29 selected PROMIS items to evaluate health related quality of life
In 2004, the U.S. National Institutes of Health initiated the Patient-Reported Outcomes Measurement Information System (PROMIS) as part of a wider project towards a more efficient and productive medical research system. The task of PROMIS was to develop and validate item banks to measure important symptoms and health concepts relevant to many different types of chronic conditions with the aim of measuring patient-reported outcomes for chronic disease, among others 1 2. The PROMIS 29 is a fixed questionnaire derived from these common item banks that measure key symptoms to assess a patient’s general health.
Its 29 items evaluate 8 dimensions of health status – physical function, anxiety, depression, fatigue, sleep disturbance, social functioning, pain interference and intensity – that can be summed up in a global physical health score and a global mental health score. The questionnaire has been applied in various areas of medicine, including orthopedics, hematology and rheumatology.
This questionnaire is a generic instrument for general health evaluation and can assess the patient’s health status independently of the particular disease involved.
Orthopedic applications include patients with chronic low back pain 3, primary stenosis, spondylolisthesis, disc herniation, symptomatic mechanical disc collapse and pseudarthrosis 4. Moreover, the tool has been used in oncological patients receiving hematopoietic stem cell transplantation 5 as well as in patients with systemic lupus erythematosus 6.
Items - Dimensions - Time to complete
Of the 29 items, 28 must be answered by selecting 1 of 5 response options. The last item is a single numerical analog scale requiring a rating from 0 – 10.
The items assess 8 dimensions: physical function, anxiety, depression, fatigue, sleep disturbance, social functioning, pain interference and pain intensity. There are 4 questions or statements for each dimension, besides pain intensity, which is rated according to a numerical analog scale. The items are either phrased in the present tense or ask the patient to answer based on how he or she has felt for the last 7 days.
There is no information in the literature on completion time. We estimate a time of 10 minutes.
The values of all item responses are averaged to generate subscores for each dimension. From these subscores, a global physical health score and a global mental health score are generated. The scores are translated into T-scores according to a reference population with a mean of 50 and a standard deviation of 10.
Score interpretation is done using the interpretation tables provided by HealthMeasures. Each dimension score and the global scores have their own charts with score cut points and their interpretation. 7
Charts for global score interpretation:
Charts for single-dimension interpretation:
The conversion to T-scores allows the PROMIS 29 scores to be interpreted easily and intuitively in relation to a reference population. Moreover, scoring allows differentiation in the different health dimensions through 8 subscores and 2 global scores.
It might take patients – especially elderly people – a while to complete. Furthermore, the scoring of the measure is made complex by the conversion to a T score and has a higher administrative burden.