Comparison of patient- and clinician-reported outcome measures in lower back rehabilitation: introducing a new integrated performance measure (t2D)

Abstract

Purpose Patient- and clinician-reported outcome measures (PROMs, CROMs) are used in rehabilitation to evaluate and track the patient’s health status and recovery. However, controversy still exists regarding their relevance and validity when assessing a change in health status. Methods We retrospectively analyzed the changes in a CROM (Fingertip-To-Floor Test – FTF) and PROMs (ODI, HAQ-DI, NPRS, EQ5D) and the associations between these outcomes in 395 patients with lower back pain (57.2 ± 11.8 years, 49.1% female). We introduced a new way to measure and classify outcome performance using a distribution-based approach (t2D). Outcome measures were assessed at baseline and after 21 days of inpatient rehabilitation. Results Overall, the rehabilitation (Cohens d = 0.94) resulted in a large effect size outcome. Medium effect sizes were observed for FTF (d = 0.70) and PROMs (d > 0.50). Best performance rating was observed for pain (NPRS). We found that 13.9% of patients exhibited a deterioration in the PROMs, but only 2.3%, in the FTF. The correlation between the PROMs and FTF were low to moderate, with the highest identified for HAQ-DI (rho = 0.30–0.36); no significant correlations could be shown for changes. High consistency levels were observed among the performance scores (t2D) in 68.9% of the patients. Conclusions Different and complementary assessment modalities of PROMs and CROMs can be used as valuable tools in the clinical setting. Results from both types of measurements and individual performance assessments in patients provide a valid basis for the meaningful interpretation of the patients’ health outcomes. Trial registration. This clinical study was entered retrospectively on August 14, 2020 into the German Clinical Trials Register (DRKS, registration number: DRKS00022854).

Associations between Patient-Reported and Clinician-Reported Outcome Measures in Patients after Traumatic Injuries of the Lower Limb

“…Both PROMs and CROMs were sensitive to changes in the subjective and objective measurements. The effect sizes of objective performance measures were clearly higher for CROMs [ 20 ].…”

“…We found strong correlations between TUG and HAQ-DI in all groups and between aROM and HAQ-DI in the hip and knee groups [ 20 ]. The results of the dataset analysis indicate that the TUG showed stronger associations with PROMs than with aROM, including more functional performance components and reflecting functional strength, balance and mobility.…”

“…To reduce a potential ceiling effect for patients who exhibited good performance at the beginning of the rehabilitation and a reduced potential for further improvement, a method mentioned earlier [ 20 ] was used to assess their performance considering their initial functional capability. Applying the formula t2 + Δ reproduces the performance as well as the functional capability and minimises the potential ceiling effect.…”

“…This study is part of a retrospective data analysis project on “clinician and patient-reported outcome measures” before and three weeks after a rehabilitation programme. Part of the dataset was published elsewhere [ 20 ]. In the present paper, data from traumatic limb injury patients were analysed.…”

Clinical Outcome Assessment in Cancer Rehabilitation and the Central Role of Patient-Reported Outcomes

“…They allow assessment within individuals and provide a normative basis for comparing different treatment pathways and environments. Standardization and provision of stratified normative values can make an important contribution to more personalized medicine and to identify critical success factors and non-responders early in the rehabilitation process [ 86 , 87 ]. This highlights how PROs can be used as prognostic factors for rehabilitation success and shows their significance for value-based care.…”