Establishing Clinically Significant Outcomes of the PROMIS Upper Extremity Questionnaire after Primary Reverse Total Shoulder Arthroplasty.

BACKGROUND and Hypothesis: Since its introduction, the Patient Reported Outcome Measurement Information System Upper Extremity (PROMIS UE) assessment has been increasingly used in shoulder arthroplasty outcome measurement. However, determination of clinically significant outcomes using PROMIS UE has yet to be investigated following reverse total shoulder arthroplasty (RTSA). We hypothesized that we could establish clinically significant outcomes of the PROMIS UE outcome assessment in patients undergoing primary RTSA and identify significant baseline patient factors associated with achievement of these measures. METHODS Consecutive patients undergoing primary RTSA between 2018-2019 who received preoperative-baseline and follow-up PROMIS UE assessments at 12 months after surgery were retrospectively reviewed. Domain-specific anchor questions pertaining to pain and function assessed at 12 months after surgery were utilized to determine minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) values for PROMIS UE using receiver operating characteristic (ROC) and area under the curve (AUC) analysis. Univariate logistic regression analysis was then performed to identify significant patient factors associated with achieving MCID, SCB, or PASS. RESULTS 95 patients met all inclusion criteria and were included in the analysis. Using anchor-based methods, the value of PASS was 36.68 (sensitivity 0.795, specificity 0.765, AUC 0.793) and of SCB was 11.62 (sensitivity 0.597, specificity 1.00, AUC 0.806). Using a distribution-based method, the value of MCID was calculated to be 4.27. Higher preoperative PROMIS UE was a positive predictor in achievement of PASS (OR 1.107; p=0.05), whereas lower preoperative PROMIS UE scores were associated with obtaining SCB (OR 0.787; p<0.001). Greater baseline forward flexion was negatively associated with achievement of PASS (OR 0.986; p=0.033) and MCID (OR 0.976, p=0.013). 83.2%, 69.5%, and 47.4% of patients achieved MCID, PASS, and SCB, respectively. CONCLUSION This study defines MCID, SCB, and PASS for the PROMIS UE outcome assessment in patients undergoing primary RTSA, of which the majority achieve meaningful outcome improvement at 12 months after surgery. These values may be utilized in assessing outcome and extent of functional improvement following RTSA.