PROMIS - Global Health 10

The Global Health 10 score is part of the PROMIS (Patient-Reported Outcomes Measurement Information System) and thus belongs to the latest generation of patient-reported outcome scores.1 Originally published in 2009 in Quality of Life Research as a subset of the (PROMIS), the PROMIS Global-10 is a gauge of general healthcare-related quality of life based on a patient sample size of 21,133.2 It was developed by the United States National Institute of Health to evaluate HRQoL, and is contrasted against United States normative scores and was designed to be a “bottom-line” assessment of a patient’s health that can be used for a wide variety of diseases (Shim, 2019).

The PROMIS Global Health-10 is a 10-item patient-reported questionnaire that assesses generic HRQoL compared with normal values for the general population with the response options presented as a 5-point (as well as a single 11-point) rating scale.

The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. These scores are then standardized to the general population, using the “T-Score”. The average “T-Score” for the United States population is 50 points, with a standard deviation of 10 points. Higher scores are indicative of a healthier patient.

Content

The questionnaire uses a combination of 10 questions to assess both the physical and mental health status of adult patients, regardless of their individual medical conditions. Patients subjectively assess their own health, quality of life and social aspects of their lives.

It measures items on a five-point response matrix which includes physical function; fatigue; pain; emotional distress and social health

Furthermore, specific attention is paid to emotional stress, general fatigue and possible pain symptoms. Thus, the Global Health 10-Score effectively highlights a wide variety of aspects that could affect the patient.3

Calculation of the PROMIS Global Health 10-Score

The evaluation of the Global Health 10 score requires answering all questions relevant for the calculation. The questions all have allocated names, for example, “Global01” or “Global09”. Utilizing the most recent version of the score (v1.2) is best as the scoring for 3 questions has changed between v1.0/v1.1 and v1.2 (recoding). In addition, 2 questions were excluded from the calculation/evaluation as a result of the questionnaire development study: Global01 because of its statistical congruence with Global03.

Global09 because of its approximately equal statistical correlation to physical and mental health.2

The questionnaire is divided into 2 separate components for separate analysis: Global Physical Health and Global Mental Health, each with 4 questions. The sum of the scores of the respective answers thus results in the respective scores of the 2 components:

Global Physical Health: Global03 + Global06 + Global7 (rescored) + Global08 (rescored)

Global Mental Health: Global02 + Global04 + Global05 + Global10 (rescored)

The possible score ranges from 0 to 20 points in each case. 0 points represent the patient’s most severe physical and/or mental impairment, while 20 points represent the best possible state of health.4

Evaluation

Strengths

The extensive development study of the Global Health Score was able to statistically prove the validity of the selected 10 questions in relation to physical and mental health in a large study population and subsequent studies have confirmed its validity in differing patient populations.5 – 7

Due to the short nature (2 – 5 mins) of the compact PROMIS-10 Global Health, clarity of its questions and the ease at which it can be evaluated it makes it a desirable inclusion into patient studies. In addition to English, it is available in 8 other languages (including German).8

In a study investigating the responsiveness of various PROMs in relation to total knee arthroplasty the PROMIS-10 Global Health tool offered superior responsiveness to change compared with the EQ5D thus suggesting that it is a useful tool in this setting.9 Moreover, it has been included in a range of diverse disease populations such as cancer, arthritis, hearing loss, joint pain and fractures and stroke.8

Limitations

The PROMIS-10 Global Health score is a relatively new player in the field of PROMs. It is currently the subject of several studies and will only be able to demonstrate its true validity and areas of application in the coming years.

Most recently, a 2021 study analyzed the utility of the PROMIS Global-10 as a post-operative PROM relative to legacy hip-specific PROMs at six-month follow-up in a cohort of patients treated with hip arthroscopy for femoroacetabular impingement syndrome (FAIS) whereby it demonstrated that the modified Harris Hip Score (mHHS) proved to be superior to the PROMIS-10 Global Health score.10

Moreover, a major weakness of the score is that one question of the Global Physical Health component (Global07) has not yet been updated in the most current version v1.2 so that it needs to be recorded prior to scoring. It is even more problematic that the available recoding key for this question is not clearly formulated so that it is unclear at first glance whether the question has already been changed in v1.2 or not. This can lead to incorrect evaluations and results of the questionnaire. In the end, we were only able to sufficiently understand with the interpretation table of the scores that the question has indeed not yet been changed.8

License

The PROMIS Health Organization and individual contributors own the rights to them. All English and Spanish versions of the PROMIS scores are in the public domain and are made available for research, clinical use, or teaching without license or fee. The PROMIS Organization website makes no statement about royalty-free use of the scores in other languages. However, commercial users and users who wish to embed the PROMIS scores in technological systems must apply for a license, which may be subject to fees.8 Our PRO consultants happily provide more in-detail information.

Conclusion

Although the PROMIS Global Health 10-Score still requires further validation in future studies in many clinical settings, preliminary results from the development study indicate similar validity to other commonly used questionnaires in the large study population. Due to its small size and fee-free usability in clinical practice and research, the PROMIS Global Health 10-Score is a feasible questionnaire that will find its place among the more general PROMs in clinical use.