PROMIS 29

What is the PROMIS 29 questionnaire?

The PROMIS 29 questionnaire, a cornerstone in patient reported outcomes, gauges health-related quality of life across seven key domains: physical function, pain interference, fatigue, sleep disturbance, physical and mental health, and social health. 

It's widely utilized in clinical practice and health services research to assess various health outcomes, including mental health factors. With its efficient short-form measures and item response theory, PROMIS 29 offers precise physical and psychological health measurements, providing summary scores that align with general population reference values. 

It incorporates PROMIS global health items, ensuring comprehensive physical and mental health assessment. This questionnaire is validated through confirmatory factor analysis and exploratory factor analysis, affirming its construct validity and internal consistency. 

In diverse contexts like general internal medicine and rheumatoid arthritis research, PROMIS 29 adheres to strict ethical standards, requiring informed consent and safeguarding personal data. It's a valuable tool in medical outcomes study, understanding health status, quality of health, patient reported outcomes, and facilitating informed decision-making in healthcare.

PROMIS 29 categories

The PROMIS 29 questionnaire encompasses various mental health scales and related domains, comprehensively assessing patients' mental health using mental health summary scores, mental health summary scores, and measures of well-being. These categories include:

• Physical function: This domain evaluates an individual's ability to perform various physical activities and tasks, such as walking, climbing stairs, or lifting objects. It provides insight into functional limitations and mobility issues.
• Pain interference: This category assesses how pain affects a person's daily activities, including work, leisure activities, social interactions, and overall quality of life. It considers both the intensity and impact of pain on functional abilities.
• Fatigue: Measures the severity of fatigue or exhaustion experienced by individuals, including feelings of tiredness, lack of energy, and decreased motivation. It assesses the impact of fatigue on daily functioning and productivity.
• Sleep disturbance: Evaluates the quality and quantity of sleep, including difficulties falling asleep, staying asleep, or waking up too early. It considers factors such as sleep latency, sleep duration, sleep efficiency, and overall sleep disturbances.
• Emotional distress: Assesses psychological distress, including symptoms of depression, anxiety, and stress. It evaluates emotional well-being, mood disturbances, and the impact of emotional symptoms on daily life activities.
• Social health: Focuses on the impact of health conditions on social interactions, relationships, and participation in social roles and activities. It considers social support, functioning, and satisfaction with social relationships.
• Physical and mental health: Provides an overall assessment of both physical and psychological well-being, integrating multiple dimensions of health to capture the holistic nature of health status. It considers the interplay between physical and mental health factors and their combined impact on overall well-being.

What is the purpose of PROMIS 29?

The purpose of PROMIS 29 is to provide a standardized and comprehensive global health assessment tool for measuring various aspects of summary health measures, physical health scales, related quality of life measures, and patient reported outcomes. Specifically, PROMIS 29 aims to have a summary of health measures:

• Capture multiple domains: PROMIS 29 assesses various health-related domains, including physical function, pain interference, fatigue, sleep disturbance, emotional distress, social health, and overall physical and mental health. By covering multiple dimensions of health, it offers a holistic perspective on patients' well-being.
• Enable efficient measurement: PROMIS 29 utilizes efficient short-form measures and item response theory to provide precise and reliable assessments with fewer questions. This allows for quicker administration and less patient burden while maintaining accuracy and validity.
• Facilitate clinical practice: The questionnaire is designed to be easily integrated into clinical practice, allowing healthcare providers to systematically assess patients' health status, monitor changes over time, and make informed treatment decisions. It aids in patient-provider communication and shared decision-making.
• Support health services research: PROMIS 29 is widely used in health services research to investigate the impact of interventions, treatments, and health conditions on patient outcomes. It facilitates the comparison of different populations, interventions, and healthcare settings, contributing to evidence-based practice and healthcare policy development.
• Enhance patient-centered care: By incorporating patient-reported outcomes, PROMIS 29 promotes a patient-centered approach to healthcare, focusing on patients' perspectives, priorities, and goals. It emphasizes the importance of addressing patients' physical, emotional, and social needs to improve overall quality of care and patient satisfaction.

How to administer the test

Administering the PROMIS 29 questionnaire involves several steps to ensure accurate and standardized assessment:

1. Selection of administration mode: Decide whether the questionnaire will be administered in person, via paper-and-pencil format, electronically (e.g., through a computer or tablet), or through a phone interview. Consider the preferences and accessibility of the individuals being assessed.
2. Explanation and instructions: Provide clear instructions to the individual undergoing the assessment. Explain the purpose of the questionnaire, the importance of providing honest and accurate responses, and how to complete the questionnaire.
3. Questionnaire completion: The PROMIS 29 questionnaire comprises 29 items across seven health domains. Each item is rated on a Likert-type scale, typically 1 to 5, with response options indicating the frequency or severity of symptoms or experiences.
4. Scoring: Score each item according to the individual's responses. Some administration methods may automate this process, while others require manual scoring. Ensure consistency and accuracy in scoring to maintain the reliability of results.
5. Data collection: Record the responses to each item accurately. This may involve entering responses into a database or electronic system for further analysis.
6. Interpretation: Interpret the questionnaire results based on established scoring algorithms and guidelines. If applicable, calculate summary scores for each health domain and overall physical and mental health scores.
7. Communication of results: Communicate the assessment results to the individual or relevant healthcare professionals involved in their care. Provide explanations of the scores and their implications for the individual's health status and quality of life.
8. Follow-up: Depending on the context and purpose of the assessment, consider follow-up assessments to monitor changes in health status over time or in response to interventions or treatments.
9. Documentation: Document the administration process, including the assessment date, administration mode, and any relevant notes or observations. Maintain confidentiality and privacy of the individual's responses by applicable regulations and ethical standards.
10. Quality assurance: Implement quality assurance measures to ensure the reliability and validity of the assessment process, including training for administrators, monitoring for consistency in administration, and periodic review of procedures.

How to score the questionnaire

Scoring the PROMIS 29 questionnaire involves several steps to accurately calculate scores for each health domain and overall for physical health and mental health. Here's a simplified guide to scoring:

1. Item responses: Start by reviewing the individual's responses to each of the 29 items in the questionnaire. Each item is typically scored on a Likert-type scale, with response options ranging from 1 to 5 or similar, indicating the frequency or severity of symptoms or experiences.
2. Reverse coding: Some items may need to be reverse-coded before scoring, depending on the directionality of the questions. Refer to the scoring instructions provided with the questionnaire to identify any items that require reverse coding.
3. Scoring algorithm: Utilize the scoring algorithm specific to the PROMIS 29 questionnaire to calculate scores for each health domain. This algorithm typically involves summing or averaging the scores of the relevant items within each domain.
4. Standardization: Once scores are calculated for each health domain, standardize the scores to ensure comparability across different populations and studies. Standardization may involve transforming raw scores into T-scores or other standardized metrics using population-based reference values.
5. Overall physical and mental health scores: If applicable, calculate overall physical and mental health summary scores based on the aggregated scores of relevant health domains. Follow the scoring guidelines provided with the questionnaire to determine the calculation method for these summary scores.
6. Interpretation: If available, interpret the scores in the context of established norms or reference values. Higher scores typically indicate better health-related quality of life or functioning in the respective domain, while lower scores may suggest more significant impairment or symptom severity.
7. Communication of results: Communicate the scores to the individual or relevant healthcare professionals clearly and understandably. Provide explanations of the scores and their implications for the individual's health status and quality of life.
8. Documentation: Document the scoring process, including the method used, the date of scoring, and any relevant notes or observations. Maintain confidentiality and privacy of the individual's scores by applicable regulations and ethical standards.

How to interpret the PROMIS 29 scores

Interpreting PROMIS 29 scores involves understanding the context of the scores, comparing them to reference values or norms, and considering the individual's unique circumstances. Here's a guide to interpreting PROMIS 29 scores:

1. Understanding domain scores: Start by reviewing scores for each of the seven health domains assessed by the PROMIS 29 questionnaire: physical function, pain interference, fatigue, sleep disturbance, emotional distress, social health, and overall physical and mental health. Higher scores generally indicate better functioning or fewer symptoms in that domain, while lower scores suggest more significant impairment or symptom severity.
2. Comparing to reference values: If available, compare the individual's scores to population-based reference values or norms. These reference values provide context for interpreting the scores relative to the general population. Higher scores indicate better health-related quality of life than the population mean, while lower scores suggest poorer health outcomes.
3. Monitoring changes over time: Track changes in scores to assess improvements or worsening of health-related quality of life and outcomes. Significant changes in scores may reflect changes in health status, response to interventions or treatments, or other factors affecting well-being.
4. Considering clinical significance: Evaluate the clinical significance of the scores based on established thresholds or minimally significant differences (MID). Determine whether changes in scores exceed the MID to assess meaningful improvements or deterioration in health status.
5. Individualized interpretation: Consider the individual's unique circumstances, preferences, and goals when interpreting PROMIS 29 scores. Consider factors such as age, gender, comorbidities, treatment history, and psychosocial factors that may influence health-related quality of life and outcomes.
6. Discussing with patients: Communicate the interpretation of PROMIS 29 scores to the individual clearly and understandably. Provide explanations of the scores and their implications for their health status, functional abilities, and overall well-being. Engage in shared decision-making and goal-setting based on the interpreted scores.
7. Seeking clinical expertise: Consult healthcare professionals or specialists, such as psychologists, physicians, or rehabilitation specialists, to further interpret PROMIS 29 scores, especially in complex or clinically challenging cases.

Transforming PROMIS 29 scores into actionable steps

PROMIS 29 data empowers you to personalize patient care and optimize health outcomes. Here's how to translate scores into actionable steps:

• Targeted interventions: For low scores in specific domains (physical function, pain, etc.), consider targeted interventions. This might involve referrals, evidence-based treatments, or personalized care plans to address identified areas of impairment or symptom severity, ultimately improving functional abilities and quality of life.
• Monitoring and collaborative care: Regularly monitor PROMIS 29 scores to track changes and outcomes. Schedule follow-ups to assess intervention effectiveness, evaluate progress, and adjust treatment plans collaboratively with the patient.
• Patient empowerment: Educate patients based on their scores, helping them understand their health status, manage symptoms, and make informed decisions. Offer resources, self-management strategies, and access to support services tailored to their needs.
• Shared decision-making: Involve patients in discussions about their scores, treatment options, and care goals. Collaboratively develop patient-centered plans that align with their preferences, values, and priorities.
• Multidisciplinary teamwork: Coordinate care across disciplines based on PROMIS 29 data. To ensure comprehensive and holistic care, Foster communication and collaboration among team members (physicians, therapists, social workers).
• Addressing emotional well-being: For elevated scores in emotional distress or social health domains, consider offering counseling, mental health services, support groups, or community resources to address these needs.
• Promoting overall wellness: Emphasize health promotion and wellness strategies. Encourage lifestyle modifications like exercise, healthy eating, stress management, and sleep hygiene to optimize physical and mental health outcomes.
• Quality improvement and innovation: Utilize PROMIS 29 data for quality improvement initiatives within your healthcare setting. Analyze its effectiveness in assessing interventions, evaluating patient outcomes, and identifying areas for improvement in care delivery.

Following these action steps, you can leverage PROMIS 29 data to personalize care plans, improve patient engagement, and achieve better patient health outcomes.