Expanding Options for Developing Outcome Measures From Momentary Assessment Data

Department of Psychiatry and Behavioral Science, Putnam Hall, South Campus, Stony Brook University, Stony Brook, NY 11794-8790, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 05/2012; 74(4):387-97. DOI: 10.1097/PSY.0b013e3182571faa
Source: PubMed


We propose several different patient-reported outcomes (PROs) from momentary, real-time collection of symptom data. In addition to the mean of momentary reports of symptoms, other types of summaries can reflect different aspects of the symptom experience.
With secondary analyses of two studies of patients with chronic pain assessed with real-time methods, we demonstrate principles for developing outcomes that summarize symptom experience during a 1-week period. These studies focused on pain intensity, which is used to demonstrate methods for creating summary momentary measures.
Analyses from the first study (Pain 2008;139:146-57) yielded outcome measures based on the mean, median, 90th percentile, maximum, standard deviation, proportion of reports with no pain, proportion of reports with pain more than 50 (on a 0- to 100-point scale), and time-contingent measures. The second study examined the performance of these measures (and the mean) in a longitudinal study, in which some patients changed treatment (n = 78), making pain reduction likely, whereas others had no treatment change (n = 27). The measure that best discriminated the groups was the proportion of momentary reports without pain (effect size = 0.50), closely followed by the mean of all reports (effect size = 0.45). Most measures also correlated with patients' global impression of their change (between 0.39 and 0.55, except for standard deviation [0.13]).
These analyses suggest that momentary symptom data can be useful for developing new PROs that reflect symptom experience other than the mean. They highlight knowledge gleaned from real-time studies, which deepens our understanding of symptoms by demonstrating which changes in symptoms are associated with overall perceived change.

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Available from: Joan E Broderick, Mar 24, 2014
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    • "Creation of PROs for young children will require that we develop novel methods for observing their health and eliciting their verbalizations. Frequent momentary assessments (multiple times per day) [12] hold promise as a methodology that merits further investigation for young child PRO assessment. Another aspect of children's development related to medical product labeling is concerned with the late effects of medical treatments. "

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    ABSTRACT: This report examines day-to-day variability in rheumatology patients' ratings of pain and related quality-of-life variables as well as predictors of that variability. Data from 2 studies were used. The hypothesis was that greater psychological distress (i.e., depression and anxiety) and poorer coping appraisals (i.e., higher pain catastrophizing and lower self-efficacy) are associated with more variability. Electronic daily diary ratings were collected from 106 patients from a community rheumatology practice across 28 days (study 1) and from 194 osteoarthritis patients across 7 days (study 2). In multilevel modeling analyses, substantial day-to-day variability was evident for all variables in both studies, and individual patients differed considerably and somewhat reliably in the magnitude of their variability. Higher levels of depression significantly predicted greater variability in pain, as well as in happiness and frustration (study 1). Lower self-efficacy was associated with more variability in patients' daily satisfaction with accomplishments and in the quality of their day (study 2). Greater pain catastrophizing and higher depression predicted more variability in interference with social relationships (study 2). Anxiety was not significantly associated with day-to-day variability. The results of these studies suggest that individual differences in the magnitude of symptom fluctuation may play a vital role in understanding patients' adjustment to pain. Future research will be needed to examine the clinical utility of measuring variability in patients' pain and well-being, and to understand whether reducing variability may be an important treatment target.
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