Evidence for the Use of Patient-Reported Outcome Measures in the Treatment of Patients With Noncommunicable Diseases: Systematic Review
Bibliographic record
Abstract
BACKGROUND: The use of patient-reported outcome measures (PROMs) as a clinical tool for screening and decision-making has gained widespread interest, with numerous implementation activities across specialties, even though the evidence has not been clear until now. OBJECTIVE: The aim of this study was to assess the evidence for using PROMs in clinical practice for patients with diabetes, chronic obstructive pulmonary disease (COPD), heart disease, rheumatoid arthritis (RA), and inflammatory bowel disease (IBD). Additionally, we sought to determine the characteristics of the most effective PROM interventions. METHODS: We conducted a systematic review of published randomized controlled trials (RCTs) on the use of PROMs for clinical purposes, such as systematic PROM assessment alone or with a predefined PROM-based decision-making method. Eligible studies included adult patients (>18 years) with diabetes, COPD, heart disease, RA, or IBD. We excluded studies using PROMs as an outcome measure or otherwise not meeting the inclusion criteria. We searched the PubMed/MEDLINE, CINAHL, EMBASE, and Web of Science databases until February 2023. Two investigators independently screened titles, abstracts, and relevant full texts. Three investigators completed data extraction and risk-of-bias assessment using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). The data were presented in a narrative synthesis and in summarized form. RESULTS: The search yielded 21,203 papers, 686 (3.2%) full-text papers were screened, and 56 (8.2%) original studies were included in the review. The studies included patients with heart disease (n=17, 30.4%), COPD (n=13, 23.2%), diabetes (n=10, 17.9%), IBD (n=9, 16.1%), and RA (n=6, 10.7%), as well as patients with mixed diagnoses (n=1, 1.8%). All interventions incorporated systematic PROM assessments. Some interventions additionally used a predefined method for PROM-based decision-making (n=19, 33.9%) or PROM-based dialogue (n=9, 16.1%), while 5 (8.9%) interventions aimed to substitute face-to-face consultations. The predominant mode of PROM administration was over the phone, followed by electronic devices and apps. Endpoints included disease activity, health care use, mortality, mental well-being, quality of life, self-efficacy, self-care, daily functioning, and other outcomes. Six studies with a low risk of bias demonstrated a positive effect or noninferiority of the PROM intervention. CONCLUSIONS: The evidence base for clinical use of PROMs is sparse, with few studies evaluated to have a low or a medium risk of bias. The clinical use of PROMs does not appear superior to usual care in the five included chronic diseases on any endpoint. To guide further research, we highlighted 6 (10.7%) studies with a low risk of bias and PROM interventions with a positive effect. These were characterized by symptom assessment with predefined cutoffs used for decision and dialogue support. TRIAL REGISTRATION: PROSPERO CRD42021226896; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021226896.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.151 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".