PROMIS and ODI Tools: Clinically Useful Markers of Abnormal MRI Findings in Pediatric Patients with Back Pain

Background: This study was performed to determine if the Patient-Reported Outcomes Measurement Information System (PROMIS), the 9-item Oswestry Disability Index (ODI-9), and back pain intensity predict abnormal magnetic resonance imaging (MRI) findings in pediatric patients with back pain. Methods: We performed a retrospective review from April 2021 to June 2023 of 300 children (200 girls and 100 boys) aged 5 to 18 years with caregiver-reported back pain who underwent MRI of the spine and had completed the PROMIS Pediatric computerized adaptive testing measures for Pain Interference, Mobility, and Anxiety and the ODI-9, and had rated back pain intensity on a scale ranging from 0 to 5. Patients were excluded if they had neuromuscular or syndromic scoliosis, a history of previous spinal surgeries, or isolated neck pain. MRI findings were grouped as non-spinal and spinal findings, and then categorized into subgroups as incidental, correlative, and causative findings. Incidental findings were considered those in children with normal MRI findings. Patient-reported outcome measures (PROMs) were compared between children with normal and abnormal MRI findings (defined by the presence of correlative and/or causative findings) with use of Mann-Whitney U tests and logistic regression analysis. Results: Of the 300 children, 126 (42%) had abnormal MRI findings and 174 (58%) had normal MRI findings. Lower PROMIS Mobility scores (39.2 versus 42.8, p = 0.001) and higher ODI-9 percentages (27.4 versus 23.3, p = 0.015) were associated with abnormal MRI findings. A PROMIS Mobility threshold of 40.5 and an ODI percentage threshold of 21.1 were optimal for predicting abnormal MRI findings. We did not find an association between PROMIS Anxiety, PROMIS Pain Interference, or pain intensity with abnormal MRI findings. Conclusions: Lower PROMIS Mobility scores and higher ODI-9 scores, which reflect worsening functional disability, were associated with abnormal MRI findings in pediatric patients with back pain. Additionally, the minimum clinically important difference was met for the PROMIS Mobility score between those with normal and abnormal MRI. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.