Added Value of Patient‐Reported Outcome Measures in Stroke Clinical Practice

Abstract

Background There is uncertainty regarding the clinical utility of the data obtained from patient‐reported outcome measures ( PROM s) for patient care. We evaluated the incremental information obtained by PROM s compared to the clinician‐reported modified Rankin Scale ( mRS ). Methods and Results This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROM s: Stroke Impact Scale‐16 ( SIS ‐16), EQ ‐5D, Patient Health Questionnaire‐9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROM s explained by mRS was determined using r 2 after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c‐statistic was evaluated for mRS versus SIS ‐16. Correlation between PROM s and mRS was highest for SIS ‐16 ( r =−0.64, P <0.01). The r 2 ranged from 0.11 ( PROMIS fatigue) to 0.56 ( SIS ‐16). Change in scores occurred in 51% with mRS and 35% with SIS ‐16. There was lower agreement and less ability to discriminate change in mRS than in SIS ‐16 with change in the other measures. Conclusions PROM s provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS ‐16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROM s may be a useful addition to mRS in the assessment of health status in clinical practice.