Psychometric properties, and cultural appropriateness, of patient reported outcome measures for use in primary healthcare: a scoping review.

Abstract

Purpose: To critically appraise the psychometric properties and cultural appropriateness of self-reported generic patient-reported outcome measures (PROMs) applicable for use in the primary healthcare setting using the Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

Methods: PROMs were identified via a published systematic review and searches of relevant websites. PROMs were included if they were generic (i.e., outcome measures that assessed general aspects of health); had a maximum of 30 items; were applicable for use by all adult primary care patients; and were validated in English. Data was extracted regarding the characteristics of each PROM and the characteristics of included validation studies. The COSMIN risk of bias checklist was used to assess methodological quality and the revised COSMIN criteria was used to assess measurement properties. An evidence synthesis was conducted across studies using the guidelines from the modified Grading of Recommendations Assessment, Development and Evaluation approach for systematic reviews of clinical trials.

Results: 399 PROMs were identified and 19 met inclusion criteria. The included PROMs measured general health related quality of life (n = 8), outcomes or impact of care (n = 3), patient enablement, activation, and empowerment (n = 3), quality of care (n = 3), health and disability (n = 1), and functional status (n = 1). Six PROMs met the recommended COSMIN threshold for implementation.

Conclusion: Although six PROMs can be recommended for use in primary care, further psychometric testing is still required to strengthen evidence related to internal consistency, responsiveness and cross-cultural validity/measurement invariance. Selection of a PROM for routine clinical use in primary care also needs to be guided by the patient population.