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Outcome scores and patient-reported outcome measures

What PROMs measure and what they do not. Instruments (DASH, QuickDASH, SPADI, ASES, PRWE), their validity, reliability and responsiveness, minimal clinically important difference, and the distinction between tracking an individual's change over time, comparing populations in research, and — separately — deciding treatment, which a score does not do.

68 citationsUpdated Oct 2026

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Overview

Patient-reported outcome measures (PROMs) are standardised, validated questionnaires completed by patients to measure their perceptions of their own functional status and wellbeing [4]. Although the term PROM is a relatively new designation, these measures have existed since at least the 1960s [60]. PROMs are critical for capturing the patient's perspective on health status, which cannot be observed through clinical tests or imaging [18]. Consequently, physical outcome measures are being changed for the use of patient reported outcomes, as range of motion and strength are not as reliable measures as one would think [11]. This shift is supported by the efficiency and precision of tools such as PROMIS measures, whose use is expected to continue to increase across medical and surgical specialties as health systems and payers expand their definition of healthcare quality to include patient-reported health outcomes [34].

The adoption of PROMs has largely been driven by the agenda of researchers or service payers, though this movement has failed to focus effectively on improving the quality of care from the patient's perspective [15]. There are a number of challenges in using patient-reported outcomes in clinical practice [6], and the current data collection of PROMs is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes [3]. Recommendations for the selection of patient assessed measures of health outcome are needed [9], and further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions [23]. Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation [7].

Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting [12]. Limitations of using patient-reported outcome measures in clinical practice provide considerations for the design and implementation of future PROM initiatives [63]. To address interpretation challenges, this paper provides insight into the interpretation of PROM scores by introducing the different types and characteristics of PROMs, and the most relevant concepts for the interpretation of PROM scores [45]. Additionally, this paper serves as a practical guide to help clinicians and researchers interpret reports of measurement properties for patient-reported outcome measures (PROMs) [2], while another review examines how to assess the validity and reliability of patient reported outcome measures (PROMs) [8]. The authors propose a standardized reporting of patient-reported outcome measures (PROMs) that incorporates the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS), introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes [1]. This guidance describes how the FDA evaluates patient-reported outcome (PRO) instruments used as effectiveness endpoints in clinical trials and how sponsors can use study results to support claims in approved product labeling [5]. The objectives are to assess the impact of the routine use of patient-reported outcomes in clinical practice on the process of care, patients' and professionals' experiences of care, and health outcomes [16]. This paper provides an overview of patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) in research and clinical practice [10]. The article summarizes findings from a conference on implementing patient-reported outcome measures (PROMs) in value-based payment reform [20].

How It Works

Definitions and Scope

Patient-reported outcome measures (PROMs) serve as valuable tools for patient-centered health outcome assessment, shared decision-making, and routine postoperative care [32]. They are arguably the best tools available to orthopaedic providers for delivering patient-centered care [64]. This emphasis on PROMs reflects a shift away from physical outcome measures such as range of motion and strength, which are not as reliable as previously thought [11].

Measurement Properties and Reliability

Assessing test-retest reliability for PROMs requires the two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores [13]. Standardization efforts have established consensus on components of outcome measurement instruments, specifically regarding potential sources of variation for the COSMIN Risk of Bias tool [7], and on a set of 71 items for inclusion in a reporting guideline for studies on measurement properties of PROMs [65]. Specific instruments have demonstrated robust psychometric properties; for example, the Patient Outcomes of Surgery-Hand/Arm (Pos-Hand/Arm) questionnaire showed acceptability, reliability, validity, and responsiveness to clinical change [27], while the French translation of the Western Ontario Osteoarthritis of the Shoulder index (WOOS-Fr) is valid, reliable, and responsive to change [59]. Shoulder questionnaires with coefficients greater than 0.91 indicate good test-retest reliability for interpreting change scores for individual patients [57]. Despite these advances, all PROMs require further validation studies to fill gaps in their measurement properties [41].

Interpretation and Clinical Significance

A standardized reporting approach for PROMs incorporates the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS), introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes [1]. There is a need for better standardization in the establishment of MCIDs for orthopaedic PROMs and better study design, specifically utilizing the anchor-based within-cohort design based on Food and Drug Administration recommendations until a universally accepted MCID derivation exists [61]. The Forgotten Joint Score shows moderate-to-strong correlations with established ACLR PROMs, supporting construct validity, and clinically meaningful thresholds have been reported to support clinical interpretability [35]. However, the magnitude of responsiveness over time for the Forgotten Joint Score cannot be fully characterized because of limited reporting of longitudinal effect sizes [35]. For symptom severity and functional assessments in carpal tunnel release, scores may range from 1 to 5, and the sum of each mean score for each query is used to characterize the overall outcome score [38].

Standardization and Selection

Current data collection of PROMs is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes [3]. Consequently, there is a plea for more standardization in the use of outcome measurement instruments [14]. In advanced musculoskeletal physiotherapy practice, no key measure was identified to capture functional status, with 15 different tools utilized, highlighting the need for greater standardization of outcome measurement [39]. A future systematic evaluation of the published psychometric properties of identified PROMs may inform standardisation of measurement [58].

PROMIS System

The NIH PROMIS network derived a consensus-based framework for self-reported health and systematically reviewed available instruments and datasets that address the initial PROMIS domains [56]. PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments [44]. Global health scales derived from PROMIS global items can be used to efficiently summarize physical and mental health in patient-reported outcome studies [42]. Both PROMIS and legacy scores are currently collected for tracking patient outcomes and research purposes, with predictions that PROMIS will replace legacy patient-reported outcome measures with further refinement [22].

Administration and Reporting

Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores [21]. The FDA evaluates patient-reported outcome (PRO) instruments used as effectiveness endpoints in clinical trials, and sponsors can use study results to support claims in approved product labeling [5]. The PROMs movement has largely been driven by the agenda of researchers or service payers and has failed to focus effectively on improving the quality of care from the patient's perspective [15]. Proxy-reported outcomes reliably assess physical and pain-related domains in older adult patients with traumatic orthopaedic injuries, but additional strategies are needed to improve accuracy in more subjective domains [46].

How It Is Used

The routine integration of patient-reported outcome measures (PROMs) into orthopaedic practice has the potential to transform healthcare by providing actionable objective data that improves practice efficiency and supports shared decision-making [30]. Standardized PROMs should be collected routinely, preferably via registries utilizing computerized adaptive technology, to enable accurate comparisons and clinical decision-making [25]. This approach moves beyond research-focused assessments to guide treatment consistent with patient preferences, representing the future of value-based healthcare where real-time data is shared with patients [33]. Currently, however, only 57% of primary medical providers use PROMs within their practice, and the information is largely used for research rather than clinical decision-making [17]. The movement has largely been driven by the agenda of researchers or service payers and has failed to focus effectively on improving the quality of care from the patient's perspective [26].

Data Collection Modalities: Text messaging methodology has application for clinical research in any setting utilizing patient-reported outcomes at single and multiple time points to prospectively collect data [15]. Limiting follow-up to automated methods may have the potential to transform the way that outcome-based research is designed and conducted to provide substantially better research value in large prospective cohorts [54]. In vulnerable patient populations, the use of proxy-reported patient-reported outcomes might better characterize functional impairment and pain and could decrease selection bias in outcomes research [66].

Instrumentation and Scoring: Today, both PROMIS and legacy scores are collected for tracking patient outcomes and research purposes [24]. With further refinement, PROMIS is predicted to replace legacy patient-reported outcome measures [22]. Additionally, global health scales can be used to efficiently summarize physical and mental health in patient-reported outcome studies [42].

Interpreting the Results

Patient-reported outcome measures (PROMs) are standardized, validated questionnaires completed by patients to measure their perceptions of their own functional status and wellbeing [4]. These instruments are critical for capturing the patient's perspective on health status, which cannot be observed through clinical tests or imaging [18]. In contrast, physical outcome measures such as range of motion and strength are not as reliable measures as one would think [11]. For PROMs to be effective, they must be responsive, reliable, and validated [50]. Consensus has been reached on the components of outcome measurement instruments, specifically regarding potential sources of variation, using the COSMIN Risk of Bias tool [7]. To assess test-retest reliability, the two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended [13]. The authors plea for more standardization in the use of outcome measurement instruments [14].

Standardized health-related outcome measures require evidence for change and a way to interpret change within individuals or difference between groups [31]. Statistically significant differences may not equate to clinically important differences [50]. The majority of interventional studies reporting PROMs do not report confidence intervals around between-group differences in outcome and do not define a clinically meaningful difference [37]. To address this, investigators can choose thresholds to dichotomize responses on health-related quality of life based on absolute scores or change scores to facilitate interpretation [19]. The recommended approach for estimating the minimal important difference is to use several anchor-based methods with relevant clinical or patient-based indicators, examine distribution-based estimates as supportive information, and triangulate on a single value or small range of values [28]. A systematic approach to triangulate on the Minimal Clinically Important Difference (MCID) uses both distribution-based and anchor-based methods [40]. The calculation of the MCID needs to be correlated with changes in scores on the rating scale and external anchors [49].

The MCID is a point estimate that should always be reported with its associated 95% confidence interval [52]. Clinicians must be cautious in accepting an MCID score at face value given the wide variability of established MCID scores available for a single outcome scale [29]. There is no universally applicable MCID, substantial clinical benefit (SCB), or patient acceptable symptom state (PASS) for any specific outcome score, as values vary by institution and patient population [55]. The MCID is a low bar that patients do not seek when undergoing surgery; instead, they aim for substantial clinical benefit or a patient acceptable symptom state (PASS) [43]. Measures of clinical significance such as MCID, PASS, and SCB are essential for conveying patient satisfaction [50]. The authors propose a standardized reporting of PROMs that incorporates the MCID and the PASS, introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes [1].

Routine use of PROMs has the potential to help transform healthcare [30]. The objectives of assessing the impact of the routine use of patient-reported outcomes in clinical practice include evaluating effects on the process of care, patients' and professionals' experiences of care, and health outcomes [16]. The ability to collect patient-reported outcome (PRO) data in real time and share this information with patients to inform clinical decision making represents the future of value-based healthcare, moving beyond research-focused assessments to guide treatment consistent with patient preferences [17]. Today, both PROMIS and legacy scores are collected for tracking patient outcomes and research purposes; the authors predict that with further refinement, PROMIS will replace legacy patient-reported outcome measures [22].

Specific instruments demonstrate varying levels of validity and applicability. The Forgotten Joint Score shows moderate-to-strong correlations with established ACLR PROMs, supporting construct validity, and clinically meaningful thresholds have been reported, supporting clinical interpretability [35]. Findings confirmed the acceptability, reliability, validity and responsiveness to clinical change of the Pos-Hand/Arm questionnaire [27]. In a study of unicompartmental knee arthroplasty, patients who received custom and off-the-shelf implants demonstrated comparable absolute PROM scores, delta scores, and rates of achieving MCID across all metrics [36]. Regarding scoring methodology, for each query in the symptom severity and functional assessments, the score may range from 1 to 5, and the sum of each mean score for each query was used to characterize the overall outcome score [38]. In one population, the median SF-12 MCS of 50.0 was 0.9 points below the Dutch normative population score, a difference that may not be clinically important [51].

Limitations and Pitfalls

Standardization and Reporting

Current data collection of patient-reported outcome measures (PROMs) is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes [3]. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample [67].

Measurement Properties and Reliability

All PROMs require further validation studies to fill the gaps in their measurement properties [41]. A 10-item CAT eliminated floor and decreased ceiling effects, achieving a small standard error (≤ 2.2) across scores from 20 to 50 with reliability ≥ 0.95 for a representative US sample [62].

Interpretation of MCID and Thresholds

The minimal clinically important difference (MCID) is an imperfect solution to a complicated problem, and different methods used to calculate MCID lead to highly heterogeneous values [70]. The recommended approach is to estimate the minimal important difference based on several anchor-based methods, with relevant clinical or patient-based indicators, and to examine various distribution-based estimates (i.e., effect size, standardized response mean, standard error of measurement) as supportive information, and then to triangulate on a single value or small range of values for the MID [28]. The authors describe a systematic approach to triangulate on the Minimal Clinically Important Difference (MCID) using both distribution-based and anchor-based methods [40]. MCIDs expressed as effect sizes reduce bias, which mainly results from dependency on the baseline score [69]. Investigators can choose thresholds to dichotomize responses on HRQL based on absolute scores or change scores to facilitate interpretation [19].

Clinical Utility and Implementation Barriers

When the domain of the chosen PROM does not correspond to the domain addressed by the research question, clinically meaningful differences may go undetected, producing false-negative results [48]. A clearer separation between PROM‐based benchmarking and clinical failure, alongside modest stratified or sensitivity analyses, would further strengthen the clinical interpretability of these important findings [68].

Proxy Reporting and Specific Populations

While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains [46].

Key Evidence

  • [L5] The authors propose a standardized reporting of patient-reported outcome measures (PROMs) that incorporates the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS), introducing a 'clinical relevance ratio' to report the proportion of patients achieving clinical importance rather than relying solely on mean changes. [1] (10.2106/jbjs.21.00030)
  • [L5] This paper serves as a practical guide to help clinicians and researchers interpret reports of measurement properties for patient-reported outcome measures (PROMs). [2] (10.1136/bjsports-2012-091704)
  • [L4] The current data collection of patient-reported outcome measures (PROMs) is neither uniform nor complete across the world's registries, which may impact data validity and the ability to compare outcomes. [3] (10.1097/corr.0000000000001918)
  • [Paper] Patient reported outcome measures (PROMs) are standardised, validated questionnaires that are completed by patients to measure their perceptions of their own functional status and wellbeing. [4] (10.1136/bmj.c186)
  • [Paper] This guidance describes how the FDA evaluates patient-reported outcome (PRO) instruments used as effectiveness endpoints in clinical trials and how sponsors can use study results to support claims in approved product labeling. [5] (10.1186/1477-7525-4-79)
  • [L5] However, there are a number of challenges in using patient-reported outcomes in clinical practice. [6] (10.1007/s11136-008-9379-5)
  • [Paper] Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation. [7] (10.1186/s12874-020-01179-5)
  • [L5] This paper reviews the current literature on how to assess the validity and reliability of patient reported outcome measures (PROMs). [8] (10.1177/2050640614558345)
  • [L4] Recommendations for the selection of patient assessed measures of health outcome are needed. [9] (10.1136/bmj.324.7351.1417)
  • [L5] This paper provides an overview of patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) in research and clinical practice. [10] (10.4137/hsi.s11093)
  • [Paper] Physical outcome measures are being changed for the use of patient reported outcomes, and range of motion and strength are not as reliable measures as one would think. [11] (10.1016/j.injury.2019.11.017)
  • [L2] Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. [12] (10.1177/0269216313491619)
  • [L5] To assess test-retest reliability for patient-reported outcome measures, the two-way mixed-effect analysis of variance model with interaction for the absolute agreement between single scores is recommended. [13] (10.1007/s11136-018-2076-0)
  • [L5] The authors plea for more standardization in the use of outcome measurement instruments. [14] (10.1590/bjpt-rbf.2014.0143)
  • [L5] The patient reported outcome measures (PROMs) movement has largely been driven by the agenda of researchers or service payers and has failed to focus effectively on improving the quality of care from the patient's perspective. [15] (10.1136/bmj.g7818)
  • [Paper] The objectives are to assess the impact of the routine use of patient-reported outcomes in clinical practice on the process of care, patients' and professionals' experiences of care, and health outcomes. [16] (10.1002/14651858.cd011589)
  • [L5] The ability to collect patient-reported outcome (PRO) data in real time and share this information with patients to inform clinical decision making represents the future of value-based healthcare, moving beyond research-focused assessments to guide treatment consistent with patient preferences. [17] (10.1007/s11999-016-4813-4)
  • [L5] This editorial argues that Patient Reported Outcome Measures (PROMs) are critical for capturing the patient's perspective on health status, which cannot be observed through clinical tests or imaging. [18] (10.1136/bjsports-2014-093707)
  • [L5] Investigators can choose thresholds to dichotomize responses on HRQL based on absolute scores or change scores to facilitate interpretation. [19] (10.1186/1477-7525-4-62)
  • [Paper] The article summarizes findings from a conference on implementing patient-reported outcome measures (PROMs) in value-based payment reform. [20] (10.1016/j.jval.2017.02.003)
  • [L4] Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores. [21] (10.1186/1471-2288-14-52)
  • [L5] Today, both PROMIS and legacy scores are collected for tracking patient outcomes and research purposes; the authors predict that with further refinement, PROMIS will replace legacy patient-reported outcome measures. [22] (10.1016/j.arthro.2022.08.032)
  • [L2] Further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions. [23] (10.1016/j.injury.2019.07.002)
  • [L2] The use of proxy-reported patient-reported outcomes might better characterize functional impairment and pain in a vulnerable patient population and could decrease selection bias in outcomes research. [24] (10.5435/jaaos-d-17-00644)
  • [L4] The authors conclude that integrating standardized patient-reported outcomes into routine orthopaedic visits is feasible and improves practice efficiency by providing actionable objective data for shared decision-making. [25] (10.1007/s11999-013-3143-z)
  • [L4] Only 57% of primary medical providers are using patient reported outcome measures within their practice, with the information largely used for research rather than clinical decision-making. [26] (10.1177/2325967119s00107)
  • [Paper] Findings confirmed the acceptability, reliability, validity and responsiveness to clinical change of the questionnaire. [27] (10.1016/j.jhsb.2004.06.002)
  • [L5] The recommended approach is to estimate the minimal important difference based on several anchor-based methods, with relevant clinical or patient-based indicators, and to examine various distribution-based estimates (i.e., effect size, standardized response mean, standard error of measurement) as supportive information, and then to triangulate on a single value or small range of values for the MID. [28] (10.1186/1477-7525-4-70)
  • [L5] Clinicians must be cautious in accepting an MCID score at face value given the wide variability of established MCID scores available for a single outcome scale. [29] (10.1179/2042618612y.0000000001)
  • [L5] Routine use of patient reported outcome measures (PROMs) has the potential to help transform healthcare. [30] (10.1136/bmj.f167)
  • [L4] Standardized health-related outcome measures require evidence for change and a way to interpret change within individuals or difference between groups. [31] (10.1016/j.rdc.2018.01.011)
  • [L5] Patient-reported outcome measures (PROMs) are valuable tools for patient-centered health outcome assessment, shared decision-making, and routine postoperative care. [32] (10.2106/jbjs.20.00624)
  • [L5] Patient-reported outcomes should be collected routinely, preferably via registries using computerized adaptive technology, to enable accurate comparisons and shared decision-making. [33] (10.1007/s11999-013-3224-z)
  • [L4] PROMIS measures are efficient and precise tools, and their use is expected to continue to increase across medical and surgical specialties as health systems and payers expand their definition of healthcare quality to include patient-reported health outcomes. [34] (10.5435/jaaos-d-24-00432)
  • [L4] It shows moderate-to-strong correlations with established ACLR PROMs, supporting construct validity, and clinically meaningful thresholds have been reported, supporting clinical interpretability; however, the magnitude of responsiveness over time cannot be fully characterized because of limited reporting of longitudinal effect sizes. [35] (10.1002/arj.70559)
  • [L3] Patients who received custom and OTS UKA demonstrated comparable absolute PROM scores, delta scores, and rates of achieving MCID across all metrics. [36] (10.1016/j.arth.2026.09.008)
  • [L1] The majority of interventional studies reporting PROMs do not report CIs around between-group differences in outcome and do not define a clinically meaningful difference. [37] (10.2106/jbjs.20.00474)
  • [L5] For each query in the symptom severity and functional assessments the score may range from 1 to 5, and the sum of each mean score for each query was used to characterize the overall outcome score. [38] (10.1016/j.jhsa.2004.08.002)
  • [L2] No key measure was identified to capture functional status, with 15 different tools utilized, highlighting the need for greater standardization of outcome measurement in musculoskeletal clinical practice, service evaluation and research. [39] (10.1002/msc.1200)
  • [L5] The authors describe a systematic approach to triangulate on the Minimal Clinically Important Difference (MCID) using both distribution-based and anchor-based methods. [40] (10.1016/j.apmr.2019.12.008)
  • [L1] However, all PROMs require further validation studies to fill the gaps in their measurement properties. [41] (10.1016/j.ejvs.2014.12.002)
  • [L4] These global health scales can be used to efficiently summarize physical and mental health in patient-reported outcome studies. [42] (10.1007/s11136-009-9496-9)
  • [L5] The minimal clinically important difference (MCID) is a low bar that patients do not seek when undergoing surgery; instead, they aim for substantial clinical benefit or a patient acceptable symptom state (PASS). [43] (10.1016/j.arthro.2023.10.014)
  • [L5] PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. [44] (10.1016/j.jclinepi.2010.04.011)
  • [Paper] This paper provides insight into the interpretation of PROM scores by introducing the different types and characteristics of PROMs, and the most relevant concepts for the interpretation of PROM scores. [45] (10.1111/nep.13843)
  • [L3] While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. [46] (10.1016/j.injury.2025.112163)
  • [Paper] When the domain of the chosen PROM does not correspond to the domain addressed by the research question, clinically meaningful differences may go undetected, producing false-negative results. [48] (10.1002/ksa.70620)
  • [L5] The calculation of the minimal clinically important difference (MCID) needs to be correlated with changes in scores on the rating scale and external anchors. [49] (10.1177/03635465231193405)
  • [L5] Patient-reported outcome measures need to be responsive, reliable, and validated, and measures of clinical significance such as MCID, PASS, and SCB are essential for conveying patient satisfaction, as statistically significant differences may not equate to clinically important differences. [50] (10.1016/j.arthro.2022.08.020)
  • [L3] The median SF-12 MCS of 50.0 was 0.9 points below the Dutch normative population score, a difference that may not be clinically important. [51] (10.1016/j.injury.2024.111779)
  • [L5] The Minimal Clinically Important Difference (MCID) is a point estimate that should always be reported with its associated 95% CI, as there is no basis for considering a sample-derived MCID a singular threshold to be crossed. [52] (10.1177/03635465231189223)
  • [L4] This methodology has application for clinical research in any setting utilizing patient-reported outcomes at single and multiple time points to prospectively collect data. [54] (10.1016/j.fertnstert.2015.12.103)
  • [L5] There is no universally applicable MCID, SCB, or PASS for any specific outcome score, as values vary by institution and patient population; the authors recommend improving MCID calculation by using anchor questions and ROC curves to better correlate with patient satisfaction and clinical benefit. [55] (10.1016/j.arthro.2023.11.007)
  • [Paper] The NIH PROMIS network derived a consensus-based framework for self-reported health and systematically reviewed available instruments and datasets that address the initial PROMIS domains. [56] (10.1097/01.mlr.0000258615.42478.55)
  • [Paper] The other shoulder questionnaires had coefficients greater than 0.91, indicating good test-retest reliability for interpreting change scores for individual patients. [57] (10.1016/s1058-2746(98)90002-7)
  • [L1] A future systematic evaluation of the published psychometric properties of identified PROMs may inform standardisation of measurement. [58] (10.1142/s2424835519500425)
  • [L4] The WOOS-Fr is valid, reliable and responsive to change. [59] (10.1016/j.otsr.2024.103912)
  • [L4] The term PROM is a relatively new designation for a range of measures that have existed since at least the 1960s. [60] (10.1111/hex.13254)
  • [L4] This current concepts review demonstrates the need for better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and better study design, specifically utilizing the anchor-based within-cohort design based on Food and Drug Administration recommendations until a universally accepted MCID derivation exists. [61] (10.1177/03635465211053869)
  • [L5] A 10-item CAT eliminated floor and decreased ceiling effects, achieving a small standard error (≤ 2.2) across scores from 20 to 50 with reliability ≥ 0.95 for a representative US sample. [62] (10.1016/j.jclinepi.2006.06.025)
  • [L4] These limitations shed some light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives. [63] (10.1007/s11136-021-03003-z)
  • [L5] Patient-reported outcome measures (PROMs) are arguably the best tools available to orthopaedic providers for providing patient-centered care. [64] (10.2106/jbjs.22.00587)
  • [L5] Consensus was achieved on a set of 71 items for inclusion in a reporting guideline for studies on measurement properties of PROMs. [65] (10.1007/s11136-021-02822-4)
  • [L2] Limiting follow-up to automated methods may have the potential to transform the way that outcome-based research is designed and conducted to provide substantially better research value in large prospective cohorts. [66] (10.2106/jbjs.19.00531)
  • [L4] The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. [67] (10.1097/corr.0000000000001852)
  • [Paper] A clearer separation between PROM‐based benchmarking and clinical failure, alongside modest stratified or sensitivity analyses, would further strengthen the clinical interpretability of these important findings. [68] (10.1002/ksa.70610)
  • [Paper] MCIDs expressed as effect sizes reduce bias, which mainly results from dependency on the baseline score. [69] (10.1016/j.jclinepi.2016.11.016)
  • [L5] The minimal clinically important difference (MCID) is an imperfect solution to a complicated problem, and different methods used to calculate MCID lead to highly heterogeneous values. [70] (10.1177/03635465231189222)

See Also

  • Osteoarthritis

References

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[2] Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? A practical guide for clinicians and researchers who are not biostatisticians. British Journal of Sports Medicine. 2012. DOI: 10.1136/bjsports-2012-091704

[3] CORR Insights®: Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000001918

[4] The routine use of patient reported outcome measures in healthcare settings. BMJ. 2010. DOI: 10.1136/bmj.c186

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[7] COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study. BMC Medical Research Methodology. 2020. DOI: 10.1186/s12874-020-01179-5

[8] Assessing patient reported outcome measures: A practical guide for gastroenterologists. United European Gastroenterology Journal. 2014. DOI: 10.1177/2050640614558345

[9] Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ. 2002. DOI: 10.1136/bmj.324.7351.1417

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[11] Physical outcome measures: The role of strength and range of motion in orthopaedic research. Injury. 2020. DOI: 10.1016/j.injury.2019.11.017

[12] Implementing patient-reported outcome measures in palliative care clinical practice: A systematic review of facilitators and barriers. Palliative Medicine. 2013. DOI: 10.1177/0269216313491619

[13] Assessing test–retest reliability of patient-reported outcome measures using intraclass correlation coefficients: recommendations for selecting and documenting the analytical formula. Quality of Life Research. 2018. DOI: 10.1007/s11136-018-2076-0

[14] The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Brazilian Journal of Physical Therapy. 2016. DOI: 10.1590/bjpt-rbf.2014.0143

[15] Patient reported outcome measures in practice. BMJ. 2015. DOI: 10.1136/bmj.g7818

[16] Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice. Cochrane Database of Systematic Reviews. 2015. DOI: 10.1002/14651858.cd011589

[17] Value-based Healthcare: Patient-reported Outcomes in Clinical Decision Making. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-016-4813-4

[18] Patient Reported Outcome Measures (PROMs) have arrived in sports and exercise medicine: Why do they matter?. British Journal of Sports Medicine. 2015. DOI: 10.1136/bjsports-2014-093707

[19] Interpreting the results of patient reported outcome measures in clinical trials: The clinician's perspective. Health and Quality of Life Outcomes. 2006. DOI: 10.1186/1477-7525-4-62

[20] The Role of Patient-Reported Outcome Measures in Value-Based Payment Reform. Value in Health. 2017. DOI: 10.1016/j.jval.2017.02.003

[21] Collection of patient-reported outcomes; - text messages on mobile phones provide valid scores and high response rates. BMC Medical Research Methodology. 2014. DOI: 10.1186/1471-2288-14-52

[22] Editorial Commentary: Legacy Patient‐Reported Outcome Measures Remain Important Today Despite Responder Burden, but With Further Refinement, Patient‐Reported Outcomes Measurement Information System Could Replace Legacy Instruments in the Future. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.08.032

[23] Assessing outcome measures used after rib fracture: A COSMIN systematic review. Injury. 2019. DOI: 10.1016/j.injury.2019.07.002

[24] Reliability of Proxy-reported Patient-reported Outcomes Measurement Information System Physical Function and Pain Interference Responses for Elderly Patients With Musculoskeletal Injury. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00644

[25] Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR. Clinical Orthopaedics & Related Research. 2013. DOI: 10.1007/s11999-013-3143-z

[26] THE USE OF PATIENT REPORTED OUTCOME MEASURES BY PRIMARY MEDICAL PROVIDERS IN THE PEDIATRIC SPORTS POPULATION. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00107

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[29] Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). Journal of Manual & Manipulative Therapy. 2012. DOI: 10.1179/2042618612y.0000000001

[30] Patient reported outcome measures could help transform healthcare. BMJ. 2013. DOI: 10.1136/bmj.f167

[31] Minimal Clinically Important Difference. Rheumatic Disease Clinics of North America. 2018. DOI: 10.1016/j.rdc.2018.01.011

[32] Meaningful Clinical Applications of Patient-Reported Outcome Measures in Orthopaedics. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00624

[33] The Importance of Outcome Measurement in Orthopaedics. Clinical Orthopaedics & Related Research. 2013. DOI: 10.1007/s11999-013-3224-z

[34] Use of Patient-Reported Outcomes Measurement Information System Measures in Orthopaedic Specialties: Results of a Scoping Review for 2018 to 2022. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00432

[35] The Forgotten Joint Score Shows High Correlation With Established Anterior Cruciate Ligament Reconstruction Patient‐Reported Outcome Measures While Capturing Joint Awareness and Functional Recovery: A Systematic Review. Arthroscopy. 2026. DOI: 10.1002/arj.70559

[36] Patient-Reported Outcomes Following Custom Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.09.008

[37] Interpreting Patient-Reported Outcome Measures in Orthopaedic Surgery. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00474

[38] Patient-reported outcome after carpal tunnel release for advanced disease. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.08.002

[39] Patient‐reported outcome measures in advanced musculoskeletal physiotherapy practice: a systematic review. Musculoskeletal Care. 2017. DOI: 10.1002/msc.1200

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[41] Assessing the Quality of Available Patient Reported Outcome Measures for Intermittent Claudication: A Systematic Review Using the COSMIN Checklist. European Journal of Vascular and Endovascular Surgery. 2015. DOI: 10.1016/j.ejvs.2014.12.002

[42] Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research. 2009. DOI: 10.1007/s11136-009-9496-9

[43] Editorial Commentary : The Minimal Clinically Important Difference Is Less Important Than It Sounds: Patients Seek to Achieve Substantial Clinical Benefits and Not Minimally Perceptible Improvements When They Undergo Arthroscopic Surgery. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.10.014

[44] The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology. 2010. DOI: 10.1016/j.jclinepi.2010.04.011

[45] Patient‐reported outcome measures ( PROMs): making sense of individual PROM scores and changes in PROM scores over time. Nephrology. 2020. DOI: 10.1111/nep.13843

[46] Proxy-reported outcomes accurately reflect objective patient-reported outcomes in older adult patients with traumatic orthopaedic injuries. Injury. 2025. DOI: 10.1016/j.injury.2025.112163

[48] The right measure for the right question: A framework for domain‐matched patient‐reported outcome measure selection in knee arthroplasty research. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70620

[49] The Minimal Clinically Important Difference Changes Greatly Based on the Different Calculation Methods: Letter to the Editor. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231193405

[50] Guidelines for Proper Reporting of Clinical Significance, Including Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, Substantial Clinical Benefit, and Maximal Outcome Improvement. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.020

[51] Long-term patient reported outcomes after revision surgery for lower extremity nonunion: A retrospective cohort study. Injury. 2024. DOI: 10.1016/j.injury.2024.111779

[52] The Minimal Clinically Important Difference: Letter to the Editor. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231189223

[54] Text messaging yields high research response rate to track menstrual cycles and patient-reported outcomes. Fertility and Sterility. 2016. DOI: 10.1016/j.fertnstert.2015.12.103

[55] Does Calculation of the Minimal Clinically Important Difference Make Sense? Ways to Improve. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.11.007

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[58] Systematic Review of the Use of Patient Reported Outcome Measures in Studies of Electively-Managed Hand Conditions. The Journal of Hand Surgery (Asian-Pacific Volume). 2019. DOI: 10.1142/s2424835519500425

[59] Validity, reliability and responsiveness of a French translation of the Western Ontario Osteoarthritis of the Shoulder index (WOOS). Orthopaedics & Traumatology: Surgery & Research. 2024. DOI: 10.1016/j.otsr.2024.103912

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