A comparison of brief versus explicit descriptors for verbal rating scales: interrupted time series design.
Comparative study
Patient reported outcomes
Postoperative period
Psychometrics
Validation study
Journal
Health and quality of life outcomes
ISSN: 1477-7525
Titre abrégé: Health Qual Life Outcomes
Pays: England
ID NLM: 101153626
Informations de publication
Date de publication:
13 Sep 2023
13 Sep 2023
Historique:
received:
27
06
2023
accepted:
21
08
2023
medline:
15
9
2023
pubmed:
14
9
2023
entrez:
13
9
2023
Statut:
epublish
Résumé
Verbal rating scales (VRS) are widely used in patient-reported outcome (PRO) measures. At our institution, patients complete an online instrument using VRSs with a five-point brief response scale to assess symptoms as part of routine follow-up after ambulatory cancer surgery. We received feedback from patients that the brief VRS descriptors such as "mild" or "somewhat" were vague. We added explicit descriptors to our VRSs, for instance, "Mild: I can generally ignore my pain" for pain severity or "Somewhat: I can do some things okay, but most of my daily activities are harder because of fatigue" for fatigue interference. We then compared responses before and after this change was made. The symptoms investigated were pain, fatigue and nausea. Our hypothesis was that the explicit descriptors would reduce overall variance. We therefore compared the coefficient of variation of scores and tested the association between symptoms scores and known predictors thereof. We also compared time to completion between questionnaires with and without the additional descriptors. A total of 17,500 patients undergoing 21,497 operations were assigned questionnaires in the period before the descriptors were added; allowing for a short transition period, 1,417 patients having 1436 operations were assigned questionnaires with the additional descriptors. Symptom scores were about 10% lower with the additional descriptors but the coefficient of variation was slightly higher. Moreover, the only statistically significant difference between groups for association with a known predictor favored the item without the additional language for nausea severity (p = 0.004). Total completion time was longer when the instrument included the additional descriptors, particularly the first and second time that the questionnaire was completed. Adding descriptors to a VRS of post-operative symptoms did not improve scale properties in patients undergoing ambulatory cancer surgery. We have removed the additional descriptors from our tool. We recommend further comparative psychometric research using data from PROs collected as part of routine clinical care.
Sections du résumé
BACKGROUND
BACKGROUND
Verbal rating scales (VRS) are widely used in patient-reported outcome (PRO) measures. At our institution, patients complete an online instrument using VRSs with a five-point brief response scale to assess symptoms as part of routine follow-up after ambulatory cancer surgery. We received feedback from patients that the brief VRS descriptors such as "mild" or "somewhat" were vague. We added explicit descriptors to our VRSs, for instance, "Mild: I can generally ignore my pain" for pain severity or "Somewhat: I can do some things okay, but most of my daily activities are harder because of fatigue" for fatigue interference. We then compared responses before and after this change was made.
METHODS
METHODS
The symptoms investigated were pain, fatigue and nausea. Our hypothesis was that the explicit descriptors would reduce overall variance. We therefore compared the coefficient of variation of scores and tested the association between symptoms scores and known predictors thereof. We also compared time to completion between questionnaires with and without the additional descriptors.
RESULTS
RESULTS
A total of 17,500 patients undergoing 21,497 operations were assigned questionnaires in the period before the descriptors were added; allowing for a short transition period, 1,417 patients having 1436 operations were assigned questionnaires with the additional descriptors. Symptom scores were about 10% lower with the additional descriptors but the coefficient of variation was slightly higher. Moreover, the only statistically significant difference between groups for association with a known predictor favored the item without the additional language for nausea severity (p = 0.004). Total completion time was longer when the instrument included the additional descriptors, particularly the first and second time that the questionnaire was completed.
CONCLUSIONS
CONCLUSIONS
Adding descriptors to a VRS of post-operative symptoms did not improve scale properties in patients undergoing ambulatory cancer surgery. We have removed the additional descriptors from our tool. We recommend further comparative psychometric research using data from PROs collected as part of routine clinical care.
Identifiants
pubmed: 37705045
doi: 10.1186/s12955-023-02184-0
pii: 10.1186/s12955-023-02184-0
pmc: PMC10498613
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
105Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
J Pain Symptom Manage. 2011 Jun;41(6):1073-93
pubmed: 21621130
Qual Life Res. 2020 Mar;29(3):745-753
pubmed: 31701432
Patient Relat Outcome Meas. 2010 May;2010(1):9-18
pubmed: 21709756
Patient. 2008 Apr 1;1(2):105-13
pubmed: 22272807
J Rheumatol. 2011 Dec;38(12):2581-7
pubmed: 21965643
Int J Technol Assess Health Care. 1999 Fall;15(4):709-16
pubmed: 10645112
Can J Anaesth. 2002 Mar;49(3):237-42
pubmed: 11861340
Med Care. 2008 Apr;46(4):423-31
pubmed: 18362823
J Clin Epidemiol. 2009 Sep;62(9):991-7
pubmed: 19216054
J Allergy Clin Immunol Pract. 2022 Jun;10(6):1527-1533.e3
pubmed: 35259537
J Urol. 2019 Oct;202(4):770-778
pubmed: 31039099
Qual Life Res. 2010 Feb;19(1):125-36
pubmed: 19941077
Ann Surg. 2021 Sep 1;274(3):441-448
pubmed: 34132697
Anesthesiology. 2021 Dec 1;135(6):1104-1119
pubmed: 34731245
J Natl Cancer Inst. 2014 Sep 29;106(9):
pubmed: 25265940
AMIA Annu Symp Proc. 2018 Dec 05;2018:166-174
pubmed: 30815054
Psychol Assess. 2019 Apr;31(4):557-566
pubmed: 30869956
World J Surg. 1993 Mar-Apr;17(2):226-31
pubmed: 8511918