{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:11Z","timestamp":1787755571637,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01404","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:00:29Z","timestamp":1754330429000},"page":"2015-2022","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["PROMIS and ODI Tools: Clinically Useful Markers of Abnormal MRI Findings in Pediatric Patients with Back Pain"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1694-9272","authenticated-orcid":false,"given":"Devan","family":"Devkumar","sequence":"first","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas"},{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-5648","authenticated-orcid":false,"given":"Karina","family":"Zapata","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8699-5236","authenticated-orcid":false,"given":"Yuhan","family":"Ma","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2159-2095","authenticated-orcid":false,"given":"Chan-Hee","family":"Jo","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-230X","authenticated-orcid":false,"given":"Brandon","family":"Ramo","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"bib1-20250917","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1546-0096-8-28","article-title":"Review for the generalist: evaluation of low back pain in children and adolescents","volume":"8","author":"Houghton","year":"2010","journal-title":"Pediatr Rheumatol Online J."},{"key":"bib2-20250917","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1471-2431-13-14","article-title":"Prevalence of low back pain in children and adolescents: a meta-analysis","volume":"13","author":"Calvo-Mu\u00f1oz","year":"2013","journal-title":"BMC Pediatr."},{"issue":"1","key":"bib3-20250917","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1186\/s12887-018-1335-0","article-title":"Prevalence of pain reports in pediatric primary care and association with demographics, body mass index, and exam findings: a cross-sectional study","volume":"18","author":"Grout","year":"2018","journal-title":"BMC Pediatr."},{"issue":"4","key":"bib4-20250917","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1179\/108331909X12488667116899","article-title":"A systematic review of the incidence and prevalence of low back pain in children","volume":"14","author":"Hill","year":"2009","journal-title":"Phys Ther Rev."},{"issue":"2","key":"bib5-20250917","doi-asserted-by":"crossref","first-page":"382","DOI":"10.2106\/00004623-200402000-00027","article-title":"Low-back pain in athletes","volume":"86","author":"Bono","year":"2004","journal-title":"J Bone Joint Surg Am."},{"issue":"4 Pt 1","key":"bib6-20250917","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1542\/peds.111.4.822","article-title":"Predictors of low back pain in British schoolchildren: a population-based prospective cohort study","volume":"111","author":"Jones","year":"2003","journal-title":"Pediatrics."},{"issue":"5","key":"bib7-20250917","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1746-1561.2007.00198.x","article-title":"Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents","volume":"77","author":"Moore","year":"2007","journal-title":"J Sch Health."},{"issue":"3","key":"bib8-20250917","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1136\/adc.2006.115535","article-title":"The investigation and management of back pain in children","volume":"93","author":"Davis","year":"2008","journal-title":"Arch Dis Child Educ Pract Ed."},{"issue":"11","key":"bib9-20250917","first-page":"1669","article-title":"Evaluation of back pain in children and adolescents","volume":"76","author":"Bernstein","year":"2007","journal-title":"Am Fam Physician."},{"issue":"5","key":"bib10-20250917","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1007\/s00247-021-05044-5","article-title":"Safety challenges related to the use of sedation and general anesthesia in pediatric patients undergoing magnetic resonance imaging examinations","volume":"51","author":"Artunduaga","year":"2021","journal-title":"Pediatr Radiol."},{"issue":"2","key":"bib11-20250917","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.rcl.2010.11.004","article-title":"The economic burden of incidentally detected findings","volume":"49","author":"Ding","year":"2011","journal-title":"Radiol Clin North Am."},{"issue":"2","key":"bib12-20250917","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/BPO.0b013e3181651bc8","article-title":"Diagnostic modalities for the evaluation of pediatric back pain: a prospective study","volume":"28","author":"Bhatia","year":"2008","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib13-20250917","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5435\/JAAOS-D-14-00130","article-title":"Evaluation and Diagnosis of Back Pain in Children and Adolescents","volume":"24","author":"Shah","year":"2016","journal-title":"J Am Acad Orthop Surg."},{"issue":"5S","key":"bib14-20250917","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1016\/j.jacr.2017.01.039","article-title":"Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria\u00ae Back Pain-Child","volume":"14","author":"Booth","year":"2017","journal-title":"J Am Coll Radiol."},{"issue":"6","key":"bib15-20250917","doi-asserted-by":"crossref","first-page":"e478","DOI":"10.1097\/BPO.0000000000001353","article-title":"Are Constant Pain, Night Pain, or Abnormal Neurological Examination Adequate Predictors of the Presence of a Significant Pathology Associated With Pediatric Back Pain?","volume":"39","author":"Ram\u00edrez","year":"2019","journal-title":"J Pediatr Orthop."},{"issue":"22","key":"bib16-20250917","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib17-20250917","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.outlook.2014.05.009","article-title":"Patient-Reported Outcomes Measurement Information System (PROMIS): efficient, standardized tools to measure self-reported health and quality of life","volume":"62","author":"Bevans","year":"2014","journal-title":"Nurs Outlook."},{"issue":"1","key":"bib18-20250917","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1186\/s13018-020-02068-9","article-title":"Reporting and utilization of Patient-Reported Outcomes Measurement Information System\u00ae (PROMIS\u00ae) measures in orthopedic research and practice: a systematic review","volume":"15","author":"Horn","year":"2020","journal-title":"J Orthop Surg Res."},{"issue":"7","key":"bib19-20250917","doi-asserted-by":"crossref","first-page":"e720","DOI":"10.1097\/BPO.0000000000002190","article-title":"Construct Validity of Pediatric PROMIS Computerized Adaptive Testing Measures in Children With Adolescent Idiopathic Scoliosis","volume":"42","author":"Mitchell","year":"2022","journal-title":"J Pediatr Orthop."},{"issue":"2","key":"bib20-20250917","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/MLR.0000000000000289","article-title":"The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care","volume":"53","author":"Jensen","year":"2015","journal-title":"Med Care."},{"issue":"2","key":"bib21-20250917","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s43390-023-00783-x","article-title":"Back pain and disability according to early onset scoliosis etiology in children younger than 10 years","volume":"12","author":"Zapata","year":"2024","journal-title":"Spine Deform."},{"issue":"6","key":"bib22-20250917","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1093\/pm\/pnw357","article-title":"Assessment of Patient-Reported Outcome Instruments to Assess Chronic Low Back Pain","volume":"18","author":"Ramasamy","year":"2017","journal-title":"Pain Med."},{"issue":"6","key":"bib23-20250917","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1177\/18632521221137392","article-title":"Assessing need for advance imaging among children with back pain using pain intensity as clinical marker","volume":"16","author":"Olivella","year":"2022","journal-title":"J Child Orthop."},{"issue":"1","key":"bib25-20250917","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11136-015-1058-8","article-title":"Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method","volume":"25","author":"Thissen","year":"2016","journal-title":"Qual Life Res."},{"issue":"1","key":"bib26-20250917","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1302\/1863-2548.15.200158","article-title":"Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints","volume":"15","author":"Rathjen","year":"2021","journal-title":"J Child Orthop."},{"issue":"2","key":"bib27-20250917","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s43390-023-00807-6","article-title":"The Oswestry Disability Index is reflective of pain interference and mobility in children","volume":"12","author":"Zapata","year":"2024","journal-title":"Spine Deform."},{"issue":"5","key":"bib28-20250917","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2214\/AJR.10.5457","article-title":"Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation","volume":"196","author":"Park","year":"2011","journal-title":"AJR Am J Roentgenol."},{"issue":"2","key":"bib29-20250917","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00007632-200201150-00012","article-title":"Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system","volume":"27","author":"Hollenberg","year":"2002","journal-title":"Spine (Phila Pa 1976)."},{"issue":"4","key":"bib30-20250917","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/BF00194188","article-title":"Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc","volume":"17","author":"Kim","year":"1993","journal-title":"Int Orthop."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:33Z","timestamp":1787751873000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":29,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.01404","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]}}}