title: Individuals with knee impairments identify items in need of clarification in the Patient Reported Outcomes Measurement Information System (PROMIS®) pain interference and physical function item banks - a qualitative study.
abstract: BACKGROUND
  The content and wording of the Patient Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference item banks have not been qualitatively assessed by individuals with knee joint impairments. The purpose of this investigation was to identify items in the PROMIS Physical Function and Pain Interference Item Banks that are irrelevant, unclear, or otherwise difficult to respond to for individuals with impairment of the knee and to suggest modifications based on cognitive interviews.
  
  
  METHODS
  Twenty-nine individuals with knee joint impairments qualitatively assessed items in the Pain Interference and Physical Function Item Banks in a mixed-methods cognitive interview. Field notes were analyzed to identify themes and frequency counts were calculated to identify items not relevant to individuals with knee joint impairments.
  
  
  RESULTS
  Issues with clarity were identified in 23 items in the Physical Function Item Bank, resulting in the creation of 43 new or modified items, typically changing words within the item to be clearer. Interpretation issues included whether or not the knee joint played a significant role in overall health and age/gender differences in items. One quarter of the original items (31 of 124) in the Physical Function Item Bank were identified as irrelevant to the knee joint. All 41 items in the Pain Interference Item Bank were identified as clear, although individuals without significant pain substituted other symptoms which interfered with their life.
  
  
  CONCLUSIONS
  The Physical Function Item Bank would benefit from additional items that are relevant to individuals with knee joint impairments and, by extension, to other lower extremity impairments. Several issues in clarity were identified that are likely to be present in other patient cohorts as well.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 229 Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA, 15219, USA. adl45@pitt.edu.|UPMC Center for Sports Medicine, Pittsburgh, PA, USA. adl45@pitt.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Lynch
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Dodds
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pilkonis
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 229 Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA, 15219, USA.|Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.|UPMC Center for Sports Medicine, Pittsburgh, PA, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Irrgang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000592:standards*; D063868:Patient Outcome Assessment; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: Item interpretation; Knee joint (MeSH); PROMIS; Patient outcome assessment (MeSH); Patient-reported outcomes