Abstract
The study of patient-reported outcomes, now common in clinical research, had its origins in social and scientific developments during the latter twentieth century. Patient-reported outcomes comprise functional and health status, health-related quality of life, and quality of life. The terms overlap and are used inconsistently, and these reports of experience should be distinguished from expressions of preference regarding health states. Regulatory standards from the USA and European Union provide some guidance regarding reporting of patient-reported outcomes. The determination that measurement of patient-reported outcomes is important depends in part on the balance between subjective and objective outcomes of the health problem under study. Instrument selection depends to a large extent on practical considerations. A number of instruments can be identified that are frequently used in particular clinical situations. The domain coverage of commonly used generic short forms varies substantially. Individualized measurement of quality of life is possible, but resource intensive. Focus groups are useful, not only for scale development but also to confirm the appropriateness of existing instruments.
Under classical test theory, validity and reliability are the critical characteristics of tests. Under item response theory, validity remains central, but the focus moves from the reliability of scales to the relative levels of traits in individuals and items’ relative difficulty. Plans for clinical studies should include an explicit model of the relationship of patient-reported outcomes to other parameters, as well as definition of the magnitude of difference in patient-reported outcomes that will be considered important. It is particularly important to minimize missing patient-reported outcome data; to a limited extent, a variety of statistical techniques can mitigate the consequences of missing data.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
McDowell I (2006) Measuring health: a guide to rating scales and questionnaires, 3rd edn. Oxford University Press, New York, NY
Elkinton JR (1966) Medicine and the quality of life. Ann Intern Med 64:711–714
Noll HH. Social indicators and social reporting: the international experience (Part 1). Canadian Council on Social Development. http://www.gesis.org/fileadmin/upload/institut/wiss_arbeitsbereiche/soz_indikatoren/Publikationen/isscnoll.pdf. Accessed 13 Jan, 2015
United Nations (1964) Constitution of the World Health Organization, p 2
Streiner DL, Norman GR (2003) Health measurement scales: a practical guide to their development and use. Oxford Medical Publications, 3rd edn. Oxford University Press, New York, NY
The Center for Health Promotion, University of Toronto. QOL concepts: the QOL Model. University of Toronto, Canada. Sites.utoronto.ca/qol/qol_model.htm. Accessed 13 Jan, 2015
U.S. Food and Drug Administration (2009) Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims. U.S. Department of Health and Human Services, Washington, DC
European Medicines Agency (2005) Reflection paper on the regulatory guidance for the use of health-related quality of life (HRQL) measures in the evaluation of medicinal products. Committee for Medicinal Products for Human Use (CHMP), London
Chassany O et al (2002) Patient-reported outcomes: the example of health-related quality of life. A European guidance document for the improved integration of health-related quality of life assessment in the drug regulation process. Drug Inform J 36:209–238
McHorney CA (1999) Health status assessment methods for adults: past accomplishments and future challenges. Annu Rev Public Health 20:309–335
Hays RD (2005) Generic versus disease-targeted instruments. In: Fayers PM, Hays RD (eds) Assessing quality of life in clinical trials: methods and practice. Oxford University Press, New York, NY, pp 3–8
McHorney CA et al (2002) The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 17(2):97–114
PROMIS®: Patient Reported Outcomes Measurement Information System, available at www.nihpromis.org
O’Boyle CA, Hoefer S, Ring L (2005) Individualized quality of life. In: Fayers PM, Hayes RD (eds) Assessing quality of life in clinical trials: methods and practice. Oxford University Press, New York, NY, pp 225–242
Cote-Arsenault D, Morrison-Beedy D (1999) Practical advice for planning and conducting focus groups. Nurs Res 48(5):280–283
International Association of Facilitators (2002) Basic facilitation skills. Freely available 40-page manual on facilitation in general. http://www.iaf-world.org/Libraries/Facilitation_Articles/ASQ-IAF_Facilitation_Primer.sflb.ashx. Accessed 13 Jan 2015
Greenbaum TL (2000) Moderating focus groups: a practical guide for group facilitation. Sage Publications, Thousand Oaks, CA
Greenbaum TL (2000) On-line summary Sage Publications by Thomas Greenbaum
Wainer H, Dorans NJ, Flaugher R et al (2000) Computerized adaptive testing: a primer, 2nd edn. Lawrence Erlbaum Associates, Hillside, NJ
Nunnally JC (1978) Psychometric theory, 2nd edn. McGraw-Hill, New York, NY
Weatherly BD et al (2006) The reliability of the ankle-brachial index in the Atherosclerosis Risk in Communities (ARIC) study and the NHLBI Family Heart Study (FHS). BMC Cardiovasc Disord 6:7
Hays RD, Morales LS, Reise SP (2000) Item response theory and health outcomes measurement in the 21st century. Med Care 38(9, Suppl):II28–II42
Reise SP, Waller NG (2009) Item response theory and clinical measurement. Annu Rev Clin Psychol 5:27–48
Carle AC et al (2011) Advancing PROMIS’s methodology: results of the Third Patient-Reported Outcomes Measurement Information System (PROMIS(®)) Psychometric Summit. Expert Rev Pharmacoecon Outcomes Res 11(6):677–684
McHorney CA (2003) Ten recommendations for advancing patient-centered outcomes measurement for older persons. Ann Intern Med 139(5, Pt 2):403–409
Guyatt GH et al (2002) Methods to explain the clinical significance of health status measures. Mayo Clin Proc 77(4):371–383
Sprangers MA et al (2002) Assessing meaningful change in quality of life over time: a users’ guide for clinicians. Mayo Clin Proc 77(6):561–571
Osoba D, King M (2005) Meaningful differences. In: Fayers PM, Hays RD (eds) Assessing quality of life in clinical trials: methods and practice. Oxford University Press, New York, NY, pp 243–257
Fairclough DL (2002) Design and analysis of quality of life studies in clinical trials: interdisciplinary statistics. Chapman & Hall/CRC, Boca Raton, FL
Fairclough DL (2004) Patient reported outcomes as endpoints in medical research. Stat Methods Med Res 13(2):115–138
Other Sources
Streiner DL, Norman GR (2003) Health measurement scales: a practical guide to their development and use, 3rd edn. Oxford University Press, New York, NY, A terse, organized, and elegant introduction to the field with a single authorial voice
Fayers PM, Hayes RD (2005) Assessing quality of life in clinical trials: methods and practice, 2nd edn. Oxford University Press, New York, NY, A collection of essays by well-known investigators
McDowell I (2006) Measuring health: a guide to rating scales and questionnaires, 3rd edn. Oxford University Press, New York, NY, A compendium of over 100 instruments, each accompanied by a critical essay, actual items of the instrument, and a bibliography. It begins with a 35-page essay, “Theoretical and Technical Foundations of Health Measurement.” Its areas include physical disability and handicap, social health, psychological well-being, anxiety, depression, mental status testing, pain, general health status and quality of life
Embretson SE, Reise SP (2000) Item response theory for psychologists. L. Erlbaum Associates, Mahwah, NJ
PROQOLID: Patient-Reported Outcomes and Quality of Life Instruments Database, available at www.qolid.org. Online database maintained by MAPI Research Trust, currently cataloging 562 instruments. Basic information is freely available, details for free.
International Quality of Life Assessment Project Links Page, available at www.iqola.org/links.aspx. Links to other patient outcome websites.
Health and Quality of Life Outcomes, available at www.hqlo.com. Freely available online journal.
Centers for Disease Control and Prevention, available at www.cdc.gov/hrqol. Freely available background, concepts and resources.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this protocol
Cite this protocol
Richardson, M.M., Grobert, M.E., Meyer, K.B. (2015). Randomized Controlled Trials 3: Measurement and Analysis of Patient-Reported Outcomes. In: Parfrey, P., Barrett, B. (eds) Clinical Epidemiology. Methods in Molecular Biology, vol 1281. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-2428-8_11
Download citation
DOI: https://doi.org/10.1007/978-1-4939-2428-8_11
Published:
Publisher Name: Humana Press, New York, NY
Print ISBN: 978-1-4939-2427-1
Online ISBN: 978-1-4939-2428-8
eBook Packages: Springer Protocols