Patient-reported outcome measures for patients with chronic comorbidities: a systematic review of psychometric properties

To identify and evaluate the psychometric properties of available patient-reported outcome measures (PROMs) for patients with chronic comorbidities.

A comprehensive literature search was conducted across ten databases: China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals, China Biomedical Literature Database, Cochrane Library, PubMed, Web of Science, Embase, CINAHL, and PsycINFO. The search period extended from each database’s inception up to November 9, 2024, encompassing studies published in English and Chinese. Studies were eligible for inclusion if they (a) utilized any relevant research design and (b) reported at least one psychometric property of instruments applied to populations with chronic comorbidities. Two independent reviewers performed data extraction and applied the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines to evaluate three key aspects: (1) methodological quality, (2) psychometric properties, and (3) level of evidence (assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] framework). A third reviewer resolved discrepancies arising during screening and data extraction.

Among the 40 included studies, 24 measured ≥ 5 psychometric properties. While structural validity and internal consistency were rated as having acceptable quality (19 studies for structural validity and 16 for internal consistency rated “very good”), critical deficiencies were observed in content validity (only 1 study rated “adequate”), cross-cultural validity (only 3 studies), and responsiveness (only 4 studies). Three instruments (MEQ-EPMCD, NL-MTBQ, and the German version of MTBQ) demonstrated sufficiently strong evidence to warrant strong recommendations.

This systematic review emphasizes the need for more in-depth validation of current PROMs in chronic comorbidities. Future research should adhere to COSMIN guidelines, prioritize cross-cultural adaptation, and integrate patient-centered design elements, such as user engagement and cognitive interviewing, to enable accurate comorbidity assessment within integrated disease management frameworks.