Electronic Patient-reported Outcome Measures Research Articles

Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record.

102 Background: Electronic patient-reported outcome measures (ePROs) offer a new strategy for symptom assessment that can improve quality of life and prolong survival in routine cancer care. However, ePRO systems are often separate from existing electronic medical records (EMRs) and not well integrated into oncology clinics. In this pilot project, we assessed the feasibility and utility of integrating ePROs into our existing EMR and clinical workflows. Methods: The 10-question Edmonton Symptom Assessment Scale (ESAS) was integrated into the Epic EMR at three outpatient clinics in the Duke Cancer Institute. Patients with active MyChart accounts were offered the ESAS survey prior to their visit, via the patient portal. ePRO data were routed to clinicians in tabular and graphical formats. A “SmartPhrase” facilitated easy data integration into clinical notes. We subsequently interviewed clinicians and optimized workflows. Several patient engagement strategies were used, including automated messages, phone call reminders, and electronic tablets, to increase response rate. Results: It was feasible to quickly customize and activate an ePRO in Epic. Over 10 months, 161 patients completed 208 ePRO surveys. Initially, 10-20% of eligible patients completed the MyChart questionnaire. Patient engagement strategies, including phone calls and personalized MyChart messages, had little effect. Ultimately, tablets were introduced in the clinic check-in process, increasing response rates to >90%. Clinicians reported positive regard for the system, and an impact on patient symptom management. Clinician workflow optimization resulted in minimal “clicks” in the EMR, and the SmartPhrase was used in 128 clinical notes. Conclusions: Integration of ePROs into the clinical setting poses three challenges: technical implementation, workflow optimization, and patient engagement. While technical implementation is important, it was the easiest to solve, with patient engagement as the greatest barrier. Clinicians value an integrated ePRO system that automatically routes data to the clinical note. The key to successful ePRO integration is in ease of use for both patients and clinicians.

An electronic patient-reported outcomes measurement system in paediatric orthopaedics.

PurposeThe purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs.MethodsParticipants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey.ResultsIn all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096).Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms.ConclusionPROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients.Level of EvidenceII

Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36.

BackgroundAlthough patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level.MethodsAfter testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality.ResultsA total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population.ConclusionsNationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.

Electronic Patient-Reported Outcome Measures in Radiation Oncology: Initial Experience After Workflow Implementation.

BackgroundMobile health (mHealth) technologies are increasingly used in various medical fields. However, the potential of mHealth to improve patient care in radiotherapy by acquiring electronic patient reported outcome measures (ePROMs) during treatment has been poorly studied so far.ObjectiveThe aim of this study was to develop and implement a novel Web app (PROMetheus) for patients undergoing radiotherapy. Herein, we have reported our experience with a focus on feasibility, patient acceptance, and a correlation of ePROMs with the clinical course of the patients.MethodsIn the period between January and June 2018, 21 patients used PROMetheus to score side effects, symptoms, and quality of life–related parameters during and after their treatment. Items of the Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) were chosen based on the primary site of disease, 27 items for head and neck tumors, 21 items for thoracic tumors, and 24 items for pelvic tumors.ResultsIn total, 17 out of the 21 patients (81%) regularly submitted ePROMs and more than 2500 data points were acquired. An average of 5.2, 3.5, and 3.3 min was required to complete the head and neck, thorax, and pelvis questionnaires, respectively. ePROMS were able to detect the occurrence of both expected and unexpected side effects during the treatment.In addition, a gradual increase in the severity of side effects over the course the treatment and their remission afterward could be observed with ePROMs. In total, 9 out of the 17 patients (53%), mostly those with head and neck and thoracic cancers, reported PRO-CTCAE grade III or IV fatigue with severe impairments of activities of daily life.ConclusionsThis study shows the successful implementation of an ePROM system and a high patient acceptance. ePROMs have a great potential to improve patient care in radiotherapy by providing a comprehensive documentation of symptoms and side effects, especially of ones that are otherwise underreported.

SAT-037 STUDY PROTOCOL FOR THE SYMPTOM MONITORING WITH FEEDBACK TRIAL (SWIFT): A NOVEL REGISTRY-BASED CLUSTER RANDOMISED TRIAL AMONG ADULTS WITH END-STAGE KIDNEY DISEASE MANAGED ON HAEMODIALYSIS

Women and men on haemodialysis frequently experience symptoms of severe or overwhelming pain, fatigue, nausea, cramping, itching, trouble sleeping, and depression that contribute to poor quality of life. A focus on laboratory biomarkers of lower relevance to patients, may have resulted in missed opportunities to intervene and reduce symptoms and improve health-related quality of life. Recent trials in other clinical settings have shown that active symptom management can improve overall survival. The aim of this trial is to determine whether regular symptom monitoring with feedback to the renal team can improve health-related quality of life and overall survival among adults with end-stage kidney disease (ESKD) managed with facility-haemodialysis. Using a novel ANZDATA registry-based cluster randomised trial design, with adults receiving haemodialysis, the proposed trial will test the hypothesis that: 1) three-monthly symptom monitoring using the IPOS-Renal tool with feedback to clinicians improves health-related quality of life (measured by the EQ-5D), dialysis duration and frequency, and cause-specific mortality compared with usual care; and 2) electronic capture of patient-reported outcomes within a clinical quality registry is cost-effective. A two-arm design of 160 clusters (~3072 individuals) has 90% power to detect a 7% clinically meaningful increase in health-related quality of life (primary endpoint); and 80% power to detect an 11% reduction in deaths from dialysis withdrawal (secondary endpoint). The SWIFT pilot study commencing in December 2018 will assess the feasibility and acceptability of the intervention to patients and clinicians including feedback of how data was used. Funding for the SWIFT pilot study was awarded from Kidney Health Australia in July 2018. Ethics approval was received in August 2018, and the electronic patient reported outcome measures were developed in Qualtrics software, with a novel QR reader interface to link with the ANZDATA registry. Preliminary user testing suggested the recording of quality of life and symptom scores within defined response categories is straight forward, however has identified issues with the touch screen interface on tablet computers for the EQ-5D visual analogue scale. The findings from SWIFT may result in improved quality of life, lower symptom burden (both severity and number of symptoms), and lower rates of dialysis withdrawal with the potential to change practice in haemodialysis care. Of significance, SWIFT provides a template for registry-based randomised trial of health services interventions; ongoing bi-national monitoring of patient-reported outcome measures; and infrastructure for economic evaluation of subsequent interventions.

Electronic Patient-Reported Outcome Collection Systems in Orthopaedic Clinical Practice.

» The recent emphasis on the electronic collection of patient health information has catalyzed the development of numerous platforms for capturing electronic patient-reported outcome measures (EPROMs).» There are several important considerations for selecting the most appropriate PROM for each orthopaedic practice.» In this article, we evaluate various aspects of PROMs, examine the challenges and obstacles that are associated with routine collection, and review 6 commonly used electronic collection systems for orthopaedic clinical practice.

Development and initial validation of an electronic personal assessment questionnaire for menstrual, pelvic pain and gynaecological hormonal disorders (ePAQ-MPH)

ObjectiveMenstrual disorders, pelvic-pain and gynaecological hormonal conditions in women can have a significant impact on quality-of-life. Reliable assessment and monitoring of these intimate conditions is challenging. Patient reported outcome measures (PROMs) can be invaluable in providing objective assessment, but no comprehensive PROM assessing all of these conditions and their impact on quality of life is currently available. The purpose of this study was to develop and undertake initial psychometric testing of a comprehensive interactive electronic patient reported outcome measure for these conditions. Study designA prototype electronic PROM (ePAQ-MPH) was developed following systematic literature review, semi structured interviews with 25 patients and expert panel review. Exploratory factor analysis was undertaken in 291 women attending a menstrual-disorders clinic; establishing a domain structure and enabling item reduction. Two validated PROMS (Women’s Health Questionnaire and Menstrual Distress Questionnaire) were completed to assess criterion validity in 213 patients. Test-retest reliability was carried out in 30 women completing ePAQ-MPH at least one week apart. Patients' views on ‘Value’ and ‘Burden’ were assessed in 278 women using a validated 10-item survey measuring questionnaire utility (QQ-10). Confirmatory factor analysis (CFA) of the revised version of ePAQ-MPH following item reduction was undertaken in a different sample of 254 women. ResultsExploratory factor analysis identified 18 domains (Cronbach’s α > 0.7) and 30 redundant items. Test-retest analysis found acceptable intra-class correlations of 0.6–0.9 (p < 0.05). Eight domains were compared with Menstrual Distress Questionnaire showing moderate or strong correlation in seven domains. Ten domains were compared with Women’s Health Questionnaire, six of which showed moderate correlation. Mean QQ-10 Value and Burden scores were 76 and 25, respectively (SD=15.8 and 15.5). The mean completion time for ePAQ-MPH was 31 min. CFA of the revised version 2 instrument with 15 domains showed good model fit. ConclusionsWhilst wider psychometric testing of the revised version of ePAQ-MPH is required, including in different settings and in assessments of data quality and responsiveness, initial analysis provides some evidence for reliability, validity and acceptability of this multi-dimensional electronic PROM. ePAQ-MPH shows potential for both patient assessment and roles in service evaluation and research.

Evaluation of inpatient cancer rehabilitation by routine electronic patient-reported outcome measures (ePROM): Improvement of quality of life (QoL) and psychological distress.

e18294 Background: Many cancer survivors suffer from psychological distress and poor QoL. Cancer rehabilitation is aimed at improving their condition but the benefit remains controversial, we have thus investigated the outcome. Methods: ePROM were routinely integrated into the inpatient program of a cancer rehabilitation center in Austria. Hospital Anxiety and Depression Scale (HADS) was used to assess distress, and EORTC QLQ-C30 questionnaire for analysis of cancer-related symptoms and functions. Patients answered questions via internet prior to admission (T0). This allowed for allocation of physical therapies and 4-8 psychological counseling sessions according to their needs. Following informed consent, the outcome was investigated likewise by the time of discharge after 3 weeks (T1). Data were analyzed with SPSS software using ANOVA repeated measures. Results: 4198 patients (age 59.2±11.7 yr; range 18-91 years; 61.5% female) participated between January 2015, and August 2018. HADS identified a marked reduction of anxiety and depression, with distress levels similar to the normal population by T1. QLQ-C30 revealed significant increases for global QoL; physical, social, emotional and role functions. All recorded symptoms were improved, in particular fatigue, pain and insomnia. Moreover, subgroup analyses confirmed improvement for 11 investigated entities. Of notice, decrease of anxiety was most prominent in survivors of breast, head/neck and lung cancer patients (p &lt; 0.001). No significant differences were observed between a subgroup of 1122 elderly ( &gt; 70 yr), and younger patients except for the physical function, which improved significantly in older patients (p = 0.003). Conclusions: Our study shows that inclusion of ePROM into inpatient cancer rehabilitation helps allocate therapies according to individual needs. This large series demonstrates significant reduction of psychological distress and improvement of all parameters of QoL. [Table: see text]

Using a Web-Based Data Collection Platform to Implement an Effective Electronic Patient-Reported Outcome Registry

Modern health care places significant emphasis on patient-centered care. As a result, many orthopaedic providers are incorporating routine patient-reported outcome measure (PROM) collection into their practice. However, routine PROM collection often disrupts clinical workflow and can place a burden on both the patient and the provider. Electronic PROM collection systems, if implemented deliberately to maximize convenience and efficiency, have the potential to mitigate these obstacles. This technique guide presents an overview of designing and implementing a PROM-based clinical registry for the ambulatory orthopaedic clinic using Research Electronic Data Capture (REDCap; Vanderbilt University, Nashville, TN). We outline the basic steps of creating a simple but effective patient registry using this accessible data collection platform.

Patient and Clinician Perspectives on Electronic Patient-Reported Outcome Measures in the Management of Advanced CKD: A Qualitative Study

Chronic kidney disease (CKD) can substantially affect patients' health-related quality of life. Electronic patient-reported outcome measures (ePROMs) may capture symptoms and health-related quality of life and assist in the management of CKD. This study explored patient and clinician views on the use of a renal ePROM system. Qualitative study. 12 patients with stage 4 or 5 CKD (non-dialysis dependent); 22 clinicians (6 CKD community nurses, 1 clinical psychologist, 10 nephrologists, 3 specialist registrars, and 2 renal surgeons) in the United Kingdom. Semi-structured interviews and focus group discussion during which patients received paper versions of the Kidney Disease Quality of Life-36 and the Integrated Patient Outcome Scale-Renal to exemplify the type of content that could be included in an ePROM. Thematic analysis of interview transcripts. 4 themes were identified: (1) general opinions of PROMs, (2) potential benefits and applications of an ePROM system, (3) practical considerations for the implementation of ePROMs, and (4) concerns, barriers, and facilitators. Patients were willing to complete ePROMs on a regular basis as part of their care despite clinician concerns about patient burden. Patients assessed the questionnaires favorably. Clinicians suggested that the extent of adoption of renal ePROM systems in routine clinical settings should be based on evidence of significant impact on patient outcomes. Clinicians were concerned that an ePROM system may raise patient expectations to unrealistic levels and expose clinicians to the risk for litigation. Patients and clinicians identified potential benefits and highlighted issues and concerns that need to be addressed to ensure the successful implementation of the renal ePROM system. Transferability of the findings may be limited because only English-speaking participants were recruited to the study. A renal ePROM system may play a supportive role in the routine clinical management of patients with advanced CKD if the concerns of clinicians and patients can be sufficiently addressed.

VALIDATION OF A COMPUTER-BASED SYSTEM FOR THE COLLECTION OF PATIENT REPORTED OUTCOME MEASURES IN PEDIATRIC SPORTS MEDICINE

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p&lt;0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]

Utilizing the Patient Reported Outcomes Measurement Information System (PROMIS®) to increase referral to ancillary support services for severely symptomatic patients with gynecologic cancer

ObjectiveThe Patient-Reported Outcomes Measurement Information System (PROMIS®) Network has developed a comprehensive repository of electronic patient reported outcomes measures (ePROs) of major symptom domains that have been validated in cancer patients. Their use for patients with gynecologic cancer has been understudied. Our objective was to establish feasibility and acceptability of PROMIS ePRO integration in a gynecologic oncology outpatient clinic and assess if it can help identify severely symptomatic patients and increase referral to supportive services. MethodsEnglish-speaking patients with a confirmed history of gynecologic cancer completed PROMIS ePROs on iPads in the waiting area of an outpatient gynecologic oncology clinic. Symptom scores were calculated for each respondent and grouped using documented severity thresholds. Response data was compared with clinicopathologic characteristics across symptom domains. Severely symptomatic patients were offered referral to ancillary services and asked to complete post-exposure surveys assessing acceptability of the ePRO. ResultsOf the 336 patients who completed ePROs, 35% had active disease and 19% had experienced at least one disease recurrence. Sixty-nine percent of the cohort demonstrated moderate to severe physical dysfunction (60%), pain (36%), fatigue (28%), anxiety (9%), depression (8%), and sexual dysfunction (32%). Thirty-nine (12%) severely symptomatic patients were referred to services such as psychiatry, palliative care, pain management, social work or integrative oncology care. Most survey respondents identified the ePROs as helpful (78%) and easy to complete (92%). ConclusionsOutpatient PROMIS ePRO administration is feasible and acceptable to gynecologic oncology patients and can help identify severely symptomatic patients for referral to ancillary support services.

Electronic Patient-Reported Outcome Validation: Disablement in the Physically Active Scale.

Determining patient outcomes is essential to quality health care. Administering electronic patient-reported outcomes measures (PROMs) offers potential advantages, including faster completion and efficient data access and storage. However, commonly used PROMs have not been studied across multiple administration modes, limiting clinicians to paper forms until the electronic versions are validated. To determine the validity of an electronic version of the Disablement in the Physically Active (DPA) scale compared with the paper version. Electronic and paper versions of the DPA scale were randomly administered to 117 participants (38 women, 79 men; age = 21.6 ± 5.9 years) 24 to 48 hours apart. Responses were compared using Pearson product moment correlations, canonical correlations, and covariance modeling. The electronic version of the DPA scale was strongly correlated with the paper version when compared using a bivariate correlation (r = 0.86, P < .001) or covariance modeling approach (r = 0.90, P < .001). The electronic version of the DPA scale was comparable with the paper version, making the former more efficient for use in athletic training. This study provides a template for other clinician-researchers to perform similar evaluations of electronic PROMs to determine their equivalency with the paper versions before implementing them in practice.

Electronic capturing of patient-reported outcome measures on a touchscreen computer in clinical diabetes practice (the DiaPROM trial): a feasibility study

BackgroundLiving with type 1 diabetes (T1D) is demanding, and emotional problems may impair ability for diabetes self-management. Thus, diabetes guidelines recommend regular assessment of such problems. Using patient-reported outcome measures (PROMs) to assess diabetes-related distress and psychological well-being is considered useful. It has been proposed that future work should examine the use of PROMs to support the care of individual patients and improve the quality of health services. To our knowledge, the use of PROMs has not been systematically evaluated in diabetes care services in Norway. Electronically captured PROMs can be directly incorporated into electronic patient records. Thus, the study’s overall aim was to examine the feasibility and acceptability of capturing PROMs electronically on a touchscreen computer in clinical diabetes practice.MethodsAdults with T1D age ≥ 40 years completed PROMs on a touchscreen computer at Haukeland University Hospital’s diabetes outpatient clinic. We included 46 items related to diabetes-related distress, self-perceived diabetes competence, awareness of hypoglycaemia, occurrence of hyperglycaemia, hypoglycaemia and fluctuating glucose levels, routines for glucose monitoring, general well-being and health-related quality of life. Participants subsequently completed a paper-based questionnaire regarding comprehension and relevance of the PROMs, acceptance of the number of items and willingness to complete electronic PROMs annually. We wrote field notes in the outpatient clinic based on observations and comments from the invited participants.ResultsDuring spring 2017, 69 participants (50.7% men), age 40 to 74 years, were recruited. Generally, the touchscreen computer functioned well technically. Median time spent completing the PROMs was 8 min 19 s. Twenty-nine (42.0%) participants completed the PROMs without missing items, with an 81.4% average instrument completion rate. Participants reported that the PROMs were comprehensible (n = 62) and relevant (n = 46) to a large or very large degree, with an acceptable number of items (n = 51). Moreover, 54 were willing to complete PROMs annually. Participants commented that the focus on living with diabetes was valued.ConclusionsCapturing PROMs on a touchscreen computer in an outpatient clinic was technically and practically feasible. The participants found the PROMs to be relevant and acceptable with a manageable number of items, and reported willingness to complete PROMs annually.

Hip Disability and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index Values in Asymptomatic and Arthritic Cohorts.

The primary aim of this study was to determine whether an electronic, multicenter data collection system could be used to establish normal population reference values for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The secondary aim was to investigate differences in asymptomatic HOOS and WOMAC values reported in 2 geographically distinct English-speaking countries and compare these with a symptomatic arthritic patient cohort. A total of 552 participants were recruited. Asymptomatic Australian and Canadian cohorts were compared; combined asymptomatic cohorts were compared with an arthritic cohort. There was a statistically significant association between age and asymptomatic HOOS (P<.0001) and WOMAC (P<.0001) values; as age increased, values worsened. Females had worse HOOS and WOMAC values (P<.0001). When compared with age- and sex-matched asymptomatic participants, arthritic participants had worse scores (P<.0001). Asymptomatic Australians had a statistically significant 3.8% better (higher) HOOS (P<.0001) in all age groups (P<.0001). When compared with age- and sex-matched asymptomatic participants, younger arthritic participants reported worse activities of daily living and sports and recreation HOOS values. This observational study established an electronic HOOS and WOMAC patient-reported outcome measures database of asymptomatic individuals in 2 geographically distinct countries. An asymptomatic control group should be sourced from the same country of origin as the proposed study. Factors that should be considered when recording the HOOS and WOMAC include age, sex, geographic location, history of an inactive hip problem, contralateral hip disease, and active knee, ankle, or foot problems. [Orthopedics. 2019; 42(2):e216-e224.].

Electronic patient reported outcomes to support care of patients with traumatic brain injury: PRiORiTy study qualitative protocol

IntroductionTraumatic brain injury (TBI) represents a major health and socioeconomic problem internationally. The expansive nature of injuries results in a heterogeneous population. The degree and type of long-term impacts following...

Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study.

BackgroundThe Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts.ObjectiveThe goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser.MethodsWe recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95.ResultsWe included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS.ConclusionsThe eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population.

Use of an electronic patient-reported outcome measure in the management of patients with advanced chronic kidney disease: the RePROM pilot trial protocol

IntroductionChronic kidney disease (CKD) affects up to 16% of adults in the UK. Patient quality of life is particularly reduced in end-stage renal disease and is strongly associated with increased...

Team Approach: Clinical Outcome Collection, Done Practically.

* Patient-reported outcome measures (PROMs) have gained traction as a critical part of orthopaedic clinical outcome reporting. However, routine collection of these forms can be very challenging because of administrative, logistic, and financial burdens to providers.* Successful integration of PROM collection practices requires coordinated efforts from the orthopaedic provider as well as key clinical support staff and practice leaders.* Electronic PROM reporting offers many advantages over traditional paper-and-pencil forms, such as real-time clinical monitoring and research applications.* A number of different electronic PROM platforms exist. Ideally, providers should choose a platform that can be utilized across the practice and meet the individual practice needs.* The provider must tailor the PROM collection process to his or her unique clinical flow scenario to maximize efficiency and patient compliance.

Development and usability testing of an electronic patient-reported outcome measure (ePROM) system for patients with advanced chronic kidney disease

BackgroundChronic kidney disease (CKD) is a long-term medical condition associated with symptoms which may negatively impact on patients' health-related quality of life (HRQOL). Patient-reported outcome (PRO) measures or questionnaires may be used to capture symptoms/HRQOL experienced by patients with advanced CKD. MethodTwo PRO questionnaires were electronically adapted and incorporated in an electronic system developed at University Hospitals Birmingham NHS Foundation Trust (UHB), Birmingham. Usability testing was conducted with patients with advanced CKD. Qualitative methodology was used to elicit participants' views. ResultsParticipants had a mean age of 64.3 years (range: 36–87 years). All owned electronic devices and had access to the internet. The mean time required to complete the two electronic questionnaires was 15.9 min (range = 8–34 min). Patients who had difficulties with the system were those who had the least experience of using the internet and electronic devices. The average usability and satisfaction score was 4.6 (5-point scale). ConclusionsOur study suggests that individuals with advanced CKD may find the Renal ePROM system acceptable and easy to use. The use of the Renal ePROM may complement clinician-reported outcomes and assist with the management of patients with advanced CKD.