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Outcome scores: what they measure, and what they don't

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What PROMs (patient-reported outcome measures) like the DASH, QuickDASH, SPADI, ASES and PRWE actually are, and how to read your own score. They exist to track how YOUR symptoms and function change over time, and to compare groups of patients in research. They are not a test that decides what treatment you should have — a score does not diagnose anything, and two people with the same number can need completely different things. Covers what the numbers mean, why a change matters more than a single reading, what a 'minimal clinically important difference' is, and the limits of a questionnaire.

Updated Sep 202617 citations

What it is

A patient-reported outcome measure is a questionnaire you fill in about your own health. Instead of a test done to you, it asks you how you feel and what you can do. These questionnaires have been around since at least the 1960s, though the name for them is newer [1].

Your doctor cannot see pain or tiredness on an X-ray or through a physical test. Research points out that things like range of motion and strength are not as reliable as you might think, which is why more clinics now ask patients directly [2]. That is the gap these questionnaires fill: they capture your view of your own function and wellbeing, which no scan or clinical test can observe [3].

Some of these questionnaires are long lists of questions about daily life. Newer ones, such as the PROMIS measures developed through a US research network, are shorter and more precise [4]. You might fill one in on paper with a pen, or answer a few questions by text message on your phone. Studies have found both ways give comparable scores [5].

Your answers are scored and compared over time, so changes can be tracked before and after treatment. Researchers also use them to compare results across large groups of patients, though the data collected is not uniform or complete across the world's joint registries, which can make comparisons harder [6].

One thing worth knowing: these scores measure averages across groups of patients. They do not predict how any one person will feel. Your doctor will use your score as one piece of information alongside your examination and your own goals, not as a verdict on your recovery.

Why it matters

These questionnaires do two different jobs, and it helps to know which is which.

The first job is following you over time. You fill in the same questionnaire before treatment and again afterwards, so your care team can see how much has changed for you. That makes your own score most useful as a marker of your own progress, not as a number to be ranked against other people. Two people can start from different places and end up with different scores while both have done well.

The second job happens at a much bigger scale. When many patients complete the same questionnaires, whole groups can be compared, so treatments and services can be judged across a whole population. This is how the results feed into research and into decisions about care more broadly. Collecting this information routinely is described as the future of healthcare that puts value on what matters to patients [1], and adding it to regular orthopaedic visits is workable and gives doctors and patients solid information to make decisions together [2].

There is a catch worth knowing about. The movement behind these questionnaires has been driven mostly by researchers and the people who pay for care, and it has not always focused on improving care from the patient's point of view [3]. Some limits in how the scores are used may explain why filling them in does not always lead to better results for patients [4].

So what does this mean for you? Your score is one piece of information your doctor uses alongside your examination and your own goals. It is not a grade, and it is not a prediction. What it offers is a way to put words on changes you can feel but nobody else can see, and a way for your progress to be part of a bigger picture that helps judge care for everyone.

What the results mean

So you have a score. What does it actually tell you?

One thing to know first: which way is better depends on the questionnaire. The form itself, or the person who gave it to you, will tell you which way round it runs.

A small change in the number may not mean much. Researchers have worked on this problem, and they use a few ideas to help read the scores. One is called the minimal clinically important difference, which is the smallest change a patient would actually notice in daily life. Another is called the patient acceptable symptom state, which is the point where a patient feels well enough that they would consider their symptoms acceptable [1].

Here is the catch: there is no single threshold that works for everyone. Values for these markers vary between hospitals and between patient groups [2]. Different methods of calculating them give quite different answers [3], and any one value should be read as a range rather than a firm line [4]. So if your score moves by a small amount, that alone does not tell you much. The same score measured again later, and the direction it is heading, says far more.

It is also worth knowing that a change can be statistically significant without being something you would feel. Research on these measures points out that a difference that shows up in the numbers may not match a difference that matters to you [5]. That is why your care team looks at your score alongside your examination and your own goals, rather than treating the number as the whole answer.

One more limit. No single questionnaire has emerged as the standard way to measure function. One review found 15 different tools in use for this purpose, which is why researchers keep calling for more standardisation [6]. All of these measures still need further study to confirm how well they perform [7].

So read your score as one signal among several. Ask what changed, by how much, and whether you can feel it.

What it can't tell you

A questionnaire score cannot diagnose anything. It records how you feel, not what is wrong with you. It also does not decide which treatment you should have. That decision belongs to you and your doctor together, using your examination, your goals and your own judgement alongside the number.

A single result is not a verdict on how you are doing either. These scores measure averages across groups of patients, and an average hides the range of individual experiences. Two people can have the same score and feel completely different about it. Your own story matters more than your place in that group.

There are practical traps worth knowing about. Some questions may miss what matters most to you, because no single questionnaire has settled on a standard set [1]. Some results bunch up at the very top or bottom of the scale, so a real change in how you feel may not show in the number. And the thresholds used to judge whether a change is meaningful vary between hospitals and between patient groups [2], so a small shift in your score does not carry the same meaning everywhere.

The honest summary is this: your score is one signal among several. It can put words on things nobody else can see, and it can track your progress over time. What it cannot do is tell you what is wrong, choose your treatment for you, or sum up your recovery in a single number.

The bottom line

These questionnaires are good at one thing: putting your own words on how you feel and what you can do, in a way that can be tracked over time. They are not a diagnosis, not a treatment choice, and not a prediction of your recovery. The one thing worth remembering is that your score is one signal among several. Your care team reads it alongside your examination and your own goals, so a number on its own never tells the whole story.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References
  1. Patient‐reported outcome measures (PROMs): A review of generic and condition‐specific measures and a discussion of trends and issues. *Health Expectations*. 2021. 10.1111/hex.13254
  2. Physical outcome measures: The role of strength and range of motion in orthopaedic research. *Injury*. 2020. 10.1016/j.injury.2019.11.017
  3. Patient Reported Outcome Measures (PROMs) have arrived in sports and exercise medicine: Why do they matter?. *British Journal of Sports Medicine*. 2015. 10.1136/bjsports-2014-093707
  4. Use of Patient-Reported Outcomes Measurement Information System Measures in Orthopaedic Specialties: Results of a Scoping Review for 2018 to 2022. *Journal of the American Academy of Orthopaedic Surgeons*. 2025. 10.5435/jaaos-d-24-00432
  5. Collection of patient-reported outcomes; - text messages on mobile phones provide valid scores and high response rates. *BMC Medical Research Methodology*. 2014. 10.1186/1471-2288-14-52
  6. CORR Insights®: Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations. *Clinical Orthopaedics & Related Research*. 2021. 10.1097/corr.0000000000001918
  7. Value-based Healthcare: Patient-reported Outcomes in Clinical Decision Making. *Clinical Orthopaedics & Related Research*. 2016. 10.1007/s11999-016-4813-4
  8. Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR. *Clinical Orthopaedics & Related Research*. 2013. 10.1007/s11999-013-3143-z
  9. Patient reported outcome measures in practice. *BMJ*. 2015. 10.1136/bmj.g7818
  10. Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies. *Quality of Life Research*. 2021. 10.1007/s11136-021-03003-z
  11. A Call for a Standardized Approach to Reporting Patient-Reported Outcome Measures. *Journal of Bone and Joint Surgery*. 2021. 10.2106/jbjs.21.00030
  12. Does Calculation of the Minimal Clinically Important Difference Make Sense? Ways to Improve. *Arthroscopy*. 2024. 10.1016/j.arthro.2023.11.007
  13. The Minimal Clinically Important Difference: Response. *The American Journal of Sports Medicine*. 2023. 10.1177/03635465231189222
  14. The Minimal Clinically Important Difference: Letter to the Editor. *The American Journal of Sports Medicine*. 2023. 10.1177/03635465231189223
  15. Guidelines for Proper Reporting of Clinical Significance, Including Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, Substantial Clinical Benefit, and Maximal Outcome Improvement. *Arthroscopy*. 2022. 10.1016/j.arthro.2022.08.020
  16. Patient‐reported outcome measures in advanced musculoskeletal physiotherapy practice: a systematic review. *Musculoskeletal Care*. 2017. 10.1002/msc.1200
  17. Assessing the Quality of Available Patient Reported Outcome Measures for Intermittent Claudication: A Systematic Review Using the COSMIN Checklist. *European Journal of Vascular and Endovascular Surgery*. 2015. 10.1016/j.ejvs.2014.12.002
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Patient-reported outcome measures (PROMs) are critical for capturing the patient's perspective on health status, which cannot be observed through clinical tests or imaging [48].
  • Standardized health-related outcome measures require evidence for change and a way to interpret change within individuals or difference between groups [3].
  • The minimum clinically important difference (MCID) defines the smallest amount an outcome must change to be meaningful to patients [46].
  • The minimum clinically important difference, the standard error of measurement, and the minimum detectable change are proposed as indicators for the clinical interpretation of test scores [1].
  • Lack of consensus in the literature has led to confusion about which measurement properties are relevant, which concepts they represent, and how to assess these measurement properties in terms of design requirements and preferred statistical methods [16].
  • Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue [2].
  • An appropriate and validated measure that is suitable for both the particular study population and the reason for collecting the PROMs data should be chosen [6].
  • Providing access to PROM scores without clearly understanding how and why surgeons may consider using them can result in expensive and underused systems that add little value [44].
  • Reasons for limited use of PROMs by orthopedic surgeons include a lack of knowledge on how to use them and the perception that it is too time-consuming to add to regular clinical routine [45].
  • Limitations of PROM use in clinical practice shed light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives [47].
  • PROMIS measures are efficient and precise tools, and their use is expected to continue to increase across medical and surgical specialties as health systems and payers expand their definition of healthcare quality to include patient-reported health outcomes [49].

How It Works

Interpretation and Clinical Utility

  • The minimum clinically important difference, standard error of measurement, and minimum detectable change are proposed as indicators for the clinical interpretation of test scores [1].
  • Scores from tools designed to measure outcomes that matter to patients have been developed over the past 30 years, but few are used routinely at the point of care [21].
  • An appropriate and validated measure suitable for the particular study population and the reason for collecting data should be chosen for patient-reported outcome measures [6].

Reliability and Validity Assessment

  • The two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended to assess test-retest reliability for patient-reported outcome measures [4].
  • Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how results inform about the quality of the outcome measurement instrument [2].
  • The Patient-Reported Outcomes Measurement Information System (PROMIS) item banks demonstrated good reliability across most of the score distributions [43].
  • The MOS short form health survey (SF-36) scales met required internal consistency criteria with Cronbach alpha coefficients equaling or exceeding 0.70 in a study conducted in India [33].
  • An assessment tool for brachial plexus regional anesthesia performance demonstrated construct validity by reliably discriminating between different levels of training, with senior trainees performing significantly better than junior trainees on the global rating scale [35].

Standardization and Data Collection

  • Current data collection of patient-reported outcome measures is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes [8].
  • No key measure was identified to capture functional status in advanced musculoskeletal physiotherapy practice, with 15 different tools utilized, highlighting the need for greater standardization of outcome measurement [40].
  • Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones provide comparable scores to questionnaires completed with pen and paper [7].

Limitations and Gaps

  • Physical outcome measures such as range of motion and strength are not as reliable measures as one would think, and are being changed for the use of patient reported outcomes [15].
  • All patient-reported outcome measures for intermittent claudication require further validation studies to fill the gaps in their measurement properties [32].

How It Is Used

  • Clinicians can use the minimum clinically important difference, standard error of measurement, and minimum detectable change to interpret test scores [1].
  • Standardized health-related outcome measures require evidence for change and a method to interpret change within individuals or differences between groups [3].
  • Clinicians must be cautious when accepting a minimal clinically important difference score at face value due to wide variability in established scores for a single outcome scale [5].
  • Outcomes assessed on numeric rating scales via text messages on mobile phones provide comparable scores to those completed with pen and paper questionnaires [7].
  • Investigators can choose thresholds to dichotomize responses on health-related quality of life measures based on absolute scores or change scores to facilitate interpretation [10].
  • Promoting ownership and correct use of the measure by clinicians can improve practice and the quality of care through patient-reported outcome measure data use in clinical decision-making [11].
  • The minimal important difference is not an immutable characteristic and may vary by population and context, meaning no single minimal important difference is valid for all study applications [14].
  • Routine use of patient-reported outcome measures has the potential to help transform healthcare [18].
  • High variability in scale choice and the use of measures not validated in pediatrics make comparative outcomes research difficult in the pediatric sports population [19].
  • High-quality systematic reviews on measurement instruments are advocated to recommend the best available outcome measurement instrument [20].
  • Few outcome measurement tools have been used routinely at the point of care despite being developed over the past 30 years [21].
  • Further studies are needed to provide validated outcome measures to ensure the accuracy of reported results and conclusions after rib fracture [22].
  • Comparative effectiveness research requires accurate assessments of patient numbers, follow-up completeness, clinical outcomes, and care settings [34].
  • Recommendations for the selection of patient-assessed measures of health outcome are needed [36].
  • Limiting follow-up to automated methods has the potential to transform the design and conduct of outcome-based research to provide substantially better research value in large prospective cohorts [38].
  • There are challenges in using patient-reported outcomes in clinical practice [39].
  • The routine use of patient-reported outcomes in clinical practice is assessed for its impact on the process of care, patients' and professionals' experiences of care, and health outcomes [42].

Interpreting the Results

Measurement Properties and Reliability

  • Consensus was reached on deducing a comprehensive research question from the design of a reliability study to determine how results inform the quality of an outcome measurement instrument [2].
  • The two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended for assessing test-retest reliability of patient-reported outcome measures [4].
  • Range of motion and strength are not as reliable measures as one would think [15].

Minimal Clinically Important Difference (MCID)

  • Clinicians must be cautious in accepting an MCID score at face value given the wide variability of established MCID scores available for a single outcome scale [5].
  • The recommended approach for estimating the minimal important difference is to use several anchor-based methods with relevant clinical or patient-based indicators, examine distribution-based estimates as supportive information, and triangulate on a single value or small range of values [9].
  • The Minimal Clinically Important Difference (MCID) is a point estimate that should always be reported with its associated 95% CI, as there is no basis for considering a sample-derived MCID a singular threshold to be crossed [12].
  • The minimal clinically important difference (MCID) is an imperfect solution to a complicated problem, and different methods used to calculate MCID lead to highly heterogeneous values [13].
  • The minimal important difference (MID) is not an immutable characteristic but may vary by population and context, and no one MID may be valid for all study applications [14].
  • The minimal clinically important difference (MCID) is a low bar that patients do not seek when undergoing surgery; instead, they aim for substantial clinical benefit or a patient acceptable symptom state (PASS) [17].
  • The calculation of the minimal clinically important difference (MCID) needs to be correlated with changes in scores on the rating scale and external anchors [24].
  • A systematic approach exists to triangulate on the Minimal Clinically Important Difference (MCID) using both distribution-based and anchor-based methods [29].

Reporting and Interpretation Frameworks

  • Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores [7].
  • Investigators can choose thresholds to dichotomize responses on HRQL based on absolute scores or change scores to facilitate interpretation [10].
  • A standardized reporting of patient-reported outcome measures (PROMs) has been proposed that incorporates the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS), introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes [23].
  • Routine use of patient reported outcome measures (PROMs) has the potential to help transform healthcare [18].

Limitations and Pitfalls

Measurement Properties and Reliability

  • Lack of consensus in the literature has led to confusion about which measurement properties are relevant, which concepts they represent, and how to assess these properties in terms of design requirements and preferred statistical methods [16].
  • To assess test-retest reliability for patient-reported outcome measures, the two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended [4].
  • Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results inform about the quality of the outcome measurement instrument [2].
  • A 10-item computerized adaptive test (CAT) eliminated floor and decreased ceiling effects, achieving a small standard error (≤ 2.2) across scores from 20 to 50 with reliability ≥ 0.95 for a representative US sample [31].

Minimal Clinically Important Difference (MCID)

  • The recommended approach is to estimate the minimal important difference based on several anchor-based methods with relevant clinical or patient-based indicators, examine various distribution-based estimates as supportive information, and triangulate on a single value or small range of values [9].
  • MCIDs expressed as effect sizes reduce bias, which mainly results from dependency on the baseline score [41].
  • Researchers, clinicians, and healthcare policy decision makers can consider using a specific instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences [30].

Data Collection and Standardization

  • The current data collection of patient-reported outcome measures (PROMs) is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes [8].
  • The high variability in scale choice and the use of measures not validated in pediatrics make comparative outcomes research difficult [19].
  • Only 57% of primary medical providers are using patient reported outcome measures within their practice, with the information largely used for research rather than clinical decision-making [27].
  • Further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions [22].

Clinical Application and Interpretation

  • The authors propose using the minimum clinically important difference, the standard error of measurement, and the minimum detectable change as indicators for the clinical interpretation of test scores [1].
  • Integrating standardized patient-reported outcomes into routine orthopaedic visits is feasible and improves practice efficiency by providing actionable objective data for shared decision-making [26].
  • The ability to collect patient-reported outcome (PRO) data in real time and share this information with patients to inform clinical decision making represents the future of value-based healthcare, moving beyond research-focused assessments to guide treatment consistent with patient preferences [25].
  • Promoting ownership and correct use of the measure by clinicians can potentially improve practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making [11].

Key Evidence

  • [L5] The authors propose using the minimum clinically important difference, the standard error of measurement, and the minimum detectable change as indicators for the clinical interpretation of test scores. [1] (10.1136/bjsports-2012-091704)
  • [Paper] Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue. [2] (10.1186/s12874-020-01179-5)
  • [L4] Standardized health-related outcome measures require evidence for change and a way to interpret change within individuals or difference between groups. [3] (10.1016/j.rdc.2018.01.011)
  • [L5] To assess test-retest reliability for patient-reported outcome measures, the two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended. [4] (10.1007/s11136-018-2076-0)
  • [L5] Clinicians must be cautious in accepting an MCID score at face value given the wide variability of established MCID scores available for a single outcome scale. [5] (10.1179/2042618612y.0000000001)
  • [Paper] An appropriate and validated measure that is suitable for both the particular study population and the reason for collecting the PROMs data should be chosen. [6] (10.1136/bmj.c186)
  • [L4] Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores. [7] (10.1186/1471-2288-14-52)
  • [L4] The current data collection of patient-reported outcome measures (PROMs) is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes. [8] (10.1097/corr.0000000000001918)
  • [L5] The recommended approach is to estimate the minimal important difference based on several anchor-based methods, with relevant clinical or patient-based indicators, and to examine various distribution-based estimates (i.e., effect size, standardized response mean, standard error of measurement) as supportive information, and then to triangulate on a single value or small range of values for the MID. [9] (10.1186/1477-7525-4-70)
  • [L5] Investigators can choose thresholds to dichotomize responses on HRQL based on absolute scores or change scores to facilitate interpretation. [10] (10.1186/1477-7525-4-62)
  • [L2] This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making. [11] (10.1177/0269216313491619)
  • [L5] The Minimal Clinically Important Difference (MCID) is a point estimate that should always be reported with its associated 95% CI, as there is no basis for considering a sample-derived MCID a singular threshold to be crossed. [12] (10.1177/03635465231189223)
  • [L5] The minimal clinically important difference (MCID) is an imperfect solution to a complicated problem, and different methods used to calculate MCID lead to highly heterogeneous values. [13] (10.1177/03635465231189222)
  • [L5] The minimal important difference (MID) is not an immutable characteristic but may vary by population and context, and no one MID may be valid for all study applications. [14] (10.1016/j.jclinepi.2007.03.012)
  • [Paper] Physical outcome measures are being changed for the use of patient reported outcomes, and range of motion and strength are not as reliable measures as one would think. [15] (10.1016/j.injury.2019.11.017)
  • [L5] Lack of consensus in the literature has lead to confusion about which measurement properties are relevant, which concepts they represent, and how to assess these measurement properties in terms of design requirements and preferred statistical methods. [16] (10.1016/j.jclinepi.2010.02.006)
  • [L5] The minimal clinically important difference (MCID) is a low bar that patients do not seek when undergoing surgery; instead, they aim for substantial clinical benefit or a patient acceptable symptom state (PASS). [17] (10.1016/j.arthro.2023.10.014)
  • [L5] Routine use of patient reported outcome measures (PROMs) has the potential to help transform healthcare. [18] (10.1136/bmj.f167)
  • [L4] The high variability in scale choice and the use of measures not validated in pediatrics make comparative outcomes research difficult. [19] (10.1177/2325967119s00036)
  • [L5] They advocate for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended. [20] (10.1590/bjpt-rbf.2014.0143)
  • [L5] Scores of tools to measure outcomes that matter to patients have been developed over the past 30 years but few are used routinely at the point of care. [21] (10.1136/bmj.g7818)
  • [L2] Further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions. [22] (10.1016/j.injury.2019.07.002)
  • [L5] The authors propose a standardized reporting of patient-reported outcome measures (PROMs) that incorporates the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS), introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes. [23] (10.2106/jbjs.21.00030)
  • [L5] The calculation of the minimal clinically important difference (MCID) needs to be correlated with changes in scores on the rating scale and external anchors. [24] (10.1177/03635465231193405)
  • [L5] The ability to collect patient-reported outcome (PRO) data in real time and share this information with patients to inform clinical decision making represents the future of value-based healthcare, moving beyond research-focused assessments to guide treatment consistent with patient preferences. [25] (10.1007/s11999-016-4813-4)
  • [L4] The authors conclude that integrating standardized patient-reported outcomes into routine orthopaedic visits is feasible and improves practice efficiency by providing actionable objective data for shared decision-making. [26] (10.1007/s11999-013-3143-z)
  • [L4] Only 57% of primary medical providers are using patient reported outcome measures within their practice, with the information largely used for research rather than clinical decision-making. [27] (10.1177/2325967119s00107)
  • [L5] The authors describe a systematic approach to triangulate on the Minimal Clinically Important Difference (MCID) using both distribution-based and anchor-based methods. [29] (10.1016/j.apmr.2019.12.008)
  • [L4] Researchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences. [30] (10.1136/bmj.m1714)
  • [L5] A 10-item CAT eliminated floor and decreased ceiling effects, achieving a small standard error (≤ 2.2) across scores from 20 to 50 with reliability ≥ 0.95 for a representative US sample. [31] (10.1016/j.jclinepi.2006.06.025)
  • [L1] However, all PROMs require further validation studies to fill the gaps in their measurement properties. [32] (10.1016/j.ejvs.2014.12.002)
  • [L4] The questionnaire was well understood by the respondents, and all scales met the required internal consistency criteria with Cronbach alpha coefficients equaling or exceeding 0.70. [33] (10.4103/0970-0218.106623)
  • [L5] Comparative effectiveness research requires accurate assessments of patient numbers, follow-up completeness, clinical outcomes, and care settings. [34] (10.1007/s11999-013-3194-1)
  • [L4] The assessment tool demonstrated construct validity by reliably discriminating between different levels of training, as senior trainees performed significantly better than junior trainees on the global rating scale. [35] (10.1016/j.rapm.2006.10.009)
  • [L4] Recommendations for the selection of patient assessed measures of health outcome are needed. [36] (10.1136/bmj.324.7351.1417)
  • [L2] Limiting follow-up to automated methods may have the potential to transform the way that outcome-based research is designed and conducted to provide substantially better research value in large prospective cohorts. [38] (10.2106/jbjs.19.00531)
  • [L5] However, there are a number of challenges in using patient-reported outcomes in clinical practice. [39] (10.1007/s11136-008-9379-5)
  • [L2] No key measure was identified to capture functional status, with 15 different tools utilized, highlighting the need for greater standardization of outcome measurement in musculoskeletal clinical practice, service evaluation and research. [40] (10.1002/msc.1200)
  • [Paper] MCIDs expressed as effect sizes reduce bias, which mainly results from dependency on the baseline score. [41] (10.1016/j.jclinepi.2016.11.016)
  • [Paper] The objectives are to assess the impact of the routine use of patient-reported outcomes in clinical practice on the process of care, patients' and professionals' experiences of care, and health outcomes. [42] (10.1002/14651858.cd011589)
  • [L5] All item banks demonstrated good reliability across most of the score distributions. [43] (10.1016/j.jclinepi.2010.04.011)
  • [L4] Providing access to PROM scores without clearly understanding how and why surgeons may consider using them can result in expensive and underused systems that add little value. [44] (10.1097/corr.0000000000002059)
  • [L4] The reasons provided included a lack of knowledge on how to use PROMs and the perception that it is too time-consuming to add to regular clinical routine. [45] (10.1186/s13018-020-02135-1)
  • [Paper] The MCID defines the smallest amount an outcome must change to be meaningful to patients. [46] (10.1001/jama.2014.13128)
  • [L4] These limitations shed some light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives. [47] (10.1007/s11136-021-03003-z)
  • [L5] This editorial argues that Patient Reported Outcome Measures (PROMs) are critical for capturing the patient's perspective on health status, which cannot be observed through clinical tests or imaging. [48] (10.1136/bjsports-2014-093707)
  • [L4] PROMIS measures are efficient and precise tools, and their use is expected to continue to increase across medical and surgical specialties as health systems and payers expand their definition of healthcare quality to include patient-reported health outcomes. [49] (10.5435/jaaos-d-24-00432)

References

[1] Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? A practical guide for clinicians and researchers who are not biostatisticians. British Journal of Sports Medicine. 2012. DOI: 10.1136/bjsports-2012-091704

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