was used to examine the psychometric properties of the instruments, including precision and floor/ceiling effects. Results: One hundred fifty-three orthopaedic trauma patients participated in the study. Mean test administration time for PROMIS PF CAT was 44 seconds versus 599 seconds for sMFA (P < 0.05). Both instruments showed extremely high item reliability (Cronbach alpha = 0.98). In terms of instrument coverage, neither instrument showed any floor effect; however, the sMFA revealed 14.4% ceiling effect, whereas the PROMIS PF CAT had no appreciable ceiling effect. Conclusions: Administered by electronic means, the PROMIS PF CAT required less than one-tenth the amount of time for patients to complete than the sMFA while achieving equally high reliability and less ceiling effects. The PROMIS PF CAT is a very attractive and innovative method for assessing patient-reported outcomes with minimal burden to patients.