Evaluating Immediate and Short-Term Postoperative Clinical Outcomes of Patients Undergoing Ulnar Shortening for Ulnar Impaction Syndrome Using PROMISFunding None.
Background The early recovery trajectory of patients undergoing ulnar shortening for ulnar impaction syndrome using the Patient-Reported Outcomes Measurement Information System (PROMIS) is unknown.
Questions/Purposes Using PROMIS Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression, we asked (1) do patients undergoing operative management for ulnar impaction syndrome present at their preoperative visit with notable impairment?; (2) At immediate follow-up, do patients present with a clinically appreciable change in symptom severity?; and (3) At short-term follow-up, do patients present with a clinically appreciable change in symptom severity?
Materials and Methods We identified patients from 01/2017 to 12/2019 at our institution undergoing ulnar shortening for ulnar impaction syndrome who completed all PROMIS domains at a preoperative visit and at least one postoperative time point (i.e., less than 4 weeks and/or greater than 12 weeks). Distribution- and anchor-based minimal clinically important difference estimates were used to evaluate clinically appreciable changes in symptoms over time.
Results A total of 38 patients met our inclusion criteria. The average change in PROMIS UE, PF, PI, and Depression scores from preoperative to immediate postoperative follow-up were –3.8, –4.3, 3.2, and 0.5, respectively. However, by short-term follow-up, the average change in PROMIS UE, PF, PI, and Depression scores were 3.7, 3.2, –4.7, and –3.9, respectively.
Conclusions Patients have worsening function at the immediate postoperative follow-up. By short-term postoperative follow-up, functional status and PI levels improve. Our findings can help hand surgeons provide evidence-based guidance on expected initial recovery following operative management for ulnar impaction syndrome.
Level of Evidence This is a level II, prognostic study.
Keywordsulnar impaction syndrome - recovery pattern - patient-reported outcome measures - PROMs - PROMIS
The work was performed at the Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, New York.
The Institutional Review Board (IRB) of the University of Rochester Medical Center approved this study. The approved protocol number is: STUDY00000872.
Eingereicht: 10. September 2020
Angenommen: 03. Februar 2021
Artikel online veröffentlicht:
24. März 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
- 2 Ahsan ZS, Song Y, Yao J. Outcomes of ulnar shortening osteotomy fixed with a dynamic compression system. J Hand Surg Am 2013; 38 (08) 1520-1523
- 3 Elgammal A, Rozée B. Outcomes of the ulnar shortening osteotomy using a dynamic compression plate on the ulnar surface of the ulna. J Wrist Surg 2018; 7 (04) 344-349
- 4 Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. J Bone Joint Surg Am 2005; 87 (12) 2649-2654
- 5 Fries JF, Bruce B, Cella D. The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes. Clin Exp Rheumatol 2005; 23 (5, Suppl 39): S53-S57
- 6 Tyser AR, Beckmann J, Franklin JD. et al. Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 2014; 39 (10) 2047-2051
- 7 Beckmann JT, Hung M, Voss MW, Crum AB, Bounsanga J, Tyser AR. Evaluation of the patient-reported outcomes measurement information system upper extremity computer adaptive test. J Hand Surg Am 2016; 41 (07) 739-744
- 8 Overbeek CL, Nota SP, Jayakumar P, Hageman MG, Ring D. The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness. Clin Orthop Relat Res 2015; 473 (01) 311-317
- 9 Bernstein DN, Houck JR, Mahmood B, Hammert WC. Responsiveness of the PROMIS and its concurrent validity with other region- and condition-specific PROMS in patients undergoing carpal tunnel release. Clin Orthop Relat Res 2019; 477 (11) 2544-2551
- 10 Makhni EC, Meadows M, Hamamoto JT, Higgins JD, Romeo AA, Verma NN. Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting?. J Shoulder Elbow Surg 2017; 26 (02) 352-357
- 11 Hammert WC, Calfee RP. Understanding PROMIS. J Hand Surg Am 2020; 45 (07) 650-654
- 12 HealthMeasures. PROMIS®. Accessed February 18, 2021 at: http://www.healthmeasures.net/score-and-interpret/interpret-scores/promis
- 13 Papuga MO, Dasilva C, McIntyre A, Mitten D, Kates S, Baumhauer JF. Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record. Health Syst (Basingstoke) 2017; 7 (01) 1-12
- 14 Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003; 41 (05) 582-592
- 15 Kazmers NH, Qiu Y, Yoo M, Stephens AR, Tyser AR, Zhang Y. The minimal clinically important difference of the PROMIS and QuickDASH instruments in a nonshoulder hand and upper extremity patient population. J Hand Surg Am 2020; 45 (05) 399-407.e6
- 16 Kortlever JT, Janssen SJ, van Berckel MM, Ring D, Vranceanu AM. What is the most useful questionnaire for measurement of coping strategies in response to nociception?. Clin Orthop Relat Res 2015; 473 (11) 3511-3518
- 17 Smet LD, Vandenberghe L, Degreef I. Ulnar impaction syndrome: ulnar shortening vs. arthroscopic wafer procedure. J Wrist Surg 2014; 3 (02) 98-100
- 18 Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am 2013; 38 (04) 641-649
- 19 Beleckas CM, Gerull W, Wright M, Guattery J, Calfee RP. Variability of PROMIS scores across hand conditions. J Hand Surg Am 2019; 44 (03) 186-191.e1
- 20 Brodke DJ, Saltzman CL, Brodke DS. PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg 2016; 24 (11) 744-749
- 21 Baumhauer JF. Patient-reported outcomes - are they living up to their potential?. N Engl J Med 2017; 377 (01) 6-9