Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice.
Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice.
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DOI：
10.1161/jaha.116.005356
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发表时间：
2017-07-21
影响因子：
5.4
通讯作者：
Uchino K
中科院分区：
文献类型：
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作者：
Katzan IL;Thompson NR;Lapin B;Uchino K
关于从患者报告的结果测量(PROMS)中获得的用于患者护理的数据的临床实用性存在不确定性。我们将PROMS获得的增量信息与临床医生报告的改良Rankin量表(MRS)进行了比较。这是一项对2012年9月14日至2015年6月16日在脑血管诊所就诊的3283名缺血性中风患者的观察性研究，这些患者完成了常规收集的PROMS：卒中影响量表-16(SIS-16)、情商-5D、患者健康问卷-9、Promis身体功能和Promis疲劳。在对年龄和卒中损伤程度进行调整后，使用R2来确定MRS解释的胎膜早破的变异量。对≥2次就诊的患者计算有意义变化的比例。MRS与SIS-16的相关性最高(r=−0.64，P<；0.01)。R2从0.11(前肌疲劳)到0.56(SIS-16)。MRS和SIS-16的得分变化分别为51%和35%。与SIS-16相比，MRS的一致性更低，区分其他指标变化的能力也更弱。与在门诊环境中看到的中风患者的MRS相比，PROM提供了额外的有价值的信息。在与患者相关的健康状况方面，SIS-16可能比MRS具有更好的识别变化的能力。在临床实践中，PROM可能是MRS的一个有用的补充，用于评估健康状况。
There is uncertainty regarding the clinical utility of the data obtained from patient‐reported outcome measures (PROMs) for patient care. We evaluated the incremental information obtained by PROMs compared to the clinician‐reported modified Rankin Scale (mRS). This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROMs: Stroke Impact Scale‐16 (SIS‐16), EQ‐5D, Patient Health Questionnaire‐9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROMs explained by mRS was determined using r2 after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c‐statistic was evaluated for mRS versus SIS‐16. Correlation between PROMs and mRS was highest for SIS‐16 (r=−0.64, P<0.01). The r2 ranged from 0.11 (PROMIS fatigue) to 0.56 (SIS‐16). Change in scores occurred in 51% with mRS and 35% with SIS‐16. There was lower agreement and less ability to discriminate change in mRS than in SIS‐16 with change in the other measures. PROMs provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS‐16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROMs may be a useful addition to mRS in the assessment of health status in clinical practice.