Grants Funded
ASPS/PSF leadership is committed to continuing to provide high levels of investigator-initiated research support to ensure that plastic surgeons have the needed research resources to be pioneers and innovators in advancing the practice of medicine.
Research Abstracts
Search The PSF database to have easy access to full-text grant abstracts from past PSF-funded research projects 2003 to present. All abstracts are the work of the Principal Investigators and were retrieved from their PSF grant applications. Several different filters may be applied to locate abstracts specific to a particular focus area or PSF funding mechanism.
Establishing Minimal Important Differences (MID) for the LIMB-Q
Principal Investigator
Lily Mundy MD
Lily Mundy MD
Year
2025
2025
Institution
Johns Hopkins University School of Medicine
Johns Hopkins University School of Medicine
Funding Mechanism
Focus Area
Microsurgery, Economic Analysis/Quality/Outcome
Microsurgery, Economic Analysis/Quality/Outcome
Abstract
Project Summary
Patient-reported outcome measures (PROMs) have become essential assessment tools in clinical care and research by capturing the patient perspective without influence by clinicians or researchers. PROMs are capable of assessing quality of life, function, symptoms, and psychosocial well-being among other metrics, many of which are difficult to quantify through history and physical exam. The LIMB-Q is currently the only PROM that was rigorously developed and validated specifically for the lower extremity trauma patient-population applicable to patients after fracture, amputation, or limb-salvage with a flap. However, a key limitation in using PROMs, including the LIMB-Q, is knowing how to interpret the scores they generate. While clinically, we can easily interpret a difference in flap failure, infection or re-operation rates, it is hard to know what a 3- or 6-point difference in a given PROM score really represents. To provide meaning to PROM scores, establishing minimal important differences are necessary. Minimal important differences (MIDs) or minimal clinically important differences (MCIDs) represent the smallest meaningful difference for patients, i.e., the smallest change in PROM score that represents a meaningful difference in health-status. This need for LIMB-Q minimal important differences has been recognized and requested by both researchers and federal study section grant reviewers. The primary AIM of this proposal is therefore to establish minimal important differences for the LIMB-Q through a prospective anchor-based approach. As a secondary AIM, we plan to use the prospectively collect granular PROM data collected in AIM 1 to inform a future clinical trial evaluating the impact of an intervention addressing financial toxicity in limb salvage patients. This second AIM will focus on demonstrating the progression of financial toxicity in the first 6 months following limb-salvage, and be
used for sample size calculations, a power analysis, and trial planning for future NIH and DoD clinical trial grant applications.
Impact Statement
This proposal has the long-term goal of improving the usability and interpretability of the LIMB-Q in lower extremity trauma research via establishing LIMB-Q minimal important differences or MIDs. Our primary objective is to establish LIMB-Q minimal
important differences via a prospective anchor-based approach. This is in direct response to requests from lower extremity trauma researchers at multiple institutions as well as clinical trial study sections for federal funding agencies. Our secondary objective is to generate preliminary data describing the initial 6-month post-operative course of financial toxicity in limb salvage patients, which will be leveraged into a future federal-funded clinical trials application aimed at reducing financial toxicity in limb-salvage patients.
Project Summary
Patient-reported outcome measures (PROMs) have become essential assessment tools in clinical care and research by capturing the patient perspective without influence by clinicians or researchers. PROMs are capable of assessing quality of life, function, symptoms, and psychosocial well-being among other metrics, many of which are difficult to quantify through history and physical exam. The LIMB-Q is currently the only PROM that was rigorously developed and validated specifically for the lower extremity trauma patient-population applicable to patients after fracture, amputation, or limb-salvage with a flap. However, a key limitation in using PROMs, including the LIMB-Q, is knowing how to interpret the scores they generate. While clinically, we can easily interpret a difference in flap failure, infection or re-operation rates, it is hard to know what a 3- or 6-point difference in a given PROM score really represents. To provide meaning to PROM scores, establishing minimal important differences are necessary. Minimal important differences (MIDs) or minimal clinically important differences (MCIDs) represent the smallest meaningful difference for patients, i.e., the smallest change in PROM score that represents a meaningful difference in health-status. This need for LIMB-Q minimal important differences has been recognized and requested by both researchers and federal study section grant reviewers. The primary AIM of this proposal is therefore to establish minimal important differences for the LIMB-Q through a prospective anchor-based approach. As a secondary AIM, we plan to use the prospectively collect granular PROM data collected in AIM 1 to inform a future clinical trial evaluating the impact of an intervention addressing financial toxicity in limb salvage patients. This second AIM will focus on demonstrating the progression of financial toxicity in the first 6 months following limb-salvage, and be
used for sample size calculations, a power analysis, and trial planning for future NIH and DoD clinical trial grant applications.
Impact Statement
This proposal has the long-term goal of improving the usability and interpretability of the LIMB-Q in lower extremity trauma research via establishing LIMB-Q minimal important differences or MIDs. Our primary objective is to establish LIMB-Q minimal
important differences via a prospective anchor-based approach. This is in direct response to requests from lower extremity trauma researchers at multiple institutions as well as clinical trial study sections for federal funding agencies. Our secondary objective is to generate preliminary data describing the initial 6-month post-operative course of financial toxicity in limb salvage patients, which will be leveraged into a future federal-funded clinical trials application aimed at reducing financial toxicity in limb-salvage patients.
Biography
Lily Mundy, MD is an Assistant Professor in the Department of Plastic and Reconstructive Surgery at Johns Hopkins University. Dr. Mundy specializes in reconstructive microsurgery, with clinical and research focuses in breast and extremity reconstruction. Her research expertise includes patient-reported outcome instrument development as well as research in health disparities, financial toxicity, and better understanding the patient experience. Her aim is to improve racial and ethnic disparities in breast reconstruction using patient-centered techniques. Dr. Mundy received her undergraduate training from New York University and medical degree from the College of Physicians and Surgeons, Columbia University. She completed her plastic surgery training at Duke University, followed by advanced clinical and research training in complex extremity reconstruction and microsurgery at the R Adams Cowley Shock Trauma Center, University of Maryland. She has been acknowledged with several notable honors during her training, including summa cum laude (2009), and inductions into both the Alpha Omega Alpha Honor Medical Society (2014) and Arnold P. Gold Humanism Honor Society (2014). She received the Albert B. Knapp Award (2014) and Glasgow-Rubin Achievement Award (2015) at Columbia University. Lastly, her research in patient-reported outcomes in breast surgery patients was awarded the Clifford C. Snyder, MD Past Chairman Award at the 2017 Annual Plastic Surgery Research Council Meeting.
Lily Mundy, MD is an Assistant Professor in the Department of Plastic and Reconstructive Surgery at Johns Hopkins University. Dr. Mundy specializes in reconstructive microsurgery, with clinical and research focuses in breast and extremity reconstruction. Her research expertise includes patient-reported outcome instrument development as well as research in health disparities, financial toxicity, and better understanding the patient experience. Her aim is to improve racial and ethnic disparities in breast reconstruction using patient-centered techniques. Dr. Mundy received her undergraduate training from New York University and medical degree from the College of Physicians and Surgeons, Columbia University. She completed her plastic surgery training at Duke University, followed by advanced clinical and research training in complex extremity reconstruction and microsurgery at the R Adams Cowley Shock Trauma Center, University of Maryland. She has been acknowledged with several notable honors during her training, including summa cum laude (2009), and inductions into both the Alpha Omega Alpha Honor Medical Society (2014) and Arnold P. Gold Humanism Honor Society (2014). She received the Albert B. Knapp Award (2014) and Glasgow-Rubin Achievement Award (2015) at Columbia University. Lastly, her research in patient-reported outcomes in breast surgery patients was awarded the Clifford C. Snyder, MD Past Chairman Award at the 2017 Annual Plastic Surgery Research Council Meeting.