Clinical Utility of CAT Administered PROMIS Measures to Track Change for Pediatric Chronic Pain

Bhandari, Rashmi; Harrison, Lauren E.; Richardson, Patricia A.; Arce, Ana B. Goya; You, Dokyoung S.; Rajagopalan, Adithi; Birnie, Kathryn A.

doi:10.1016/j.jpain.2021.06.009

Cited by 9 publications

(19 citation statements)

References 38 publications

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“…Assessing whether change is clinically significant for individual patients may therefore be a better measure of program efficacy than average scores. One established method of assessing clinically significant change (CSC) used in eating disorder (Calugi et al, 2013; Schlegl et al, 2014) and other psychiatric patient populations (Bhandari et al, 2022; Cerea et al, 2020; Roca et al, 2021; Schneider et al, 2022) determines whether (a) change in individual scores is statistically reliable, and (b) an individual patient's score shifts from dysfunctional to normative during treatment (Jacobson & Truax, 1991). Two studies of treatment response in adult inpatients with AN reported about one‐third of patients achieve CSC on measures of eating disorder pathology.…”

mentioning

confidence: 99%

Evaluating individual‐ and sample‐level response to treatment for inpatients with eating disorders: Is change clinically significant?

Schreyer

Pletch

Vanzhula

et al. 2022

Intl J Eating Disorders

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Objective Evaluating treatment efficacy solely on whether sample‐level change is statistically significant does not indicate whether clinically significant change (CSC) has occurred at the individual‐level. We assessed whether change in measures of eating disorder psychopathology was statistically significant at the sample‐level and clinically significant at the individual‐level for inpatients treated in a hospital‐based eating disorder program. Method Participants (N = 143) were consecutive underweight distinct admissions diagnosed with anorexia nervosa or other specified feeding and eating disorder. The Eating Disorder Examination Questionnaire (EDEQ) and Eating Disorder Recovery Self‐efficacy Questionnaire (EDRSQ) were assessed at admission and program discharge. CSC was defined as individual score change that was both statistically reliable and shifted from dysfunctional to normative. Results Mean EDRSQ and EDEQ scores significantly improved with treatment across the sample; effect sizes were moderate to large. Individual‐level analyses demonstrated that 85%, 50%, and 20–35% of participants had CSC or statistically reliable change in BMI, eating symptomatology, and body image respectively. One‐third of participants showed CSC on BMI and on at least one self‐report measure. Discussion Individual‐level analyses offer more nuanced outcome data that could identify patients at higher risk of relapse who may benefit from adjunctive interventions during or immediately post‐discharge. Public Significance Statement This study examined change in eating pathology for inpatients with eating disorders using sample‐ and individual‐level analyses, including whether change was statistically reliable and clinically significant (scores statistically improved and moved into the healthy range). Only half of patients responded robustly to treatment, which may be related to high relapse rates following discharge. Individual‐level analyses provided a detailed view of treatment response and may identify patients at higher relapse risk.

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mentioning

confidence: 99%

Evaluating individual‐ and sample‐level response to treatment for inpatients with eating disorders: Is change clinically significant?

Schreyer

Pletch

Vanzhula

et al. 2022

Intl J Eating Disorders

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“…It should be noted that T-scores are IRT-based scores. Because studies [25][26][27] have reported reliable change in PROMIS using RCI with CTT-based standard errors despite using IRT-based scores, we used the same approach when we applied the CTT method.…”

Section: Discussionmentioning

confidence: 99%

Identifying meaningful change on PROMIS short forms in cancer patients: a comparison of item response theory and classic test theory frameworks

et al. 2022

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Background This study compares classical test theory and item response theory frameworks to determine reliable change. Reliable change followed by anchoring to the change in categorically distinct responses on a criterion measure is a useful method to detect meaningful change on a target measure. Methods Adult cancer patients were recruited from five cancer centers. Baseline and follow-up assessments at 6 weeks were administered. We investigated short forms derived from PROMIS® item banks on anxiety, depression, fatigue, pain intensity, pain interference, and sleep disturbance. We detected reliable change using reliable change index (RCI). We derived the T-scores corresponding to the RCI calculated under IRT and CTT frameworks using PROMIS® short forms. For changes that were reliable, meaningful change was identified using patient-reported change in PRO-CTCAE by at least one level. For both CTT and IRT approaches, we applied one-sided tests to detect reliable improvement or worsening using RCI. We compared the percentages of patients with reliable change and reliable/meaningful change. Results The amount of change in T score corresponding to RCICTT of 1.65 ranged from 5.1 to 9.2 depending on domains. The amount of change corresponding to RCIIRT of 1.65 varied across the score range, and the minimum change ranged from 3.0 to 8.2 depending on domains. Across domains, the RCICTT and RCIIRT classified 80% to 98% of the patients consistently. When there was disagreement, the RCIIRT tended to identify more patients as having reliably changed compared to RCICTT if scores at both timepoints were in the range of 43 to 78 in anxiety, 45 to 70 in depression, 38 to 80 in fatigue, 35 to 78 in sleep disturbance, and 48 to 74 in pain interference, due to smaller standard errors in these ranges using the IRT method. The CTT method found more changes compared to IRT for the pain intensity domain that was shorter in length. Using RCICTT, 22% to 66% had reliable change in either direction depending on domains, and among these patients, 62% to 83% had meaningful change. Using RCIIRT, 37% to 68% had reliable change in either direction, and among these patients, 62% to 81% had meaningful change. Conclusion Applying the two-step criteria demonstrated in this study, we determined how much change is needed to declare reliable change at different levels of baseline scores. We offer reference values for percentage of patients who meaningfully change for investigators using the PROMIS instruments in oncology.

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“…Study procedures were approved by the university’s institutional review board as a retrospective patient chart review, and informed consent was not required as the information collected was within standard clinical care. Other publications have utilized Peds-CHOIR data to explore research questions 19–30 . Data were extracted retrospectively from Peds-CHOIR and patient medical charts.…”

Section: Methodsmentioning

confidence: 99%

Bridging Access to Pediatric Pain Care

Sepsey,

Sokol,

Huestis

et al. 2023

The Clinical Journal of Pain

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Objectives: To evaluate subsequent shifts to patient access to tertiary pain management care following shelter-in-place (SIP) and increased telehealth during the COVID-19 pandemic. Materials and Methods: Retrospective naturalistic design was used. Data for this study were extracted from a retrospective review of the Pediatric-Collaborative Health Outcomes Information Registry, with additional demographic information collected using chart review. Participants were 906 youth who received an initial evaluation either in-person (n=472) within the 18 months before SIP or through telehealth (n=434) within the 18 months after SIP during the COVID-19 pandemic. Patient variables to assess access included geographic distance from the clinic, ethnic and racial diversity, and patient’s insurance type. Descriptive characteristics for each group were analyzed using χ2 test, percentage change, and t-test analyses. Results: Data indicated that transitioning to telehealth resulted in maintained access rates between groups as measured by race and ethnic diversity as well as distance traveled from the clinic. A trend toward increase in government-funded insurance was found, though no statistically significant differences were identified between telehealth and in-person visits. Though the majority of participants (in-person: 52.75%; telehealth 55.81%) lived within 50 miles of the clinic, results indicated that telehealth allowed for a statistically significant increase in evaluation access for families living further from the clinic within a 50-mile radius. Discussion: Overall, accessibility to pediatric pain management through telehealth during SIP was maintained despite significant declines in overall access to health care, with some trends in increased accessibility for patients with government insurance.

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Clinical Utility of CAT Administered PROMIS Measures to Track Change for Pediatric Chronic Pain

Cited by 9 publications

References 38 publications

Evaluating individual‐ and sample‐level response to treatment for inpatients with eating disorders: Is change clinically significant?

Evaluating individual‐ and sample‐level response to treatment for inpatients with eating disorders: Is change clinically significant?

Identifying meaningful change on PROMIS short forms in cancer patients: a comparison of item response theory and classic test theory frameworks

Bridging Access to Pediatric Pain Care

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