How does PROMIS compare to
other HRQOL measures?
Ron D. Hays, Ph.D.
UCLA, Los Angeles, CA
Symposium 1077: Measurement Tools to Enhance HealthRelated Quality of Life Research: The Patient-Reported
Outcomes Measurement Information System (PROMIS)
Advantages of Short-Forms
Developed from Item Banks
• Select a set of items that are matched to
the severity level of the target population.
• All scales built from the same item bank
are linked on a common metric.
Depressive
Symptoms
Form C
Depression
Symptoms
Form A
no
depression
mild
depression


Depression
Symptoms
Form B
moderate
depression
severe
depression

 

extreme
depression

Depressive Symptoms Item Bank
Item
1
Item
2
Item
3
Item
4
Item
5
Item
6
Item
7
Item
8
Item
9
Item
n
Computerized Adaptive Testing (CAT)
• CAT selects each question to be
administered based on a person’s
response to previously administered
questions.
• By iteratively estimating a person’s
standing on the domain (e.g., depressive
symptoms) and administering the most
informative items, the maximum possible
level of precision can be obtained with the
fewest number of questions.
Example of Short Forms and CAT
• Compare results from respondents based
on two different depressive symptoms
short forms, CAT, and full item bank.
• Do they produce equivalent results?
• Implications for use of alternate PROMIS
short forms in clinical trials.
Respondent (n = 752)
Characteristics
Responded to the 28 items in the PROMIS
depressive symptoms item bank
– Mean age = 51 (18-93 range)
– 52% female
– 78% white, 10% Hispanic, 10% black
– 22% high school graduate or less
Ordering of 28 Depressive Symptom items,
Least to Most Severe
(Short Form A and B items indicated with superscript)
#
Item
#
Item
1
I felt sadb
15
I felt guilty
2
I felt disappointed in myselfa
16
I felt that I was not as good as other
people
3
I felt unhappyb
17
I felt that nothing was interestingb
4
I felt discouraged about the futurea
18
I felt like a failurea
5
I felt pessimistic
19
I felt that my life was emptyb
6
I felt emotionally exhausted
20
I felt that I was not needed
7
I had trouble feeing close to people
21
I felt that I had nothing to look forward toa
8
I felt lonely
22
I felt upset for no reason
9
I felt depressed
23
I felt helplessb
10
I found that things in my life were
overwhelminga
24
I felt that nothing could cheer me upa
11
I had trouble making decisions
25
I felt hopelessb
12
I felt ignored by people
26
I felt worthlessa
13
I withdrew from other people
27
I felt that I wanted to give up on
everythingb
14
I felt that I was to blame for things
28
I felt I had no reason for livinga
Form A Items
#
In the past 7 days…
Mean
% Never
2
I felt disappointed in myself.
2.05
41
4
I felt discouraged about the future.
2.03
44
1.85
51
1.68
62
1.61
65
1.56
66
1.51
71
1.29
82
10 I found that things in my life were overwhelming.
18 I felt like a failure.
21 I felt that I had nothing to look forward to.
24 I felt that nothing could cheer me up.
26 I felt worthless.
28 I felt I had no reason for living.
Response Options: Never, Rarely, Sometimes, Often, Always
Form B Items
In the past 7 days…
Mean
% Never
1
I felt sad.
2.08
36
3
I felt unhappy.
2.05
39
9
I felt depressed.
1.87
50
17
I felt that nothing was interesting.
1.69
55
19
I felt that my life was empty.
1.67
64
23
I felt helpless.
1.56
67
25
I felt hopeless.
1.53
68
27
I felt I wanted to give up on everything.
1.46
73
#
Response Options: Never, Rarely, Sometimes, Often, Always
Mean, Minimum and Maximum Scores
Form A
(8 items)
Form B
(8 items)
CAT
Full Bank
(8 items) (28 items)
Mean
49
49
49
49
Minimum
38
37
35
33
Maximum
82
82
84
86
Correlations Among Forms
Form A
Form B
CAT
Form A
1.000
Form B
0.895
1.000
CAT
0.946
0.958
1.000
Bank
0.953
0.955
0.976
Scale Score
Comparisons:
Short Forms,
CAT (8 items)
and Full-Bank
(28 Items)
60
60
Correlation of Depressive
Symptoms Bank with CESD
50
40
0
10
20
30
CESD
30
20
10
0
0
100
250
-2
-1
0
1
2
3
4
2
3
4
Depression
0 80
CESD
40
50
r =0.84
-2
-1
0
1
Depression
Fatigue
• Experience
and Impact
• 95-item bank
• Legacy
Instruments
• SF-36 Vitality Scale (4 items)
• FACIT-Fatigue Scale (13 items)
Comparison of Measurement Precision
Full-length Item Bank vs. Legacy vs. CAT vs. Short-form
0.6
4-item SF36/Vitality
4-item CAT
13-item FACIT-Fatigue
13-item CAT
98-item Bank
0.5
Standard Error
0.4
SE=0.32 (r=0.90)
0.3
SE=0.22 (r=0.95)
0.2
0.1
0
-2.5
No Fatigue
-1.5
-0.5
0.5
1.5
2.5
Severe Fatigue
PROMIS Fatigue Short Form
In the past 7 days …
FATEXP
20
FATEXP
5
FATEXP
18
FATIMP
33
FATIMP
30
FATIMP
21
FATIMP
40
Never Rarely
SomeOften Always
times
How often did you feel tired?





How often did you experience extreme exhaustion?





How often did you run out of energy?










How often were you too tired to think clearly?





How often were you too tired to take a bath or shower?
1
2
3
4
5
How often did you have enough energy to exercise
strenuously?
1
2
3
4
5
How often did your fatigue limit you at work
(include work at home)?
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
Garcia SF et al, J Clin Onc, 2007.
© 2007 Reprinted with permission of the PROMIS Health Organization and the PROMIS Cooperative Group
4
4
4
4
4
5
5
5
5
5
Comparison of Measurement Precision
Full-length Item Bank vs. Legacy vs. CAT vs. Short-form
0.6
7-item Short-form
7-item CAT
98-item Bank
Standard Error
0.5
0.4
SE=0.32 (r=0.90)
0.3
SE=0.22 (r=0.95)
0.2
0.1
0
-2.5
No Fatigue
-1.5
-0.5
0.5
1.5
2.5
Severe Fatigue
Physical Functioning
5
0.5
SF-36
10 items
4
0.4
SE = 3.2
rel = 0.90
3
0.3
PROMIS 10 items
SE = 2.2
rel = 0.95
2
0.2
PROMIS CAT
10 items
1
0.1
SF
00
-4
10
-320
PROMIS static
-2 10
-1
30
40
PROMIS CAT 10
0
50
1
60 2
70
Questions?
Item Response Theory (IRT): Category Response Curves
In the past 7 days,
I felt unhappy.
1.0
Never
0.8
Rarely
Some
times
Always
Often
P
0.6
0.4
0.2
0.0
-3.00
-2.00
very mild
In the past 7 days,
I felt I had no
reason for living.
-1.00
0.00
1.00
2.00
3.00
severe
Depressive Symptoms
1.0
Never
0.8
Some
Always
times
Often
Rarely
P
0.6
0.4
0.2
0.0
-3.00
very mild
-2.00
-1.00
0.00
1.00
Depressive Symptoms
2.00
3.00
severe