What Is the PROMIS Screening Tool?

Patient reported outcomes (PROs) are vital for providing an objective assessment of a patient’s progress. These outcome scores can help guide treatment progression, helping healthcare providers understand patients’ physical health, pain and difficulty, and overall experience, and how it changes over their course of care. Collecting them at baseline and periodically at follow-ups helps provide the most accurate reflection of these changes.

One of the most appropriate and advanced assessment tools is the Patient-Reported Outcomes Measurement Information System (PROMIS), an evidence-based tool that Medbridge has selected as the primary outcomes collection platform for the Musculoskeletal Program in Pathways, MedBridge’s hybrid care platform.

Let’s take a look at how the PROMIS tool works, the evidence behind the tool, and how it’s been integrated into Pathways to enhance patient assessment and their overall experience.

What Is PROMIS and PROMIS-CAT?

The Patient-Reported Outcomes Measurement Information System is a highly-validated tool used across clinical settings for assessing physical, mental, and social health. It consists of a series of standardized questions designed to measure your patient’s current health status. CAT, or Computer Adapted Testing, takes PROMIS to the next level by dynamically adjusting the questions based on patient responses.

The PROMIS-CAT is an adaptive outcome measurement system developed at Northwestern University through funding by the National Institutes of Health (NIH) that measures PROs across different domains of a patient’s health. Rather than asking every patient the same pool of questions each time, CAT adjusts questions based on users’ responses. PROMIS-CAT is also built to be delivered digitally, leading to shorter, more precise assessments compared to traditional static questionnaires. This makes the burden much lower for the patient.

PROMIS-CAT Scales Included in Pathways

Each MSK pathway includes three scales that cover pain, function, and impact on social roles. These three were chosen because they are most closely tied to clinical MSK care programs.

Physical Function:  A patient’s self-reported capability to do functional activities, such as activities of daily living (ADLs) and activities in the community.  

Pain Interference:  A patient’s self-reported impact of pain on their social, cognitive, emotional, physical, and recreational activities. 

Ability to Participate in Social Roles and Activities:  A patient’s self-reported ability to perform their usual social roles and activities.

Patients will complete their PROMIS-CAT to help clinicians measure and monitor their progression, function, and pain as applicable.

The Evidence Behind PROMIS-CAT

PROMIS is highly researched and widely validated for a large variety of musculoskeletal conditions, offering significant evidence supporting its accuracy, validity, and reliability in assessing patient-reported outcomes​. Substantial qualitative and quantitative evidence supports the validity of PROMIS® measures. Highlighted excerpts from HealthMeasures includes:

Content Validity

“Content validity is built into a test from the outset through the choice of appropriate items.¹“

“The content validity of PROMIS measures beginning in the use of patient interviews and reviews by expert review panels.”

Cross-Sectional Validity Evidence

“Cella, et al., 2010, reported results of initial validation studies of 11 PROMIS item banks measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Liu, et al., 2010 evaluated the representativeness of the Internet panel that was used for initial calibration of the PROMIS item banks. Rothrock, et al., 2010 compared PROMIS scores across chronic condition variables (e.g., number of comorbidities, whether condition was disabling).”

Responsiveness to Change

“As a person’s symptoms and function change over time, scores on PROMIS measures are expected to also change. Demonstrating responsiveness to change is done by assessing individuals over time. Often, effect sizes and standardized response means are calculated. There is evidence that PROMIS measures capture change over time in different clinical contexts (e.g., patients starting a new treatment for depression, patients with rheumatoid arthritis initiating a disease-modifying antirheumatic drug, patients with spinal disorders, and children with asthma).”

Clinical Validity Evidence

“In 2016, a series of articles was published in the Journal of Clinical Epidemiology that evaluated the function of different PROMIS measures across clinical contexts. The validity evidence presented in this series of papers was unique in that each paper evaluated a single PROMIS domain across multiple conditions in “real-world” clinical settings.”

Comparison With Legacy Measures

PROMIS has been shown to have moderate to strong correlations with traditional measures commonly used in MSK care, like the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) for patients with low back pain and neck pain, respectively.

Edelen, et al., also show that PROMIS-CAT (function, pain interference, pain intensity) reasonably predicts Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for patients with chronic low back pain.

Advantages of PROMIS-CAT Over Legacy Measures

PROMIS-CAT’s faster assessment, patient-friendly delivery, and similar validity to legacy measures make it a superior option for both patients and providers, allowing for better patient experience and higher compliance​.

Why PROMIS-CAT Was Selected for Pathways

PROMIS-CAT was chosen as the primary screening tool for Pathways based on its flexibility, ability to quickly assess patient function, and its strong correlation with other common PROs. It has been fully integrated into Pathways, providing regular, automated assessments that track patient progress and outcomes.​

This offers a streamlined patient experience with fewer but more targeted questions, which increases completion rates and enhances the quality of data collected​. This reduces the burden on patients to complete a lengthy questionnaire that may ask questions that are not relevant to their condition.

The Benefits of Using PROMIS-CAT in Pathways

Efficiency: PROMIS-CAT significantly reduces the time required for PRO assessments compared to traditional methods, making it ideal for busy healthcare settings​.

Accessibility and adaptability: The computer-adaptive nature of PROMIS ensures that assessments are customized to each patient, reducing patient fatigue and improving response accuracy​.

Cost-effectiveness: PROMIS-CAT is a cost-effective solution that replaces multiple traditional PROs with a single, adaptable system.

Conclusion

As a member of Medbridge’s Medical Advisory Board, I help provide guidance on utilization of PRO assessments, which ultimately lead Medbridge to adopting the PROMIS-CAT and incorporating it into their Pathways. PROMIS-CAT is a highly researched, widely validated outcome measurement system leveraged across the healthcare industry. Because these outcomes are optimized for digital delivery, they are significantly shorter than traditional, static outcome measures and work well with the cutting-edge, validated tools in Pathways, enhancing patient care and clinical outcomes.

Learn more about how Pathways helps providers manage their patients’ MSK and joint pain with targeted hybrid care that helps patients move better, feel better, and live better—or request a demo to see Pathways in action.