Scientific/Clinical ArticleA psychometric comparison of patient-reported outcome measures used in pediatric hand therapy
Introduction
In pediatric hand therapy, patient-reported outcome measures (PROMs) can be used in research to evaluate treatment outcomes. In clinical practice, they may be used to evaluate the child's recovery and guide the plan of care. Two types of PROMs are commonly used in pediatric hand therapy: (1) questionnaires with item banks assessing generic functional tasks, such as the Pediatric Outcomes Data Collection Instrument (PODCI) and the Patient-Reported Outcomes Measurement Information System (PROMIS), and (2) patient-centered1 tools such as the Canadian Occupational Performance Measure (COPM). However, little information exists to guide clinicians in applying these PROMs in pediatric hand therapy practice. It is unknown if these two types of PROMs provide the same information or if they provide unique data to evaluate and guide the plan of care.
In research evaluating treatment outcomes, the PODCI is the most widely reported PROM for assessing treatment outcomes in pediatric hand and upper limb conditions2, 3, 4, 5, 6, 7, 8, 9, 10, 11 although recently, the PROMIS has been used in addition.9, 12 The PODCI Upper Extremity Function scale (PODCI/UE) includes eight questions specific to the ease of using the upper extremities in functional tasks. Item reduction of questions on existing pediatric outcomes scales generated the item bank of functional questions on the PODCI/UE.13, 14 Therefore, the relevance of the items to patients receiving pediatric hand therapy is unknown.
Conversely, the COPM is tailored to each patient's unique goals for treatment.1 The COPM is administered as a semistructured interview to identify individual patient's treatment goals and then measure the patient's perception of his or her progress toward the goals he or she identified as desired treatment outcomes. The repeated interviews necessary to complete the COPM limit its clinical feasibility.15 Thus, although the COPM is individualized and gives clinicians insight into the patient's identified goals for treatment, it is more cumbersome to administer than the PODCI questionnaire.
With their inherently different designs and limitations,16, 17 the PODCI and COPM may have different utility when applied clinically to guide the plan of care in the pediatric hand therapy population. However, these two PROMs have not been compared in this population. One way to determine the relative utility of the PODCI and the COPM as PROMs in clinical practice is to evaluate the psychometric properties of these measures.18 It is unknown if the predetermined item banks of questions such as those used in the PODCI and PROMIS are effective in evaluating a child's ability to improve during hand therapy treatment.19, 20 In addition, the overall utility of the COPM for the pediatric hand therapy population has not been elucidated. Exploring the clinical utility of both the PODCI and COPM will guide clinicians in applying these tools to measure treatment outcomes and guide the plan of care.
The purpose of this retrospective case series study was to evaluate the psychometric properties of the PODCI and COPM for children receiving hand therapy for upper extremity impairment. Specifically, this study evaluates the responsiveness, the ceiling effect, and the concurrent and discriminant validity of these measures. A greater understanding of their psychometric properties will elucidate their relative utility in clinical practice and the limitations of these tools in this population. We hypothesized the COPM is more responsive to patients' changes during treatment than the PODCI and that the PODCI has a ceiling effect.
Section snippets
Design
The Institutional Review Board of Cincinnati Children's Hospital approved this study with a waiver of informed consent. This study was designed to directly compare the psychometric properties of the PODCI and COPM in a single cohort of patients. Therefore, we retrospectively evaluated patients receiving pediatric hand therapy who were simultaneously assessed with PODCI and COPM scales at various time points during the course of a hand therapy episode of care: at the initiation of therapy
Results
Seventy-five subjects met inclusion and exclusion criteria. The median age was 13 years (range, 6-18). Table 1 provides additional characteristics of the study sample. All subjects received outpatient hand therapy services delivered by occupational therapists. The median duration of therapy was 43 days (range, 21-284 days). Interim scores where PODCI and COPM scores were obtained on the same day were available in a subset of 25 patients. All scales demonstrated significant change (P < .001,
Discussion
The aim of the present study was to evaluate the psychometric properties of the COPM and the PODCI to elucidate their relative merits for clinical practice. A direct comparison of patient-derived PROMs, such as the COPM, and generic PROMs, such as the PODCI, has not been undertaken in the pediatric hand therapy population. In addition, to our knowledge, no prior studies have evaluated the use of the COPM in a pediatric hand therapy population. Only one study evaluated the COPM in an adult hand
Conclusions
The results of the present study support our hypothesis that the COPM/P and COPM/S are more sensitive to changes during treatment than the PODCI/UE and PODCI/P and that the PODCI/UE and PODCI/P have a ceiling effect early in the course of hand therapy treatment. These findings suggest that the COPM may be more useful than the PODCI in guiding the course of treatment. Furthermore, this analysis supports the need for PROMs that are aligned with the functional goals that are meaningful to children
Quiz: # 711
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.
The study design is
- a.
qualitative
- b.
retrospective case series
- c.
prospective case study
- d.
RCTs
- a.
- # 2.
The outcome measurement scales were evaluated for their
- a.
validity
- b.
ceiling effect
- c.
responsiveness
- d.
all of the above
- a.
- # 3.
The psychometric qualities of the ________________ were assessed
- a.
DASH and Short DASH
- b.
- a.
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Cited by (2)
Pediatric hand therapists’ experiences with outcomes measurement: An interpretive descriptive study
2022, Journal of Hand TherapyCitation Excerpt :Evidence that therapists report abandonment of PROMs with the pediatric population, such as the DASH and QuickDASH, because the questions are not perceived to be adequately relevant to the pediatric population suggests PROMs designed for the adult hand therapy population are not adequately aligned with the pediatric population's outcome priorities10, 11 With value-based reimbursement increasing the emphasis on delivering patient-centered care40 our finding that therapists value PROMs for facilitating patient-centered care further suggests a PROM with clinical utility in pediatric hand therapy would be accepted. The data with respect to PROM utilization in the pediatric hand therapy population not only provides further evidence that this area of practice is limited in relevant PROMs,41,42 but it also establishes guidance on design characteristics and content pediatric hand therapists desire in a PROM. Duncan et al36 discovered that allied health professionals will not use PROMs unless they perceive value in using PROMs.
Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis
2021, Journal of Hand TherapyCitation Excerpt :This method of measurement has demonstrated an improved sensitivity to determine change in health-related functional status compared with conventional methods that are less focused on the integration of individual patient perspectives.33 The COPM is more sensitive to determine the client's change in function, more responsive to change during treatment, and less limited by a ceiling effect than other scales as reported by Dorich and Cornwall in a pediatric population.38 Our results are in concordance with their conclusion and support the use of the COPM as an evaluation instrument with a good responsiveness in patients with thumb OA, but more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions and guide the plan of care as Dorich and Cornwall recommended.38
Conflicts of interest: All named authors hereby declare that they have no conflicts of interest to disclose.