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,
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.

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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Valier, A., Welch Bacon, C., Bay, R., Houston, M., & Valovich McLeod, T. (2015). The Validity of Single-Item Patient-Rated Outcomes in Concussed Adolescent Football Athletes Archives of Physical Medicine and Rehabilitation DOI: 10.1016/j.apmr.2015.11.015