Comparison of Patient-Reported Outcomes Among Patients Participating in a Lifestyle Medicine Program

Background and/or Objectives: It is unclear how to optimally capture musculoskeletal patients’ described benefits from participating in a lifestyle medicine program. We compared patients’ changes on Patient-Reported Outcomes Measurement Information System (PROMIS) measures to their global ratings of change in function and pain.

Design: Retrospective analysis of prospectively collected data

Setting : Academic medical center

Participants : Patients with chronic musculoskeletal pain

Interventions: All patients participated in an interprofessional lifestyle medicine program specifically designed to address chronic musculoskeletal pain.

Main Outcome Measures: PROMIS Physical Function and Pain Interference measures at baseline and program completion, self-reported percent improvement in function and pain at program completion

Results: Among 98 patients (mean (SD) age 57 (13) years, 74 (76%) females, mean (SD) participation duration 190 (118) days), 58 (59%) patients reported at least 50% perceived improvement in function and 55 (56%) reported at least 50% improvement in pain by program completion. Patients’ self-reported percent improvement in function and pain did correlate with their change in PROMIS Physical Function scores (r=0.209, p=0.039 for function; r=0.229, p=0.023 for pain). Nevertheless, even patients who reported 75-100% improvement in physical function achieved improvements in PROMIS Physical Function that barely met the previously established minimal clinically difference (MCID) threshold of 2.2 points (mean (SD) improvement 2.3 (2.7) points (n=26)). Patients’ self-reported improvement in pain and function did not correlate with their change in PROMIS Pain Interference scores (r= -0.111 to -0.047, p=0.3-0.6).

Conclusions: Among patients who participated in an interprofessional lifestyle medicine program for chronic musculoskeletal pain, their perceived improvement in function and pain weakly correlated with changes in their PROMIS Physical Function scores and did not correlate with changes in their PROMIS Pain Interference scores. PROMIS physical health measures may underestimate musculoskeletal patients’ functional and pain-related improvements from participating in a lifestyle medicine program. Further research is needed to identify ideal quantitative outcome measures.