Rahul Kumar, Abdelrahman M Hamouda, Zach Pennington, Gabriella L Paganucci, Jeremy K Cutsforth-Gregory, David T Jones, Neill R Graff-Radford, Ignacio Jusué-Torres, Jonathan Graff-Radford, Petrice M Cogswell, Benjamin D Elder
Approximately half of iNPH patients report significant improvement in various PROMIS domains longitudinally after VPS. Physical function demonstrated both the greatest magnitude of baseline dysfunction and improvement after VPS. With additional notable improvements in fatigue, and social ability, VPS may improve multiple functional healthcare-related quality of life domains.
OBJECTIVE: Patient-Reported Outcomes Measurement Information System (PROMIS) is a patient-reported outcome tool to overview various functional domains of health. We describe longitudinal changes in various PROMIS domains after ventriculoperitoneal shunting (VPS) for patients with idiopathic normal pressure hydrocephalus (iNPH).
METHODS: Patients with "probable" iNPH who underwent VPS from December 2017 to January 2025 and had completed pre- and post-operative PROMIS computerized adaptive testing (CAT) were retrospectively reviewed. Domains assessed included anxiety, depression, fatigue, sleep disturbance, pain interference, social ability, and physical function. Generalized additive mixed models (GAMM) were utilized to assess longitudinal changes in each domain while controlling for variable follow-up time and patient-specific repeated measures. Principal component analysis (PCA) was performed to identify patterns of change.
RESULTS: A total of 173 patients with 461 PROMIS assessments (median 3 per patient) were included with median follow-up time of 10.3 months (IQR 3.3-13.1). Patients undergoing VPS for iNPH had statistically worse pre-operative PROMIS measures (Benjamini-Hochberg adjusted Wilcoxon p<0.05) in all domains except sleep disturbance. Overall, statistically significant and temporally durable T-score improvements after VPS were identified in fatigue, physical function, and social ability. Differential patterns of post-VPS PROMIS changes disclosed three distinct patient clusters with differing baseline PROMIS functions and comorbidity burdens.
CONCLUSIONS: Approximately half of iNPH patients report significant improvement in various PROMIS domains longitudinally after VPS. Physical function demonstrated both the greatest magnitude of baseline dysfunction and improvement after VPS. With additional notable improvements in fatigue, and social ability, VPS may improve multiple functional healthcare-related quality of life domains.