Common methods of determining meaningful change in clinical practice: implications for precision patient-reported outcomes

The challenge of using patient reported outcome measures in clinical practice: how do we get there?

“…Most respondents (32) were men, with average age 59 years (range 35-72), and 27 years of experience (range 3-46). Specialties included oncology (14), surgery (6), rheumatology (3), dermatology (2), internal medicine (2), gynecology (2), and neurology (2). These 43 colleagues reported 156 measures that they use, with three common justifications: they determined whether a change in the measure was clinically meaningful based on clinical experience (44%, 69/156), published research (38%, 59/156), and established guidelines (35%, 54/156).…”

“…As is the case with these clinical measures, PROMs should not be used rigidly, but rather incorporated into practice with other clinical and personal data. For clinicians who are already using PROMs, interpretation typically involves a simple comparison between earlier and recent scores, but many clinicians also report considering a patient's other conditions in their judgments, as well as population norms for the PROM [14]. We encourage colleagues to study clinical use of PROs more formally in the future.…”

Introduction to the special section: “Methodologies and considerations for meaningful change”

“…We recommend future papers be clearer in terms of the intended magnitude, but note that the two options for the magnitude dimension in Table 1 are not exhaustive where options such as patient-perceived treatment success can be of interest. Setting the scene for the first part of the special section is a report of an online survey regarding how clinicians from different disciplines determine individual-level meaningful change on patient-reported outcome measures (PROMs) [21]. The authors investigated how oncology or mental health clinical care providers who used PROMs in the USA determine whether a patient's symptoms have changed.…”

“…The team combined the use of a longitudinal graded response model with a transition item to measure latent change. The method produced tighter estimates of meaningful change when compared to traditional methods, with the methods overlapping most when the proportion of responders was [23] N/A Individual Change over time N/A Griffiths et al [24] Meaningful change Group, Individual Change over time Minimal Ho et al [33] Distribution-based Individual, Group Change over time N/A Jones et al [21] Meaningful change Individual Change over time Not specified Lee et al [32] Both Individual Change over time Minimal Li [18] Distribution-based Individual Change over time N/A Peipert et al [30] Distribution-based Individual Change over time N/A Poon et al [29] Meaningful change Individual Change over time (hypothetical) Minimal Qin et al [27] Meaningful change Individual Change over time Not specified Smit et al [16] Both Individual Change over time Meaningful a Wyrwich & Norman [22] Meaningful change General General General Wyrwich et al [19] Meaningful change Individual Change over time (hypothetical) Meaningful b about 50% of participants. Extensions of this approach show promise for a range of applications [25,26].…”

Introduction to the special section "Methodologies and Considerations for Meaningful Change"

“…- --------------------------------Insert Table 2 about here ---------------------------------Setting the scene for the first part of the special section is a report of an online survey regarding how clinicians from different disciplines determine individual-level meaningful change on patient reported outcome measures (PROMs) (23). The authors investigated how oncology or mental health clinical care providers who used PROMs in the USA determine whether a patient's symptoms have changed.…”