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Raats JH, Ponds NHM, Brameier DT, Bain PA, Schuijt HJ, van der Velde D, Weaver MJ. Agreement between patient- and proxy-reported outcome measures in adult musculoskeletal trauma and injury: a scoping review. Qual Life Res 2024:10.1007/s11136-024-03766-1. [PMID: 39179941 DOI: 10.1007/s11136-024-03766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are widely used in medicine. As older adults, who may rely on a proxy caregiver for answers due to cognitive impairment, are representing an increasing share of the traumatically injured patient population, proxy-reported outcome measures (proxROMs) offer a valuable alternative source of patient-centered information although its association with PROMs is unclear. The objective of this scoping review is to discuss all available literature comparing PROM and proxROMs in adult patients with musculoskeletal trauma to guide future research in this field. METHODS The PRISMA extension for Scoping Reviews was used to guide this review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched without date limit for articles comparing PROM and proxROMs in setting of musculoskeletal trauma. Abstract and full-text screening were performed by two independent reviewers. Variables included study details, patient and proxy characteristics, and reported findings on agreement between PROMs and proxROMs. RESULTS Of 574 unique records screened, 13 were included. Patient and proxy characteristics varied greatly, while patients' cognitive status and type of proxy perspective were poorly addressed. 18 different PROMs were evaluated, mostly reporting on physical functioning and disability (nine, 50%) or quality of life (six, 33%). Injury- and proxy-specific tools were rare, and psychometric properties of PROMs were often not described. Studies reported moderate to good agreement between PROMs and proxROMs. There is less agreement on subjective outcome measures (e.g., depression score) compared to observable items, and proxy bias results in in worse outcomes compared to patient self-reports. CONCLUSION Current literature, though limited, demonstrates moderate to good agreement between injured patients' self- and proxy-reports. Future studies should be mindful of current guidelines on proxy reporting when developing their studies and consider including neglected populations such as cognitively impaired patients to improve clinical validity.
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Affiliation(s)
- Jochem H Raats
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis St, Boston, MA, 02115, USA.
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.
- Department of Surgery, Antonius Hospital, Utrecht, The Netherlands.
| | - Noa H M Ponds
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
- Department of Surgery, Antonius Hospital, Utrecht, The Netherlands
| | - D T Brameier
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
| | - P A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, MA, USA
| | - H J Schuijt
- Department of Surgery, Antonius Hospital, Utrecht, The Netherlands
| | - D van der Velde
- Department of Surgery, Antonius Hospital, Utrecht, The Netherlands
| | - M J Weaver
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
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Long SO, Hope SV. What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review. Eur Geriatr Med 2024; 15:629-644. [PMID: 38532081 PMCID: PMC11329537 DOI: 10.1007/s41999-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty. METHOD PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'. RESULTS 88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden. CONCLUSIONS PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.
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Affiliation(s)
- S O Long
- University of Exeter, Exeter, UK
| | - S V Hope
- University of Exeter, Exeter, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
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Hays RD, Elliott MN. Performance of the Physical Functioning Activities of Daily Living Scale in the 2020 Medicare Health Outcomes Survey. Arch Phys Med Rehabil 2024; 105:696-703. [PMID: 37995776 PMCID: PMC11097997 DOI: 10.1016/j.apmr.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Assessing functional limitations for adults at high risk of frailty yields valuable information for identifying those in need of therapy. We evaluate a self-report measure used to assess physical function among Medicare recipients in the United States. DESIGN Secondary analysis of the 2020 Medicare Health Outcomes Survey. SETTING A random sample of adult enrollees of 510 managed care plans. PARTICIPANTS 287,476 adults (37% completion rate): 58% women; 16% were <65 years old (entitled via disability), 50% 65-74, and 34% 75 or older; 77% White, 14% Black, and 8% another race; 19% had INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE We evaluate item distributions, dimensionality, monotonicity of response options, reliability, and validity of the 8-item Physical Functioning Activities of Daily Living (PFADL) scale. RESULTS Most reported they could do 6 basic activities of daily living without difficulty. More limitations were reported for the other 2 PFADL items: 32% were not limited at all in climbing several flights of stairs and 40% in moderate activities. Product-moment correlations among the 8 items ranged from r=0.19 between the easiest-to-do (eating) and most difficult-to-do (climbing several flights of stairs) items to r=0.73 between bathing and dressing. The coefficient alpha and omega for the 8-item scale were both 0.86. Item slopes ranged from 2.6 (climbing several flights of stairs and eating) to 4.8 (dressing). Item characteristic curves revealed that response options were most likely to be selected in the appropriate order along the physical functioning continuum. The PFADL had at least 0.80 reliability between about -3 SDs below the mean to the mean. It was negatively correlated with comorbid condition count, disability days, problems with balance or walking, falling, and obesity. CONCLUSIONS The PFADL is useful for assessing average or below physical function in Medicare recipients.
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Affiliation(s)
- Ron D Hays
- UCLA Division of General Internal Medicine, Department of Medicine, Los Angeles, CA.
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Park BC, Drolet BC, Perdikis G. Vanderbilt Mini-PROM-Breast for Breast Reconstruction: A Short-Form, Patient-Reported Outcomes Measure. Plast Reconstr Surg 2024; 153:291e-302e. [PMID: 38266134 DOI: 10.1097/prs.0000000000010620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Breast reconstruction procedures are among the most commonly performed plastic surgery operations. Although there are well-validated patient-reported outcomes measures (PROMs) for breast reconstruction, there are several patient-, provider-, and service-level barriers to their implementation in routine clinical settings. Therefore, we developed a short-form PROM to evaluate breast reconstruction outcomes. METHODS Using a mixed-methods approach, the Vanderbilt Mini-PROM-Breast (VMP-B) was constructed and validated to assess patient-reported outcomes from breast reconstruction. Classic test theory methods were used to evaluate acceptability, reliability, and validity. External validation was subsequently performed using the BREAST-Q as a reference standard. RESULTS The VMP-B is a 16-item instrument composed of three domains: quality of life, body image, and breast satisfaction. Psychometric properties including acceptability, reliability, and validity exceeded reference criteria. When tested with 104 patients, the authors found significant benefits of breast reconstruction on quality of life, body image, and breast satisfaction. These results were associated with sizeable effect sizes (g) (g = 0.421, g = 0.520, and g = 1.25) demonstrative of clinically meaningful results. When tested concurrently in 70 patients, the VMP-B and the BREAST-Q showed similar results, exhibiting excellent convergent validity. CONCLUSIONS The VMP-B is a validated short-form PROM that reliably assesses breast reconstruction outcomes. As a short form, the VMP-B decreases both patient and provider burden, which allows for routine, point-of-care collection of breast reconstruction outcomes.
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Affiliation(s)
| | - Brian C Drolet
- Department of Plastic Surgery
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center
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Houwen T, Theeuwes HP, Verhofstad MHJ, de Jongh MAC. From numbers to meaningful change: Minimal important change by using PROMIS in a cohort of fracture patients. Injury 2023; 54 Suppl 5:110882. [PMID: 37923506 DOI: 10.1016/j.injury.2023.110882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION use of the Patient-Reported Outcomes measurement Information System (PROMIS®) is slowly increasing in patients with a fracture. Yet, minimal important change of PROMIS in patients with fractures has been addressed in a very limited number of studies. As the minimal important change (MIC) is important to interpret PROMIS-scores, the goal is to estimate the MIC for PROMIS physical function (PF), PROMIS pain interference (PI) and PROMIS ability to participate in social roles and activities (APSRA) in patients with a fracture. Secondly, the smallest detectable change was determined. MATERIALS AND METHODS A longitudinal cohort study on patients ≥ 18 years receiving surgical or non-surgical care for fractures was conducted. Patients completed PROMIS PF V1.1, PROMIS PI V1.1 and PROMIS APSRA V2.0. For follow-up, patients completed three additional anchor questions evaluating patient-reported improvement on a seven point rating scale. The predictive modeling method was used to estimate the MIC value of all three PROMIS questionnaires. RESULTS Hundred patients with a mean age of 55.4 ± 12.6 years were included of which sixty (60%) were female. Seventy-two (72%) patients were recovering from a surgical procedure. PROMIS-CAT T-scores of all PROMIS measures showed significant correlations with their anchor questions. The predictive modeling method showed a MIC value of +2.4 (n = 98) for PROMIS PF, -2.9 (n = 96) for PROMIS PI and +3.2 (n = 91) for PROMIS APSRA. CONCLUSION By using the anchor based predictive modeling method, PROMIS MIC-values for improvement of respectively +2.4 points on a T-score metric for PROMIS-PF, -2.9 for PROMIS-PI and +3.2 for PROMIS APSRA give the impression of being meaningful to patients. These values can be used in clinical practice for managing patient expectations; to inform on treatment results; and to assess if patients experience significant change. This in order to encourage patient centered care.
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Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands; Trauma Research Unit Erasmus Medical Center, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hilco P Theeuwes
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Erasmus Medical Center, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands.
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Hu XL, Huang PK, Zhang M, Chen J, Xiao MQ. Effects of combining multiple dose reduction techniques on coronary computed tomography angiography. World J Radiol 2023; 15:32-41. [PMID: 36874259 PMCID: PMC9979190 DOI: 10.4329/wjr.v15.i2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/23/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is the preferred non-invasive examination method for coronary heart disease. However, the radiation from computed tomography has become a concern since public awareness of radiation hazards continue to increase.
AIM To explore the value of multiple dose reduction techniques for CCTA.
METHODS Consecutive normal and overweight patients were prospectively divided into two groups: Group A1, patients who received multiple dose reduction scans (n = 82); and group A2, patients who received conventional scans (n = 39). The scan parameters for group A1 were as follows: Isocentric scan, tube voltage = 80 kV, and tube current control using 80% smart milliampere. The scan parameters for group A2 were as follows: Normal position, tube voltage = 100 kV, and smart milliampere.
RESULTS The average effective doses (EDs) for groups A1 and A2 were 1.13 ± 0.35 and 3.36 ± 1.30 mSv, respectively. There was a statistically significant difference in ED between the two groups (P < 0.01). Furthermore, noise was significantly lower, and both signal-to-noise ratio and contrast signal-to-noise ratio were higher in group A2 when compared to group A1 (P < 0.01). Moreover, the subjective image quality (IQ) scores were excellent in both groups, in which there was no significant difference in subjective IQ score between the two groups (P = 0.12).
CONCLUSION Multiple dose reduction scan techniques can significantly decrease the ED of patients receiving CCTA examinations for clinical diagnosis.
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Affiliation(s)
- Xiao-Lu Hu
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 650031, Guangdong Province, China
| | - Pei-Kai Huang
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 650031, Guangdong Province, China
| | - Meng Zhang
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 650031, Guangdong Province, China
| | - Jun Chen
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 650031, Guangdong Province, China
| | - Meng-Qiang Xiao
- Department of Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 650031, Guangdong Province, China
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Smith SR, Vargo M, Zucker DS, Shahpar S, Gerber LH, Henderson M, Jay G, Cheville AL. Responsiveness and interpretation of the PROMIS Cancer Function Brief 3D Profile. Cancer 2022; 128:3217-3223. [PMID: 35788990 PMCID: PMC9541445 DOI: 10.1002/cncr.34376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Measuring function with valid and responsive tools in patients with cancer is essential for driving clinical decision-making and for the end points of clinical trials. Current patient-reported outcome measurements of function fall short for many reasons. This study evaluates the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile, a novel measure of function across multiple domains. METHODS Two hundred nine participants across five geographically distinct tertiary care centers completed the assessment and pain rating at two outpatient cancer rehabilitation clinic visits. Patients and providers completed a global rating of change measure at the second visit to indicate whether the patient was improving or worsening in function. Multiple response indices and linear models measured whether the measure was responsive to self-reported and clinician-rated changes over time. Correlations between changes in function and changes in anchors (pain rating and performance status) were also calculated. RESULTS Function as measured by the PROMIS Cancer Function Brief 3D Profile changed appropriately as both patients and clinicians rated change. Small to moderate effect sizes supported the tool's responsiveness. Function was moderately correlated with pain and more strongly correlated with performance status, and changes in function corresponded with changes in anchor variables. No floor/ceiling effect was found. CONCLUSIONS The PROMIS Cancer Function Brief 3D Profile is sensitive to changes over time in patients with cancer. The measure may be useful in clinical practice and as an end point in clinical trials. LAY SUMMARY We gave patients a questionnaire by which they told their physicians how well they were functioning, including how fatigued they were. This study tested that questionnaire to see whether the scores would change if patients got better or worse.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Vargo
- Case Western Reserve University, Cleveland, Ohio, USA
| | - David S Zucker
- Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, Washington, USA
| | | | - Lynn H Gerber
- George Mason University, Fairfax, Virginia, USA.,Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Maryanne Henderson
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gina Jay
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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The reliability and responsivity of pain intensity scales in individuals with chronic pain. Pain 2022; 163:e1184-e1191. [PMID: 35584261 DOI: 10.1097/j.pain.0000000000002692] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Prior research supports the validity and short-term test-retest stability of four commonly used scales for assessing pain intensity (Visual Analogue Scale [VAS], Verbal Rating Scale [VRS-6], 0-10 Numerical Rating Scale [NRS-11], and Face Pain Scale-Revised [FPS-R]). However, the relative stability and ability of these measures to detect changes in pain intensity over longer time periods has not yet been examined, although knowledge regarding these psychometric issues is important for selecting from among these measures. To address this knowledge gap, we administered these scales assessing worst and average pain intensity to 250 chronic pain outpatients on two occasions, four weeks apart. All four scales were found to be valid for detecting decreases in pain, and the VAS, NRS-11, and FPS-R evidenced the most validity for detecting increases in pain. The NRS-11 and VAS evidenced better test-retest stability than the VRS-6 and FPS-R. Age affected the ability of the VRS-6 for detecting improvement in worst pain, as well as the ability of the VAS for detecting worsening in both worst and average pain. However, the psychometric properties of the scales were not influenced by education level. Overall, the NRS-11 emerged as showing the most sensitivity and stability. The FPS-R appears to be a good second choice to consider for samples of individuals who might have difficulty understanding or using the NRS-11.
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What Clinicians Need to Know About Measurement. J Am Med Dir Assoc 2021; 22:1606-1608. [PMID: 34334161 DOI: 10.1016/j.jamda.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022]
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