ArticleFoot & ankle orthopaedics2026
PROMIS Computerized Adaptive Testing Demonstrates Strong Convergent Validity and Lower Patient Burden Compared With Legacy Instruments in Foot and Ankle Fracture Care.
Article in Foot & ankle orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite its advantages, Patient-Reported Outcomes Measurement Information System (PROMIS) remains underused in patients recovering from foot and ankle fractures, and it is unclear whether condition- and region-specific PROs, such as the Foot and Ankle Outcome Score (FAOS), offer additional clinical insight over PROMIS in this cohort. Therefore, PROMIS Computerized Adaptive Test (CAT) measurement properties were evaluated and compared with region-specific and lower-extremity instruments. Also, variables associated with poorer outcomes were identified. Methods: In this prospective, cross-sectional study, patients with foot or ankle fractures completed questionnaires. PROMIS Mobility (MOB) and Pain Interference (PI) CATs were compared with FAOS, Lower Extremity Functional Scale (LEFS), and Short Musculoskeletal Function Assessment (SMFA). Convergent validity (correlations), reliability (SE, Cronbach α), efficiency (number of items/completion time), and floor/ceiling effects of each instrument were assessed. Multivariable linear regression was used to evaluate factors associated with PROMIS outcomes. Results: Seventy-three patients were included (mean age 50 [SD 17] years, 60% female). PROMIS-MOB showed particularly high correlations with domains focused on lower extremity functioning (FAOS-Sport, Conclusion: Condition- and region-specific instruments may provide limited information beyond that obtained with PROMIS CATs. PROMIS (MOB, PI) CATs captured comparable constructs of functional recovery and pain interference, as demonstrated by high correlations with commonly used instruments, while substantially reducing patient burden. The relation between depressive symptoms and worse outcomes underscores the significance of psychological factors in recovery in patients with foot and ankle fractures. Levels of Evidence: Level II, diagnostic study.
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