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Research Mentor Name

Dr. Eric Makhni

Research Mentor Email Address


Institution / Department

Henry Ford Hospital System

Document Type

Research Abstract

Research Type


Level of Research



National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) assessments have become increasingly utilized within sports medicine due to their efficient administration and favorable correlation with traditional patient reported outcome measures (PROMs). One key advantage of CAT forms is the ability to draw from hundreds of item bank questions while utilizing very few questions in order to produce an accurate quantitative health measurement for the patient.

The Computer Adaptive Tests (CAT) algorithm assigns questions based on previous answers by the patient. The purpose of this study is to utilize this feature of the PROMIS PF CAT questionnaire to determine at which point during their recovery a patient is able to reach certain milestones and to elucidate the number of days – in increments of 30 (i.e., monthly) – it takes for patients who undergo ACL surgery to answer “with some difficulty” or “without any difficulty” for the five most frequently asked questions in the PROMIS PF CAT questionnaire. Understanding these timepoints will directly aid in clinical counseling and monitoring following surgery and provide an objective, quantitative bases for appropriate activity restriction and progression.

All patients who underwent ACLR by one of two sports medicine fellowship-trained orthopedic surgeons between 5/1/17 and 7/29/19 were included in this study. Post-operative PROMIS PF scores were reviewed with respect to individual item, response, and timing of response (with respect to number of days following surgery using 30-day increments). For each PROMIS PF CAT item, the following five answer choices were available: “Without any difficulty”, “With a little difficulty”, “With some difficulty”, “With much difficulty”, and “Unable to do”. A task was considered achievable if the patient answered any answer with “Without any difficulty” or “With a little difficulty”. The percentage of patients in each 30-day group who answered with either of these responses was recorded. Chi-square tests were run between the number of days postoperatively the surveys were administered and patient responses to determine whether or not there were statistically significant differences between groups.

A total of 2,822 patient responses (284 patients) were included in the final analysis with an average number of days postoperatively the surveys were administered of 72 and a standard deviation of 192.4. The five most frequently asked questions along with the percent of patients achieving these milestones were found to be: “Does your health now limit you in doing two hours of physical labor?” (n=966), “Does your health now limit you in doing yard work like raking leaves, weeding, or pushing a lawn mower?” (n=647), “Does your health now limit you in hiking a couple of miles (3km) on uneven surfaces, including hills?” (n=459), “Are you able to do chores such as vacuuming or yard work?” (n=442), and “Does your health now limit you in walking more than a mile (1.6km)?” (n=308). The times at which greater than 50% of respondents answered either “Without any difficulty” or “With a little difficulty” are shown in Table 1. All five questions showed statistically significant associations between number of days postoperatively and patient responses (p

On average, patients undergoing ACLR achieved milestones measured by the five most commonly asked questions on the PROMIS PF CAT by 2-4 months postoperatively. Patients also showed significant improvements in physical function over the same time span. These findings can be incorporated into post-operative monitoring, and patients who fail to achieve these milestones in the appropriate timepoints may require additional investigation or rehabilitation.


Orthopedics | Sports Medicine