Do PROMIS® Biopsychosocial Measures Inform Clinical Decisions in Patients with Hallux Valgus?
Authors: Hutchison Marcey Keefer , Houck DPT Jeff 
Published: March 2021

Category

Bunion; Midfoot/Forefoot

Introduction/Purpose

The PROMIS self-efficacy of symptom management(SE)(psychological) and satisfaction with social roles (SR) (social) outcomes when combined with the physical function(PF) and pain interference (PI) (biologic) outcomes capture a patient’s biopsychosocial status. Although PROMIS accomplishes assessments efficiently (i.e. low patient/provider burden), the clinical utility of psychosocial outcomes is questioned. Moreover, in foot and ankle studies, psychosocial outcomes are less emphasized than more routine biologic outcomes (i.e. PF and PI). Data showing strong correlations of psychosocial variables with PF and PI in foot and ankle patients would demonstrate their clinical importance. The purpose was to examine the correlation of biopsychosocial PROMIS measures and physical indicators of hallux valgus severity (Manchester Scale & foot strength) with two common biologic outcomes clinicians routinely use (PF and PI).

Methods

Twenty-two (22) participants with HV attended a single session to determine degree of HV deformity, foot strength (1st MTP and heel rise height) and complete PROMIS measures. Of the 22 participants (14 no-surgery, 8 post-correction surgery), 81.8% had either a moderate (C) or severe (D) deformity using the Manchester Scale. A custom force transducer set in a jig assessed 1st MTP strength. Heel rise performance was assessed using 3D movement analysis. To examine the influence of HV deformity, two one way ANOVA’s, each comparing PF and PI of patients classified by the Manchester Scale categories. Worse PF and PI were hypothesized to be associated with moderate/severe HV. A Spearman statistic was used to assess correlations. The strength of the correlations of foot strength and PROMIS SE and SR with PF and PI were categorized as excellent (>0.7), excellent-good (0.61 to 0.70), good (0.4 to 0.6), or poor (<0.4).

Results:

Correlations were significant with PF and PI affirming that psychosocial variables are correlated with biologic variables. Age and BMI were significantly correlated with PF and PI with rho values in good range. Measures of strength (heel height, 1st MTP Strength) were significantly correlated in the good to excellent range; heel height and PI showing the strongest correlation (rho=-0.74, p<0.01). The correlation of SE with PF (rho=0.71, p<0.01) and PI (rho=-0.75, p<0.01) were classified as excellent (Figure 1). The correlation of SR with PF (rho=0.45, p=0.04) and PI (rho=-0.58, p<0.01) were classified as good. ANOVA analysis of degree of deformity with PF and PI showed little association; average values for categories B, C, & D all within a ½ standard deviation of the US average.

Conclusion:

PROMIS psychosocial outcomes showed excellent to good correlations with PF and PI outcomes suggesting these variables influence physical ability and pain. The PROMIS SE outcome, a psychologic outcome, showed excellent correlations with PF and PI similar or better than performance based tests of strength. The PROMIS SR outcome showed good correlations and therefore may have less influence with patient self-report. This data suggests provider/patient interactions focusing on SE may have stronger influence on PF/PI outcomes. Providers’ interactions should focus on building SE to improve outcomes and treatment compliance that translates into higher PF and lower PI.