that both operations share, such as the ability to complete housework.
Unlike generic PROMs, condition-specific PROMs
are focused on a particular disease, set of conditions,
or part of the body. The BODY-Q, for example, is a
condition-specific PROM that was designed for obese
patients and patients who undergo bariatric and cosmetic body contouring operations. 5 Domains measured
are specific to this population and include body image,
physical appearance, effect of excess skin, psychosocial
function, and others. Condition-specific PROMs are
especially useful for evaluating outcomes associated
with different approaches to treatment for a single disease. For instance, they can provide insight into how
the body image of a young adult with Crohn’s disease
might differ after undergoing an open versus a minimally invasive colectomy.
Choosing whether to use a generic or a condition-specific PROM depends on the intended purpose. 6 Is
the objective to gain an overall understanding of the
patient’s health status, or is the goal to gain a more
detailed view of the patient? Frequently, both generic
and condition-specific PROMs are used together to get
the full picture.
Other attributes of a PROM must be considered
before selection. These can include content validity,
construct validity, inter-rater reliability, test-retest
reliability, responsiveness, and whether it is static or
dynamic. 7 “Static” is the technical term for PROMs
that are administered on paper—they are static forms.
“Dynamic” is the technical term for newer test methods
that change depending on how one answers a question. A detailed description of each of these attributes
is beyond the scope of this article; however, a good rule
of thumb is to simply read the questions posed in the
PROM. If the questions seem irrelevant or unrelated
to what you are trying to learn from patients, then you
should probably consider another PROM.
How do we collect PROs using PROMs?
PROMs are available in multiple formats. Traditionally, they were paper-based forms completed
by patients during clinic visits or returned via mail.
Because computers, and especially smartphones and
tablets, are now ubiquitous, PROMs administered in
electronic formats and accessible via handheld devices
have become increasingly popular. 7-9 For instance,
the International Consortium for Health Outcomes
Measurement (ICHOM) developed TechHub, an open
marketplace that lists health information technology
vendors who meet ICHOM’s standards for electronic
outcomes measurement. Electronically captured
PROs, called ePROs, are more efficient, less costly,
and are user friendly. Data collected using electronic
means have proven to be of equal validity to those collected using traditional methods. 10 In the near future,
electronic collection of PROs will be the norm.
Why should we collect PROs?
PRO data have been shown to enhance patient
engagement and shared decision making when
integrated into clinical care. These data provide an
assessment of the patient’s experience of illness (such
as symptoms, physical function, and vitality), their
values and preferences, and their goals of care. 2 For
instance, orthopaedic surgeons at the University of
Rochester, NY, routinely use PRO data in clinical
care to assess whether physical therapy is helpful. 11
If the therapy does not seem to be having a beneficial effect, surgeons can use the PROs to engage a
patient in a discussion about whether an operation
is a viable option. Similarly, if a patient presents for
preoperative evaluation and has PRO scores that are
as good as those of postoperative patients, then he or
she may not need an operation. As such, PROs can
be used to support patient-provider engagement by