Authors: Fermi F et al.
Anesthesia & Analgesia, February 25, 2026.
Psychometric Assessment of PROMIS-29 as a Measure of Recovery After Colorectal Surgery: A Prospective Cohort Study.
This prospective cohort study evaluated whether the PROMIS-29 questionnaire is a reliable and valid tool for measuring recovery after colorectal surgery. Patient-reported outcome measures (PROMs) are increasingly used in perioperative care to evaluate recovery from the patient’s perspective. PROMIS-29 is a widely used questionnaire that measures general aspects of physical and mental health, but its performance specifically in surgical recovery has not been well validated.
The investigators conducted the study according to the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines for evaluating patient-reported outcome measures. Adult patients undergoing elective colorectal resection at two academic hospitals in Canada were enrolled.
Participants completed the PROMIS-29 questionnaire before surgery and then weekly for four weeks after surgery. Two summary scores were calculated:
• Physical Health Summary (PHS)
• Mental Health Summary (MHS)
Higher scores indicated better perceived health status.
The researchers evaluated several psychometric properties of the questionnaire:
Content validity
Content validity measures whether the questionnaire adequately captures the domains of recovery that patients consider important. PROMIS-29 items covered only 36% of the recovery domains identified in a previously developed patient-centered conceptual framework for abdominal surgery recovery. This suggested that the instrument may not fully reflect the aspects of recovery most relevant to surgical patients.
Internal consistency
Internal consistency reflects whether items within each domain measure similar constructs. PROMIS-29 demonstrated good internal consistency across its domains, with Cronbach α values ranging from 0.81 to 0.98.
Construct validity
Construct validity evaluates whether the questionnaire can distinguish between groups of patients expected to have different recovery experiences. The investigators tested several predefined hypotheses predicting better PROMIS scores in patients who:
• Had shorter hospital stays (≤4 days)
• Did not develop postoperative complications
• Underwent minimally invasive surgery
• Did not receive a new stoma
Construct validity was limited. None of the hypotheses were supported during the first postoperative week, and only one or two were supported during later postoperative weeks.
Responsiveness
Responsiveness refers to the ability of the instrument to detect changes over time. The investigators expected PROMIS-29 scores to show an early postoperative decline followed by gradual improvement toward baseline. Responsiveness was observed during the early recovery period up to postoperative week two but was not consistently demonstrated afterward.
The study included 282 patients with a mean age of 59 years, and nearly half were female. Most procedures (78%) were minimally invasive, and the median hospital stay was three days.
Overall, the findings suggest that although PROMIS-29 demonstrates acceptable internal reliability, it does not fully capture the multidimensional recovery experience following colorectal surgery. The limited content validity and modest ability to distinguish between different recovery trajectories indicate that the tool may not be ideally suited for perioperative recovery assessment.
The authors conclude that more specialized patient-reported outcome measures designed specifically for surgical recovery may be necessary to accurately measure patient outcomes in perioperative research and clinical care.
Key Points
• PROMIS-29 is a general health questionnaire increasingly used in perioperative research.
• This study evaluated its psychometric performance after colorectal surgery.
• PROMIS-29 showed strong internal consistency across domains.
• However, it captured only 36% of recovery domains identified as important to patients.
• Construct validity was limited, and responsiveness declined after postoperative week two.
• The findings suggest PROMIS-29 may not fully reflect recovery after colorectal surgery.
• More surgery-specific patient-reported outcome measures may be needed.
Thank you to Anesthesia & Analgesia for allowing us to summarize and share this article.