Patient-reported outcomes validated in phase 3 clinical trials: a targeted literature review

Neurostatus-SMARTCARE clinical trial: Enabling health care professionals to assess EDSS for decentralized trials in multiple sclerosis

BACKGROUND

Neurostatus-Expanded Disability Status Scale (EDSS) is the standard measure used to assess impairment and disability in multiple sclerosis (MS) trials but requires trained expert neurologists.

OBJECTIVES

This study aims to evaluate the concordance of Neurostatus-EDSS assessments from specially trained health care professionals (HCPs) and standardized trained neurologists.

METHODS

A Swiss multicenter, randomized, cross-over study with 100 people with MS. HCPs were trained to assess the Neurostatus-EDSS based on the newly developed SMARTCARE-EDSS training method.

RESULTS

The concordance rate between HCPs and neurologists was 0.87 (95% confidence interval (CI) = 0.815-0.925).

CONCLUSION

Trained HCPs can reliably perform Neurostatus-EDSS assessments, supporting broader implementation and improved trial access.

Investigating item response theory model performance in the context of evaluating clinical outcome assessments in clinical trials

PURPOSE

Item response theory (IRT) models are an increasingly popular method choice for evaluating clinical outcome assessments (COAs) for use in clinical trials. Given common constraints in clinical trial design, such as limits on sample size and assessment lengths, the current study aimed to examine the appropriateness of commonly used polytomous IRT models, specifically the graded response model (GRM) and partial credit model (PCM), in the context of how they are frequently used for psychometric evaluation of COAs in clinical trials.

METHODS

Data were simulated under varying sample sizes, measure lengths, response category numbers, and slope strengths, as well as under conditions that violated some model assumptions, namely, unidimensionality and equality of item slopes. Model fit, detection of item local dependence, and detection of item misfit were all examined to identify conditions where one model may be preferable or results may contain a degree of bias.

RESULTS

For unidimensional item sets and equal item slopes, the PCM and GRM performed similarly, and GRM performance remained consistent as slope variability increased. For not-unidimensional item sets, the PCM was somewhat more sensitive to this unidimensionality violation. Looking across conditions, the PCM did not demonstrate a clear advantage over the GRM for small sample sizes or shorter measure lengths.

CONCLUSION

Overall, the GRM and the PCM each demonstrated advantages and disadvantages depending on underlying data conditions and the model outcome investigated. We recommend careful consideration of the known, or expected, data characteristics when choosing a model and interpreting its results.

Disparities in Patient-reported Outcome Measure Completion Rates and Baseline Function in Newly Presenting Spine Patients

STUDY DESIGN

Retrospective review.

OBJECTIVE

The purpose of this study was to evaluate disparities in patient-reported outcome measures (PROM) completion rates and baseline function scores among newly presenting spine patients.

SUMMARY OF BACKGROUND DATA

Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on PROMs. As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments.

METHODS

A retrospective review of 10,803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariable analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders.

RESULTS

A total of 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-White race (OR=0.661, 95% CI=0.599-0.729, P <0.001), Hispanic ethnicity (OR=0.569, 95% CI=0.448-0.721, P <0.001), and increased social vulnerability (OR=0.608, 95% CI=0.511-0.723, P <0.001) were less likely to complete PROMs. In the multivariable models, patients of non-White race reported lower levels of physical function (β=-6.5, 95% CI=-12.4 to -0.6, P =0.032) and higher levels of pain intensity (β=0.6, 95% CI=0.2-1.0, P =0.005). Hispanic ethnicity (β=1.5, 95% CI=0.5-2.5, P =0.004) and increased social vulnerability (β=1.1, 95% CI=0.4-1.8, P =0.002) were each associated with increased pain intensity.

CONCLUSIONS

Among newly presenting spine patients, those of non-White race, Hispanic ethnicity, and with increased social vulnerability were less likely to complete PROMs. As these subpopulations also reported worse physical function or pain intensity, additional strategies are needed to better capture patient-reported health status to avoid bias in clinical care, outcomes research, and health policy.

LEVEL OF EVIDENCE

4.

An Open-Label Study of a Wearable Device Targeting ADHD, Executive Function, and Academic Performance

OBJECTIVE

This was an open-label pilot study to test the feasibility and preliminary efficacy of a wearable digital intervention developed to improve on-task behavior. This was an exploratory study to test for specificity of response on parent- and teacher-reported symptom outcomes in attention and hyperactive/impulsive symptoms, as well as domains of functional impairment, including school behavior and learning and executive function.

METHOD

Participants included 38 children aged 8-12 years with a parent-reported past diagnosis of ADHD. Following baseline ratings from parents (N = 38) and teachers (N = 26), participants wore the device to school for four weeks. Parent and teacher ratings of ADHD symptoms, executive function, and functional impairment were repeated at the end of the four-week intervention period.

RESULTS

Statistically significant improvement was seen in the total scores for all parent and nearly all teacher outcomes, with moderate effect size improvements in attention, organization and planning, self-monitoring, school functioning, and teacher-reported academic performance.

CONCLUSIONS

Preliminary evidence from this open-label pilot study suggests that having a child interact with a wearable device to self-monitor attention is feasible. This exploratory, open-label pilot study found real-world improvement in functional domains, including academic performance. Future research will require a blinded, randomized, controlled trial using an appropriate sham comparator to confirm these findings.