title: PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis.
abstract: BACKGROUND
  Cirrhotic patients have an impaired health-related quality of life (HRQOL), which is usually analysed using static paper-pencil questionnaires. The Patient Reported Outcomes Measurement Information System (PROMIS) computerised adaptive testing (CAT) are flexible, freely available, noncopyrighted, HRQOL instruments with US-based norms across 11 domains. CAT presents five to seven questions/domain depending on the patient's response, from large validated question banks. This provides brevity and precision equivalent to the entire question bank.
  
  
  OBJECTIVE
  To evaluate PROMIS CAT tools against 'legacy instruments' for cirrhotics and their informal caregivers.
  
  
  METHODS
  A total of 200 subjects: 100 cirrhotics (70 men, 53% decompensated) and 100 caregivers were administered the PROMIS and legacy instruments [Sickness Impact Profile (SIP), Beck depression/anxiety inventories, Pittsburgh Sleep-Quality Index (PSQI) and Epworth Sleepiness scale (ESS)] concurrently. Both legacy and PROMIS results for patients were compared with caregivers and US norms. These were also compared between compensated and decompensated patients. Preference for SIP or PROMIS was inquired of a selected group (n = 70, 50% patients). Test - retest reliability was assessed in another group of 20 patients.
  
  
  RESULTS
  Patients had significant impairment on all PROMIS domains apart from anger and anxiety compared with caregivers and US norms (P < 0.02 to <0.0001). Decompensated patients had significantly worse sleep, pain, social and physical function scores compared with compensated ones, similar to legacy instruments. There was a statistically significant correlation between PROMIS and their corresponding legacy instruments. The majority (71%) preferred PROMIS over SIP. PROMIS tools had significant test - retest reliability (ICC range 0.759-0.985) when administered 12 ± 6 days apart.
  
  
  CONCLUSIONS
  PROMIS computerised adaptive testing tools had significant concurrent and discriminant validity, test - retest reliability and subject preference for assessing HRQOL in cirrhotic patients.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, McGuire VA Medical Center, Richmond, 23249, USA. jsbajaj@vcu.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Bajaj
authors.forename: L R
authors.initials: LR
authors.lastname: Thacker
authors.forename: J B
authors.initials: JB
authors.lastname: Wade
authors.forename: A J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: D M
authors.initials: DM
authors.lastname: Heuman
authors.forename: R K
authors.initials: RK
authors.lastname: Sterling
authors.forename: D P
authors.initials: DP
authors.lastname: Gibson
authors.forename: R T
authors.initials: RT
authors.lastname: Stravitz
authors.forename: P
authors.initials: P
authors.lastname: Puri
authors.forename: M
authors.initials: M
authors.lastname: Fuchs
authors.forename: V
authors.initials: V
authors.lastname: Luketic
authors.forename: N
authors.initials: N
authors.lastname: Noble
authors.forename: M
authors.initials: M
authors.lastname: White
authors.forename: D
authors.initials: D
authors.lastname: Bell
authors.forename: D A
authors.initials: DA
authors.lastname: Revicki
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology; D003936:Diagnosis, Computer-Assisted; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008103:Liver Cirrhosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires