ArticleQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2025
Clarifying thresholds for defining levels of physical function and pain interference using bookmarking in orthopaedics.
Article in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Deciding on thresholds for clinical relevance of PROMIS-upper extremity v2.0 in patients with upper extremity injury.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
purposeBookmarking is a qualitative method used to assign descriptive labels to ranges of patient-reported outcome (PROM) scores. We aimed to evaluate variability between bookmarking samples and test score ranges where there was variability in expert opinion in previous studies.
methodsWe conducted two bookmarking sessions with patients who experienced orthopaedic fractures (n = 11) and one session with orthopaedic clinicians (n = 10). Participants reviewed vignettes comprised of PROM items and responses that represented hypothetical patients with a range of severity. Vignettes were constructed for PROMIS Upper Extremity Function, Physical Function, and Pain Interference measures. Participants placed bookmarks between vignettes that reflected different levels of severity (e.g., mild, moderate). The score reflecting the midpoint between vignettes was used as the recommended threshold between categories. We evaluated the variability in thresholds across participants, bookmarking panels, and previous studies.
resultsAlthough patients and clinicians were not unanimous, the majority agreed on thresholds separating levels of severity for PROMIS Upper Extremity (≥ 40 = within normal limits, 30-39 = mild, 23-29 = moderate, < 23 = severe), PROMIS Physical Function (≥ 46 = within normal limits, 38-45 = mild, 26-37 = moderate, < 26 = severe), and PROMIS Pain Interference (≤ 50 = within normal limits, 51-60 = mild, 61-68 = moderate, > 68 = severe).
conclusionTesting new vignette scores within the same patient population enables more nuanced testing of score ranges without clear consensus and provides additional evidence for recommending thresholds for severity categories. These thresholds can be utilized to help interpret PROMIS scores from patients receiving orthopaedic care.
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