A systematic review to examine the relationship between objective and patient‐reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice

Abstract

Background Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient‐reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations. Methods A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis. Results In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5). Conclusion Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.

The Role of Social Media in Improving Patient Recruitment for Research Studies on Persistent Post-Infectious Olfactory Dysfunction

“…Even though it is well-known that self-reported OD poorly correlates with olfactory tests [ 19 ] and PROMs could be unreliable when used to assess smell recovery in the long-term [ 9 ], they remain of value given their good discriminative ability [ 20 ]. Considering it would be almost impossible to assess olfaction using Sniffin’ Stick evaluation (average time 30–40 min per test), an accurate screening tool becomes crucial and, in this regard, PROMs play an important role.…”

Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

“…Prior studies have assessed correlations between PNIF and rhinitis symptom scores to this point, with some reporting correlations with nasal obstruction on VAS 12,55,56 and others reporting weak correlations with PROMs or TNSS. 57,58 Ultimately, the use of objective parameters can complement clinical evaluation elicited from patients’ perspectives on their disease impact, but more accurate physiologic measures are needed.…”

Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies

“…The lack of relationships between other clinical outcomes and PROMs might be explained by several factors. First, it has been suggested that objective outcome measurements often focus on one physiological aspect, whereas PROMs are multifactorial [ 25 ]. Second, school-aged children with congenital anomalies tend to overestimate their performance, a phenomenon known as superiority bias [ 26 ].…”