Computerized Adaptive Testing for Patient Reported Outcomes in Ankle Fracture Surgery

Foot Ankle Int. 2018 Oct;39(10):1192-1198. doi: 10.1177/1071100718782487. Epub 2018 Jul 4.


Background: Advantages of using computerized adaptive testing (CAT) include decreased survey-burden, diminished floor and ceiling effect, and improved ability to detect the minimal clinical significant difference (MCID) among patients. The goal of this study was to compare the legacy patient-reported outcome measures (PROMs) to the Patient-Reported Outcomes Measurement Information System (PROMIS) scores in terms of ability to detect clinically significant changes in patients who have undergone surgery for ankle fractures.

Methods: Patients who underwent osteosynthesis for an unstable ankle fracture between 2013-2016 and completed legacy outcome scores (Foot and Ankle Outcome Score [FAOS], Olerud and Molander Ankle Score [OMAS], and Weber Score) along with the PROMIS Physical Function (PF) and PROMIS Lower Extremity (LE) CATs postoperatively were included. Correlation between the scores at 3-month, 6-month, and 1-year intervals, as well as floor and ceiling effects, in addition to MCIDs were calculated for each instrument. A total of 132 patients were included in the study.

Results: There was no observed floor or ceiling effect in either the PROMIS PF or the PROMIS LE scores. Clinically significant changes in the PROMIS LE score were detected in patients between 6-month and 12-month postoperative visits ( P = .0006), whereas the reported OMAS score and Weber scores did not identify a clinically significant difference between patients at their 6-month and 12-month visit.

Conclusion: The results of this study indicate that the PROMIS LE was superior for evaluating patients following ankle fracture surgery in terms of lower floor and ceiling effects and greater ability to distinguish clinically significant changes in patients between time points following surgery.

Level of evidence: Level III, comparative study.

Keywords: PROMIS; ankle fractures; computerized adaptive testing; minimal clinical important difference; patient-reported outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Ankle Fractures / physiopathology*
  • Ankle Fractures / surgery*
  • Disability Evaluation*
  • Female
  • Fracture Fixation, Internal / methods*
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Postoperative Period
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome