The validity of single-item patient-rated outcomes in concussed adolescent football athletes
Valier AF, Bacon CAW, Bay C, Houston MN, McLeod TCV. Arch Phys Med Rehabil. 2015. [Epub Ahead of Print].
Take Home Message: Single-item patient-reported outcome measures are valid for assessing patient progress in adolescent football athletes with concussions.
Clinicians who treat patients with sports-related concussions often use patient-reported outcomes (PRO) to monitor a patient’s symptoms and guide treatment; however, PROs with multiple questions are often cumbersome and time-consuming. An alternative is a single-item PRO that could be easier for clinicians to implement, while still providing clinicians with valuable feedback. Therefore, Valier and colleagues completed a longitudinal study of high school athletes with a concussion to determine the validity of 3 single-item PROs over time (the global ratings of change [GROC], daily activities [GRODA], and athletic activities [GROAA]). A total of 94 male, football athletes (age ~16 years, grade ~10) who sustained a concussion completed the GROC, GRODA, and GROAA at 3, 10, and 30 days post-concussion. Patients also completed 3 validated PRO scales during the same time points (The Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale, and Headache Impact Test-6). All three single-item PROs improved overtime, except for the GROC between Day 10 and Day 30. Overall, there was fair to moderate correlations between the single-item PROs and validated multi-item PROs.
The results of this study indicate that the single-item PROs assessed in this study are valid for the assessment of concussed adolescent football athletes during recovery. While the 3 single-item PROs improved over time the GROC score was not different between Day 10 and 30. This may indicate that between Day 3 and 10 the athletes perceived themselves to be much better and that this perceived improvement was maintained at Day 30. These single-item PROs could be a great resource for clinicians attempting to assess the progress of their athletes as these tools take less time than multi-item PROs. This could allow clinicians to still assess patient progress without occupying too much treatment time. Unfortunately, the current study lacked data on how long each assessment took to complete. This makes it difficult to quantify how much time could be saved by implementing single-item PROs instead of multi-item PROs. Regardless, a clinician who has been hesitant to ask patients with concussions to complete a PRO because of time concerns should consider using a single-item PRO. The single-item PROs can detect changes over time, relates well with multi-item PROs, and may serve as a great tool to monitor and record a patient’s recovery.
Questions for Discussion: Do you use either single-item or multi-item PROs in your current clinical practice? What, if any other issues have you had regarding implementing these tools?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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