Differential item functioning of the PROMIS physical function, pain interference, and pain behavior item banks across patients with different musculoskeletal disorders and persons from the general population
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To investigate the validity of comparisons across patients with different musculoskeletal disorders and persons from the general population by evaluating differential item functioning (DIF) for the PROMIS physical function (PROMIS-PF), pain interference (PROMIS-PI), and pain behavior (PROMIS-PB) item banks.
Patients with chronic pain, rheumatoid arthritis (RA), or osteoarthritis (OA); patients receiving physiotherapy (PT); and persons from the Dutch general population completed the full Dutch-Flemish PROMIS-PF (121-items), PROMIS-PI (40-items), or PROMIS-PB (39-items) banks. DIF was assessed with ordinal logistic regression models and McFadden’s pseudo R2-change of ≥ 2% as critical value. The impact of DIF on item scores and the T-scores per bank was examined by inspecting item characteristic curves (ICCs) and test characteristic curves (TCCs).
2762 patients with chronic pain, 2029 with RA, 1247 with OA, 805 receiving PT, and 1310 healthy persons participated. For the PROMIS-PF, 25 out of 121 items were flagged for DIF, of which 10 items were flagged in multiple comparisons. For the PROMIS-PI, only 2 out of 40 items were flagged for DIF and for the PROMIS-PB, only 3 out of 39 items. Most DIF items had R2 values just above the critical value of 2% and all showed uniform DIF. The ICCs and TCCs showed that the magnitude and impact of DIF on the item and T-scores were negligible.
This study supports the universal applicability of PROMIS across (patient) populations. Comparisons across patients with different musculoskeletal disorders and persons from the general population are valid, when applying the PROMIS-PF, PROMIS-PI, and PROMIS-PB banks.
KeywordsPROMIS Chronic pain Rheumatoid arthritis Hip or knee osteoarthritis General population Differential item functioning
The Dutch-Flemish PROMIS group is an initiative that aims to translate, investigate, and implement PROMIS item banks, short forms, and CATS in the Netherlands and Flanders (http://www.dutchflemishpromis.nl). The CHECK-cohort study is funded by the Dutch Arthritis Foundation. Involved are Erasmus Medical Center Rotterdam; Kennemer Gasthuis Haarlem; Leiden University Medical Center; Maastricht University Medical Center; Martini Hospital Groningen/Allied Health Care Center for Rheumatology and Rehabilitation Groningen; Medical Spectrum Twente Enschede/Ziekenhuisgroep Twente Almelo; Reade Center for Rehabilitation and Rheumatology; St. Maartenskliniek Nijmegen; University Medical Center Utrecht; and Wilhelmina Hospital Assen.
Compliance with ethical standards
Conflict of interest
Dr. C.B. Terwee is president of the PROMIS Health Organization. All authors are members of the Dutch-Flemish PROMIS group. All authors have no financial or non-financial conflicts of interest.
As this study did not involve experiments with patients, it was exempt from ethical approval according to the Dutch Medical Research in Human Subjects Act (WMO) by the medical ethics committee of the VU University Medical Center, and of Slotervaart and Reade, Amsterdam.
Human and animal rights
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
According to the Dutch Medical Research in Human Subjects Act (WMO), obtaining informed consent was not necessary. The waiver includes that a signature from the patient on a separate informed consent form was not required, but that completion of the questionnaire by the patient can be considered as informed consent.
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