Journal of Shoulder and Elbow Surgery

PROMIS Global-10 performs poorly relative to legacy shoulder instruments in patients undergoing total shoulder arthroplasty for glenohumeral arthritis

Published:November 18, 2020DOI:


      The PROMIS Global-10 is a 10-item questionnaire that assesses general health-related quality of life. There is a paucity of research on the utility of the PROMIS Global-10 in the evaluation of orthopedic conditions. The aim of this study is to compare PROMIS Global-10 and legacy shoulder-specific patient-reported outcome measures (PROMs) in patients undergoing total shoulder arthroplasty (TSA) for shoulder arthritis.


      This retrospective cohort study included patients who underwent TSA for shoulder arthritis and completed preoperative and 1-year postoperative surveys. Primary outcome measures were the physical (PROMIS-P) and mental (PROMIS-M) components of PROMIS Global-10. The legacy PROMs included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Shoulder Activity Scale (SAS). Analyses included postoperative changes for each outcome, correlations between measures and a responsiveness assessment.


      A total of 170 patients met inclusion criteria. Average age and body mass index were 67.7 ± 7.8 years and 28.0 ± 4.9, respectively. All legacy PROMs and PROMIS-P were significantly higher at 1-year follow-up compared with the preoperative level (P < .0001), whereas PROMIS-M did not change (P = .06). Preoperatively, both PROMIS components were either poorly correlated with all legacy PROMs (r < .04, P < .05) or not correlated at all (P > .05). Postoperatively, PROMIS-M was poorly correlated with all legacy PROMs (r < .04, P < .01), whereas PROMIS-P had fair correlation with ASES (r = .5, P < .0001) and poor correlation with SANE and SAS (r < .04, P < .01). A floor effect was observed for SANE, and SANE and ASES had a ceiling effect. The effect sizes for SANE and ASES were high (d = 2.01 and 2.39 respectively), whereas the effect size for SAS was moderate (d = 0.65), and the effect sizes for the PROMIS measures were small (d < .5). ASES was the most responsive measure and PROMIS-M was the least responsive.


      PROMIS Global-10 had limited correlation with legacy PROMs and was less responsive at 1-year follow-up in patients following TSA. The Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA.

      Level of evidence


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        • Anthony C.A.
        • Glass N.A.
        • Hancock K.
        • Bollier M.
        • Wolf B.R.
        • Hettrich C.M.
        Performance of PROMIS instruments in patients with shoulder instability.
        Am J Sports Med. 2017; 45: 449-453
        • Bohannon R.W.
        • Depasquale L.
        Physical functioning scale of the short-form (SF) 36: internal consistency and validity with older adults.
        J Geriatr Phys Ther. 2010; 33: 16-18
        • Brophy R.H.
        • Beauvais R.L.
        • Jones E.C.
        • Cordasco F.A.
        • Marx R.G.
        Measurement of shoulder activity level.
        Clin Orthop Relat Res. 2005; 439: 101-108
        • Cella D.
        • Yount S.
        • Rothrock N.
        • Gershon R.
        • Cook K.
        • Reeve B.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-S11
        • Cheung E.C.
        • Moore L.K.
        • Flores S.E.
        • Lansdown D.A.
        • Feeley B.T.
        • Zhang A.L.
        Correlation of PROMIS with orthopaedic patient-reported outcome measures.
        JBJS Rev. 2019; 7: e9
        • Cohen J.
        Statistical power analysis for the behavioural sciences.
        Lawrence Erlbaum, Hillsdale, NJ1988
        • Dowdle S.B.
        • Glass N.
        • Anthony C.A.
        • Hettrich C.M.
        Use of PROMIS for patients undergoing primary total shoulder arthroplasty.
        Orthop J Sport Med. 2017; 5
        • Dunlap W.P.
        • Cortina J.M.
        • Vaslow J.B.
        • Burke M.J.
        Meta-analysis of experiments with matched groups or repeated measures designs.
        Psychol Methods. 1996; 1: 170-177
        • Fidai M.S.
        • Saltzman B.M.
        • Meta F.
        • Lizzio V.A.
        • Stephens J.P.
        • Bozic K.J.
        • et al.
        Patient-reported outcomes measurement information system and legacy patient-reported outcome measures in the field of orthopaedics: a systematic review.
        Arthroscopy. 2018; 34: 605-614
        • Fu M.C.
        • Chang B.
        • Wong A.C.
        • Nwachukwu B.U.
        • Warren R.F.
        • Dines J.S.
        • et al.
        PROMIS physical function underperforms psychometrically relative to American Shoulder and Elbow Surgeons score in patients undergoing anatomic total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2019; 28: 1809-1815
        • Gowd A.K.
        • Charles M.D.
        • Liu J.N.
        • Lalehzarian S.P.
        • Cabarcas B.C.
        • Manderle B.J.
        • et al.
        Single Assessment Numeric Evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty.
        J Shoulder Elbow Surg. 2019; 28: 2238-2246
        • Hays R.D.
        • Bjorner J.B.
        • Revicki D.A.
        • Spritzer K.L.
        • Cella D.
        Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items.
        Qual Life Res. 2009; 18: 873-880
        • Harreld K.
        • Clark R.
        • Downes K.
        • Virani N.
        • Frankle M.
        Correlation of subjective and objective measures before and after shoulder arthroplasty.
        Orthopedics. 2013; 36: 808-814
        • Jones I.A.
        • Togashi R.
        • Heckmann N.
        • Vangsness C.T.
        Minimal clinically important difference (MCID) for patient-reported shoulder outcomes.
        J Shoulder Elbow Surg. 2020; 29: 1484-1492
        • Kocher M.S.
        • Horan M.P.
        • Briggs K.K.
        • Richardson T.R.
        • O'Holleran J.
        • Hawkins R.J.
        Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis.
        J Bone Joint Surg Am. 2005; 87: 2006-2011
        • Landy D.C.
        • Boyadjian H.
        • Shi L.L.
        • Lee M.J.
        General health measures in shoulder surgery: are we powered for success?.
        J Shoulder Elbow Surg. 2019; 28: 1341-1346
        • Liang M.H.
        • Larson M.G.
        • Cullen K.E.
        • Schwartz J.A.
        Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research.
        Arthritis Rheum. 1985; 28: 542-547
        • Kahan J.B.
        • Kassam H.F.
        • Nicholson A.D.
        • Saad M.A.
        • Kovacevic D.
        Performance of PROMIS global-10 to legacy instruments in patients with lateral epicondylitis.
        Arthroscopy. 2019; 35: 770-774
        • Minoughan C.E.
        • Schumaier A.P.
        • Fritch J.L.
        • Grawe B.M.
        Correlation of PROMIS physical function upper extremity computer adaptive test with American Shoulder and Elbow Surgeons shoulder assessment form and simple shoulder test in patients with shoulder arthritis.
        J Shoulder Elbow Surg. 2018; 27: 585-591
        • Nicholson A.D.
        • Kassam H.F.
        • Pan S.D.
        • Berman J.E.
        • Blaine T.A.
        • Kovacevic D.
        Performance of PROMIS global-10 compared with legacy instruments for rotator cuff disease.
        Am J Sports Med. 2019; 47: 181-188
        • Nilsdotter A.
        • Roos E.M.
        • Westerlund J.P.
        • Roos H.P.
        • Lohmander L.S.
        Comparative responsiveness of measures of pain and function after total hip replacement.
        Arthritis Rheum. 2001; 45: 258-262
        • Nwachukwu B.U.
        • Chang B.
        • Beck E.C.
        • Neal W.H.
        • Movassaghi K.
        • Ranawat A.S.
        • et al.
        How should we define clinically significant outcome improvement on the iHOT-12?.
        HSS J. 2019; 15: 103-108
        • Saad M.A.
        • Kassam H.F.
        • Suriani R.J.
        • Pan S.D.
        • Blaine T.A.
        • Kovacevic D.
        Performance of PROMIS Global-10 compared with legacy instruments in patients with shoulder arthritis.
        J Shoulder Elbow Surg. 2018; 27: 2249-2256
        • Sciascia A.D.
        • Morris B.J.
        • Jacobs C.A.
        • Edwards T.B.
        Responsiveness and internal validity of common patient-reported outcome measures following total shoulder arthroplasty.
        Orthopedics. 2017; 40: e513-e519
        • Smith M.V.
        • Calfee R.P.
        • Baumgarten K.M.
        • Brophy R.H.
        • Wright R.W.
        Upper extremity-specific measures of disability and outcomes in orthopaedic surgery.
        J Bone Joint Surg Am. 2012; 94: 277-285
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • van der Windt D.A.W.M.
        • Knol D.L.
        • Dekker J.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Unger R.Z.
        • Burnham J.M.
        • Gammon L.
        • Malempati C.S.
        • Jacobs C.A.
        • Makhni E.C.
        The responsiveness of patient- reported outcome tools in shoulder surgery is dependent on the underlying pathological condition.
        Am J Sports Med. 2019; 47: 241-247
        • Ware Jr., J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233