Member's paper - Kidney Health Education and Research Group

Abstract

Validation of the PROMIS Preference scoring system (PROPr) in patients on dialysis and kidney transplant recipients (KTR).

Zhang, J., Breitner, D., Dewitt, B., Hanmer, J., Saqib, M., Li, D., Edwards, N., Peipert, J., Novak, M., Mucsi, I.

2019

Canadian Society of Transplantation

Full Abstract
Background: PROPr is a preference-based health state summary score within the Patient-Reported-Outcomes Measurement Information System (PROMIS). It could potentially be used in cost-effectiveness analyses. We assessed the validity of PROPr among patients with end stage kidney disease (ESKD) using EQ5D5L and SF6D as “legacy” instruments. Methods: A cross-sectional sample of adults on dialysis and KTR (kidney transplant recipients) completed questionnaires including PROMIS57 (7 domains: anxiety, depression, fatigue, physical-function, sleep-disturbance, pain-interference and ability to participate in social-roles), Patient Health Questionnaire-9, Edmonton Symptom Assessment Scale-revised, Kidney Disease Quality of Life-36 (KDQOL36), and EQ5D5L. SF6D was generated from the SF12 (part of KDQOL36). PROPr is estimated from PROMIS57 domain-scores. PROPr score ranges from -0.022 (all-worst state) to 1.0 (full health). Known-group comparisons were evaluated using age and sex-stratified median scores and calculating “clinical condition impacts”, that is the coefficient for a health condition when summary score was regressed on age, gender, and a single health condition. Convergent validity was assessed with Spearman’s correlation. Results: Mean ([Standard deviation] SD) age of the 318 participants was 57 (17) years, 57% were male and 51% Caucasian. Median ([Interquartile range] IQR) scores were 0.38 (0.22-0.61), 0.71 (0.58-0.86) and 0.85 (0.67-0.91) for PROPr, SF6D and EQ5D5L, respectively. PROPr and SF6D scores were less subject to ceiling-effects compared to EQ5D5L. The age and sex adjusted condition impact was larger for PROPr for all conditions tested compared to the other two scores. Condition impact for PROPr was: kidney transplant recipients (KTR) vs. dialysis (-0.21, P<0.001), low vs. high comorbidity (-0.10, P<0.001), and low vs. high depression (-0.31, P<0.001). Strong correlations were observed between PROPr and EQ5D5L (rho=0.76) and SF6D (rho=0.84). Conclusions: These results support the validity of PROPr among patients with ESKD. Moreover, PROPr may be more sensitive to differences in health states compared to other preference-based measures. Keywords: PROMIS, PROPr, End Stage Kidney Disease, Patient-reported outcomes, Health utility, SF6D, EQ5D5L, Validation study

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