2010 review - Patient-Reported Outcomes Measurement - University ...

5. SUMMARY AND RECOMMENDATIONS
Table 2 provides a summary of the evidence of psychometric properties for the instruments
identified in this review. Table 3 shows the HRQoL domains covered by each PROM. A
summary of their content and scoring method can be found in Appendix B.
Preference-based measures
Amongst the preference-based measures, the EQ-5D was the only instrument with sufficient
evidence to warrant consideration (seven studies; five with UK samples). It demonstrated
validity and responsiveness with both CABG and PCI samples. However, there was mixed
evidence regarding its acceptability to patients, as reflected in response rates. Where a utility
is required, the EQ-5D is the most appropriate measure to use.
Generic measures
Amongst the generic, multidimensional instruments reviewed, the SF-36 had by far the most
evidence supporting its use with the ECP population (39 studies, eight with UK samples).
The SF-36 appears to work well in both types of procedure, although there were many more
studies with patients undergoing CABG compared with PCI. Evidence for reliability, validity,
responsiveness, and acceptability to patients was substantial; however, one study reported
ceiling effects, and some studies had low response rates. If the aim is to compare ECP
patients with other disease populations, the SF-36 may be considered; however, if used alone,
it may not be sensitive to subtle changes within this particular group.
Condition-specific measures
Of the condition-specific instruments identified, the Seattle Angina Questionnaire had by far
the most evidence supporting its use with patients undergoing CABG or PCI (22 studies),
demonstrating most of the important psychometric properties. It has been extensively applied
in both types of procedure, and with UK patient samples (five studies). However, it was
developed for the assessment of CAD in general, and could be said to lack some items that
are important for patients undergoing cardiac surgery. In particular, psychological well-being
appears to be an important predictor of recovery, and there is evidence that cardiac
procedures, particularly CABG, may have long-term effects on cognitive functioning. The
SAQ does not include cognitive functioning, and does not fully cover the psychosocial
domain.
Although there is as yet relatively little evidence to support its use (five studies, all UK), the
Coronary Revascularisation Outcomes Questionnaire, recently developed in the UK, is
promising. The CROQ includes both psychosocial and cognitive functioning, as well as
surgery-specific items. Some of the other measures reviewed, such as the Cardiac Symptom
Survey and the Heart Surgery Symptom Inventory, may also prove valuable if further
evidence emerges. Choice of instrument may be influenced by whether short- and medium-,
or longer-term outcomes are the focus of investigation. If short- and medium-term outcomes
are the main object of attention, one of these surgery-specific measures could be the
instrument of choice.
The Duke Activity Status Index has considerable merit as a measure of cardiac patients’
capacity to engage in activities which are important to their QoL. It has greater reliability and
sensitivity than the NYHA and CCS classification systems, and stronger psychometric
properties than the Specific Activity Scale; it has also been widely used with patients
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