Acute Pain in Service Members With Upper-Limb Disability Using the Patient-Reported Outcomes Measurement Information System (PROMIS): A Mixed Methods Study

PURPOSE: The purpose of this research was to evaluate the strength of the relationship of the Patient Reported Outcomes Measurement Information System (PROMIS) self-report questionnaire and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) in U.S. active duty Service Members (SMs) with an upper extremity (UE) disability. Additionally, correlations between the questionnaires were evaluated and an understanding of the experience of an upper extremity injury was sought. The current literature demonstrates a high prevalence of acute injuries of the arm and shoulder among active duty SMs. Limitations from an UE injury can affect the SMs level of interaction with their environment, personal needs, completion of everyday tasks, and work demands. Broader insight on how SMs respond to acute pain may aid in development of further treatment options. Occupational therapists (OTs) strive to carefully select the appropriate outcome measures to accurately determine functional outcomes, which are critical to improve care and effectiveness. To date, no studies have investigated the use of the PROMIS and the qualitative aspects of acute pain in active duty SMs with an UE disability.

DESIGN: This study is a mixed-methods sequential explanatory study which recruited a convenience sample of active duty SMs with acute pain secondary to an UE injury who were treated by OT at two military medical clinics. Individuals were excluded if they were already taking narcotics for pain management or disability was chronic in nature. Qualitative data was gathered using maximum variation purposeful sampling through semi-structured interviews and was analyzed using Braun and Clarke’s method for thematic analysis.

METHOD: Participants completed the following self-report questionnaires at initial evaluation and a follow-up (30-90 days): PROMIS-Upper Extremity CAT, PROMIS-Pain Interference CAT, PROMIS-Anxiety CAT, PROMIS-Pain Behavior CAT, QuickDASH, and demographic information. Quantitative data was analyzed using parametric tests. A portion of the sample participated in a semi-structured interview to explore participant experiences of acute pain during recovery and analyzed using thematic analysis.

RESULTS: The initial and follow up scores from the self-reported questionnaires demonstrated a strong correlation between the PROMIS Upper Extremity and the QuickDASH (r = -.645; r = -.808; p<.001. Three themes emerged from the qualitative results: impact of military culture, psychosocial effects of acute pain, and therapist contributions to disability awareness.

CONCLUSION: The findings demonstrate several cultural and psychosocial influences concerning the SMs experience, which have not previously been reported in this population. The present research addresses this gap in the literature utilizing a mixed methods analysis. The incorporation of qualitative and quantitative data, allows the deeper meaning to be observed of the entire phenomena.

IMPACT: This research demonstrates the QuickDASH and PROMIS outcome measures are useful with military SMs as correspondingly in the civilian population. Qualitative reports indicate military culture impacts a SMs experiences of pain, provides a psychosocial impact on the SM, and impacts the therapist’s role in recovery.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667

Beaton, D. E., Wright, J. G., & Katz, J. N. (2005). Development of the QuickDASH: Comparison of three item-reduction approaches. The Journal of Bone & Joint Surgery, 87(5), 1038–1046. https://doi.org/10.2106/JBJS.D.02060

Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.