Purpose: As the United States moves toward value-based care, there has been increasing emphasis on collecting and reporting patient reported outcome measures (PROs).  However, PROs are based on subjectively collected data with the potential for unreliable measurement and response bias.  Importantly, the relationship between PROs and clinical/real-world outcomes remain unclear. Further investigation on interpreting PROs is required prior to utilizing them to drive clinical practice and prior to incorporating them into alternative payment models.  The purpose of the present study is to identify the time course of recovery after traumatic injury and to identify variables independently associated with patient reported outcome and may account for the variation in recovery.

Methods: 488 patients who underwent fracture fixation from 2011 to 2018 who filled out PROMIS General Health (including Physical Component and Mental Component Scores) on at least two occasions postoperatively were identified from the medical record at one level 1 trauma center.  The medical record was reviewed for demographic, treatment and admission characteristics. The trend in PROMIS Physical Component Score (PCS) during recovery was documented and linear regression was performed to identify variables accounting for variation in recovery.

Results: In this cohort, patients made the most rapid recovery during the first six months, at which time the mean PCS scores plateaued or worsened. There was an independent association between time after surgery (coefficient 2.33, 95% CI 1.87 to 2.79), PROMIS mental component (between persons coefficient 0.22, 95% CI 0.13 to 0.30, within persons coefficient 0.24, 95% CI 0.18 to 0.29), readmission within 1 year (coefficient -2.32, 95% CI -3.68 to -0.97), lower extremity injury (coefficient -2.34, 95% CI -3.57 to -1.12) and multiple fractures (coefficient -3.56, -5.81 to -1.31).

Conclusion: Independent drivers of variation in PROMIS physical component scores can be explained by PROMIS mental component scores (positive relationship), having a complication resulting in readmission within 1 year (negative relationship), lower extremity or multiple extremity injury (as compared to upper extremity injury) (negative relationship). Appropriate risk-adjustment of the above associations will aid in the use of PROs in musculosketal patients.

Patient-Reported Outcome Measures in Musculoskeletal Trauma Patients