Longitudinal Predictors of PROMIS Satisfaction With Social Roles and Activities After Shoulder and Knee Sports Orthopaedic Surgery in United States Military Servicemembers: An Observational Study

Krista B Highland; Michael Kent; Nicholas McNiffe; Jeanne C Patzkowski; Michael S Patzkowski; Alexandra Kane; Nicholas A Giordano

doi:10.1177/23259671231184834

Longitudinal Predictors of PROMIS Satisfaction With Social Roles and Activities After Shoulder and Knee Sports Orthopaedic Surgery in United States Military Servicemembers: An Observational Study

Orthop J Sports Med. 2023 Jul 28;11(7):23259671231184834. doi: 10.1177/23259671231184834. eCollection 2023 Jul.

Authors

Krista B Highland¹, Michael Kent², Nicholas McNiffe^{3

4}, Jeanne C Patzkowski⁵, Michael S Patzkowski^{1

4}, Alexandra Kane^{1

6}, Nicholas A Giordano⁷

Affiliations

¹ Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA.
² Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
³ School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
⁴ Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
⁵ Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
⁶ Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.
⁷ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.

Abstract

Background: Satisfaction with social roles and activities is an important outcome for postsurgical rehabilitation and quality of life but not commonly assessed.

Purpose: To evaluate longitudinal patterns of the Patient-Reported Outcomes Measurement Information System (PROMIS) Satisfaction with Social Roles and Activities measure, including how it relates to other biopsychosocial factors, before and up to 6 months after sports-related orthopaedic surgery.

Study design: Cohort study (diagnosis); Level of evidence, 3.

Methods: Participants (N = 223) who underwent knee and shoulder sports orthopaedic surgeries between August 2016 and October 2020 completed PROMIS computer-adaptive testing item banks and pain-related measures before surgery and at 6-week, 3-month, and 6-month follow-ups. In a generalized additive mixed model, covariates included time point; peripheral nerve block; the PROMIS Anxiety, Sleep Disturbance, and Pain Behavior measures; and previous 24-hour pain intensity. Patient-reported outcomes were modeled as nonlinear (smoothed) effects.

Results: The linear (estimate, 2.06; 95% CI, 0.77-3.35; P = .002) and quadratic (estimate, 2.93; 95% CI, 1.78-4.08; P < .001) effects of time, as well the nonlinear effects of PROMIS Anxiety (P < .001), PROMIS Sleep Disturbance (P < .001), PROMIS Pain Behavior (P < .001), and pain intensity (P = .02), were significantly associated with PROMIS Satisfaction with Social Roles and Activities. The cubic effect of time (P = .06) and peripheral nerve block (P = .28) were not. The proportion of patients with a 0.5-SD improvement in the primary outcome increased from 23% at 6 weeks to 52% by 6 months postsurgery, whereas those reporting worsening PROMIS Satisfaction with Social Roles and Activities decreased from 30% at 6 weeks to 13% at 6 months.

Conclusion: The PROMIS Satisfaction with Social Roles and Activities measure was found to be related to additional domains of function (eg, mental health, behavioral, pain) associated with postsurgical rehabilitation.

Keywords: anxiety; orthopaedic surgery; pain; rehabilitation; sleep; social function.