PROMIS Physical Function PROMIS Fatigue PROMIS Sleep-Related Impairment 3 Activities and Pain Impact Scale
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1 Assessment Domains and Surveys Defense and Veterans Rating Scale. Catastrophizing Scale TBI QOL Headache Interference Neuropathic Scale Diagram Physical Physical Function Fatigue Sleep-Related Impairment 3 Activities and Impact Scale Psycho- Social Depression Anxiety Anger Social Role Satisfaction Primary Care PT Screen Behavior Alcohol Use Prescription Medication Misuse Treatment History & Effectiveness History of Present Illness All scales, except the Neuropathic Scale, leverage Computer Adaptive Testing, whereby scales are typically completed in 3- questions.
2 Surveys, Minimally Important Differences (MID), & Prosetta Stone *Note: scale scores are interpreted according to their names. Example: Higher Physical Functioning scores = better physical functioning, but higher Interference scores = worse pain interference. ProsettaStone.net has calibrated linking tables to cross-walk scale scores with legacy scale scores (e.g., GAD-7, PHQ9). The available linking tables are listed on the right side of the scale name. Minimal important differences (MID) sometimes vary according to pain type and duration. Non- Scales 3% or Defense and Veterans Rating Scale (DVPRS) 3-% Catastrophizing Scale -3.3 Physical Functioning SF-3 Physical Functioning, HAQ-Disability Index, DASH/Quick DASH.5-.5 Fatigue FACIT- Fatigue, SF- 3 Vitality -5.5 Interference BPI Interference, SF-3 Bodily.5 Sleep- Related Impairment Note: scales are t-scores, mean = 5, =.
3 Surveys, Clinically-Meaningful Changes, & Prosetta Stone Cont d *Note: scale scores are interpreted according to their names. Example: Higher Physical Functioning scores = better physical functioning, whereas higher Interference scores = worse pain interference. ProsettaStone.net has calibrated linking tables to cross-walk scale scores with legacy scale scores (e.g., GAD-7, PHQ9). 5 Satisfaction with Social Roles Anxiety GAD-7, SF- 3 Mental Health, MAX-PC, MASQ, PANAS Depression PHQ-9, CES- D, BDI-II, PANAS, PHQ-, SF- 3 Mental Health.-.3 Anger BPAQ These scales are reported in the report s alert box. If scores are 1 above the norm or above preestablished threshold, the alert box will be positive. Primary Care PT Screen Neuropathic Quality Scale Alcohol Use Prescription Medication Misuse
4 Provider Report A -page provider report displays patient responses, across time. Includes alert box to flag concerns.
5 Name: Date: Record ID: DVPRS 79 Fedilynn Donald -Nov-17 1 Date # ful Morphine Rx Med Locations Equivalent Dose Misuse T-Score 1-Apr May Nov Dec PAIN LOCATIONS 1 Front Left Lower Leg Front Left Lower Arm 3 Front Left Upper Arm Back Right Shoulder 5 Front Left Pinky Toe Front Left Leg 7 Back Left Leg Back Right Thigh 9 Front Left Upper Thigh Back Left Upper Thigh 11 Front Left Wrist 1 Right Wrist Primary Care: Tripler Age: Gender: Female Prescription Medication Negative Screen Misuse PT Negative Screen Alcohol Concern Negative Screen Depression Moderately Severe (equiv to PHQ9~15-19) Anxiety Moderate (equiv GAD7-1) Neuropathic Screen Negative Screen Intensity Current Average Worst Impact Activity Mood Sleep Stress -Mar May-17 -Nov-17 -Mar May-17 -Nov-17 Treatment History and Effectiveness Type of Treatment (examples) When it was used Effectiveness Exercise, physical therapy or occupational therapy Currently Moderately Other physical treatments (heat, massage, TENS) 1-3 years ago No Opioid medications (oxycodone, morphine) Currently Moderately Behavioral treatment (CBT, relaxation, distraction) 5+ years ago No Non-steroidal anti-inflammatory medication (ibprofen) and/or acetaminophen (Tylenol, etc.) Neuropathic pain medications (gabapentin, nortriptyline, duloxetine, etc.) Complementary and integrative therapies (acupuncture, yoga, etc.) This year Never Never No N/A N/A Injection therapies (epidural steroid or joint injections, etc.) This year N/A Orthopedic or neurosurgical surgeries (spinal fusion, arthroscopic joint surgeries, joint replacement, etc.) 1-3 years ago Moderately
6 Scales Physical Function Social Function -Mar May-17 -Nov Depression Anxiety Anger -Mar May-17 -Nov Sleep-Related Impairment Fatigue Interference -Mar May-17 -Nov Catastrophizing -Nov May-17 -Nov Important activities that are limited by pain Play with my kids. Walk to the store. Reduce opioids. -Mar May-17 -Nov-17
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