Time-dependent variation of patient reported outcome (PRO) measurement in patients with chronic conditions: a scoping review

Problem

Patient reported outcomes measurements (PROMs) are instruments collecting health outcomes, such as quality of life or functional status, directly reported by an individual without an interpretation of the response by a clinician or someone else. PROMs require individuals to reflect and evaluate their experience of their health condition over different periods of time, relying on their recall. For patients with chronic conditions recall is problematic as symptoms are known to fluctuate over time. Although diurnal patterning of symptoms has been documented in the biological literature and the timing of the day has been recognised as important for certain conditions, there has been a lack of literature examining the patterns in patient reported outcomes.

Approach

A scoping review of the literature was undertaken with the protocol registered on PROSPERO (CRD42017058365). A search strategy was developed based on previously conducted relevant reviews and implemented in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions was placed on article types. Backward and forward citation searches were conducted. Screening and data extraction was independently completed by up to three reviewers. An adapted version of CASP assessed quality of included articles.

Findings

3092 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews focusing mainly on mental health, respiratory and musculoskeletal conditions. Increased amplitudes and variability in self-reported scores (daily, weekly, and seasonally) were found in the conditions in comparison to healthy controls, demonstrating different rhythmic patterns (e.g. diurnal, circadian and infradian). Symptoms (e.g. pain, fatigue) have distinct temporal profiles that can be picked up by the variability of PRO scores in patients with different chronic conditions, including COPD, rheumatoid arthritis, osteoarthritis, and depression.

Consequences

Day-to-day fluctuations may be important to patients in managing their condition and improving their quality of life, thus should not be overlooked by clinicians who generally focus on persistent symptoms at the time of patient consultations. Fluctuating patient reported outcomes reported by patients could have a bearing on the evaluation of treatment plans and disease progression.