Validity and Reliability of Patient Reported Outcomes Measurement Information System Computerized Adaptive Tests in Systemic Lupus Erythematosus

• Published in: Journal of rheumatology 2017-07, Vol.44 (7), p.1024-1031
• Main Authors: Kasturi, Shanthini, Szymonifka, Jackie, Burket, Jayme C, Berman, Jessica R, Kirou, Kyriakos A, Levine, Alana B, Sammaritano, Lisa R, Mandl, Lisa A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Humans; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - psychology; Male; Middle Aged; Patient Reported Outcome Measures; Patient Satisfaction; Quality of Life; Reproducibility of Results; Self Report; Severity of Illness Index; Social Participation; Surveys and Questionnaires; Young Adult
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.161202

The aims of this study were to assess the construct validity and the test-retest reliability of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CAT) in patients with systemic lupus erythematosus (SLE). Adults with SLE completed the Medical Outcomes Study Short Form-36, LupusQoL-US version ("legacy instruments"), and 14 selected PROMIS CAT. Using Spearman correlations, PROMIS CAT were compared with similar domains measured with legacy instruments. CAT were also correlated with the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) disease activity and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores. Test-retest reliability was evaluated using ICC. There were 204 outpatients with SLE enrolled in the study and 162 completed a retest. PROMIS CAT showed good performance characteristics and moderate to strong correlations with similar domains in the 2 legacy instruments (r = -0.49 to 0.86, p < 0.001). However, correlations between PROMIS CAT and the SELENA-SLEDAI disease activity and SDI were generally weak and statistically insignificant. PROMIS CAT test-retest ICC were good to excellent, ranging from 0.72 to 0.88. To our knowledge, these data are the first to show that PROMIS CAT are valid and reliable for many SLE-relevant domains. Importantly, PROMIS scores did not correlate well with physician-derived measures. This disconnect between objective signs and symptoms and the subjective patient disease experience underscores the crucial need to integrate patient-reported outcomes into clinical care to ensure optimal disease management.