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PROMIS Physical Function Short Forms Display Item- and Scale-Level Characteristics at Least as Good as the Roland Morris Disability Questionnaire in Patients With Chronic Low Back Pain

  • Alessandro Chiarotto
    Correspondence
    Corresponding author Alessandro Chiarotto, PT, MSc, PhD, Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, VU University De Boelelaan 1085, Room U-601, 1081HV, Amsterdam, The Netherlands.
    Affiliations
    Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, VU University, Amsterdam, The Netherlands

    Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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  • Leo D. Roorda
    Affiliations
    Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
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  • Martine H. Crins
    Affiliations
    Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
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  • Maarten Boers
    Affiliations
    Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands

    Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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  • Raymond W. Ostelo
    Affiliations
    Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, VU University, Amsterdam, The Netherlands

    Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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  • Caroline B. Terwee
    Affiliations
    Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, VU University, Amsterdam, The Netherlands
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Published:November 02, 2019DOI:https://doi.org/10.1016/j.apmr.2019.09.018

      Abstract

      Objective

      To compare dimensionality, item-level characteristics, scale-level reliability, and construct validity of PROMIS Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP).

      Design

      Cross-sectional study.

      Setting

      Secondary care center for rehabilitation and rheumatology.

      Participants

      Patients with nonspecific LBP ≥3 months (N=768). Mean age was 49±13 years, 77% were female, and 54% displayed pain for more than 5 years.

      Interventions

      Not applicable.

      Main Outcome Measures

      Dutch versions of the 4-, 6-, 8-, 10-, and 20-item PROMIS-PF and of the RMDQ-24.

      Results

      PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: comparative fit index>0.950, Tucker-Lewis index>0.950, root means square error of approximation<0.060), whereas the other instruments did not. All instruments were free of local dependence except PROMIS-PF-20 with 4 item pairs with clear residual correlations. Mokken scale analysis found 1 nonmonotone item for PROMIS-PF-20 and 8 for RMDQ-24 (ie, the probability of endorsing these items was not increasing with increasing level on the underlying construct). PROMIS-PF-20 displayed 2 misfitting items (S-χ2 P value>.001). Two-parameter item response theory models found 2 items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments and differences between relevant subgroups were met.

      Conclusions

      PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6, PROMIS-PF-8, and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison with disease-specific physical functioning instruments in LBP.

      Keywords

      List of abbreviations:

      CAT (computerized adaptive testing), CFA (confirmatory factor analysis), COSMIN (consensus-based standards for the selection of health measurement instruments), IRT (item response theory), LBP (low back pain), NRS (numeric rating scale), PROM (patient-reported outcome measure), RMDQ-24 (24-item Roland Morris Disability Questionnaire), PROMIS (Patient Reported Outcomes Measurement Information System), PROMIS-PF (Patient Reported Outcomes Measurement Information System Physical Function), PROMIS-PF-4 (4-item PROMIS Physical Function short form), PROMIS-PF-6 (6-item PROMIS Physical Function short form), PROMIS-PF-8 (8-item PROMIS Physical Function short form), PROMIS-PF-10 (10-item PROMIS Physical Function short form), PROMIS-PF-20 (20-item PROMIS Physical Function short form), PROMIS-GH-10 (10-item PROMIS Global Health short form)
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