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Hazewinkel MHJ, Gfrerer L, Ashina S, Austen WG, Klassen AF, Pusic A, Kaur MN. Readability analysis and concept mapping of PROMs used for headache disorders. Headache 2024; 64:410-423. [PMID: 38525832 DOI: 10.1111/head.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To assess the readability and the comprehensiveness of patient-reported outcome measures (PROMs) utilized in primary headache disorders literature. BACKGROUND As the health-care landscape has evolved toward a patient-centric model, numerous PROMs have been developed to capture treatment outcomes in patients with headache disorders. For these PROMs to advance our understanding of headache disorders and their treatment impact, they must be easy to understand (i.e., reading grade level 6 or less) and comprehensively capture what matters to patients with headache. The aim of this study was to (a) assess the readability of PROMs utilized in headache disorders literature, and (b) assess the comprehensiveness of PROMs by mapping their content to a health-related quality of life framework. METHODS In this scoping review, recently published systematic reviews were used to identify PROMs used in primary headache disorders literature. Readability analysis was performed at the level of individual items and full PROM using established readability metrics. The content of the PROMs was mapped against a health-related quality-of-life framework by two independent reviewers. RESULTS In total, 22 PROMs (15 headache disorders related, 7 generic) were included. The median reading grade level varied between 7.1 (interquartile range [IQR] 6.3-7.8) and 12.7 (IQR 11.8-13.2). None of the PROMs were below the recommended reading grade level for patient-facing material (grade 6). Three PROMs, the Migraine-Treatment Assessment Questionnaire, the Eurolight, and the European Quality of Life 5 Dimensions 3 Level Version, were between reading grade levels 7 and 8; the remaining 19 PROMs were above reading grade level 8. In total, the PROMs included 425 items. Most items (n = 134, 32%) assessed physical function (e.g., work, activities of daily living). The remaining items assessed physical symptoms (n = 127, 30%; e.g., pain, nausea), treatment effects on symptoms (n = 65, 15%; e.g., accompanying symptoms relief, headache relief), treatment impact (n = 56, 13%; e.g., function, side effects), psychological well-being (n = 41, 10%; e.g., anger, frustration), social well-being (n = 29, 7%; e.g., missing out on social activities, relationships), psychological impact (n = 14, 3%; e.g., feeling [not] in control, feeling like a burden), and sexual well-being (n = 3, 1%; e.g., sexual activity, sexual interest). Some of the items pertained to treatment (n = 27, 6%), of which most were about treatment type and use (n = 12, 3%; e.g., medication, botulinum toxin), treatment access (n = 10, 2%; e.g., health-care utilization, cost of medication), and treatment experience (n = 9, 2%; e.g., treatment satisfaction, confidence in treatment). CONCLUSION The PROMs used in studies of headache disorders may be challenging for some patients to understand, leading to inaccurate or missing data. Furthermore, no available PROM comprehensively measures the health-related quality-of-life impact of headache disorders or their treatment, resulting in a limited understanding of patient-reported outcomes. The development of an easy-to-understand, comprehensive, and validated headache disorders-specific PROM is warranted.
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Affiliation(s)
- Merel H J Hazewinkel
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lisa Gfrerer
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sait Ashina
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - William G Austen
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Pusic
- Patient Reported Outcomes, Value and Experience Center (PROVE), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Manraj N Kaur
- Patient Reported Outcomes, Value and Experience Center (PROVE), Brigham and Women's Hospital, Boston, Massachusetts, USA
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Yalinay Dikmen P, Ozge A, Martelletti P. The use of clinical scales and PROMs in headache disorders and migraine, summarizing their dissemination and operationalization. Heliyon 2023; 9:e16187. [PMID: 37251845 PMCID: PMC10220237 DOI: 10.1016/j.heliyon.2023.e16187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Measurements are an essential aspect of scientific research. This review will present clinical scales and patient-reported outcome measures (PROMs) for headache disorders and migraine that have been endorsed by the International Headache Society (IHS) and are intended for use by both physicians and researchers. A clinical scale is a tool to assess a patient's condition or symptoms in a standardized and quantifiable way. Clinical scales are often used in research settings and can be used to track a patient's progress over time, monitor the effectiveness of treatment, and make decisions. They can be self-administered or completed by a healthcare professional. PROMs are tools used to evaluate a patient's health status, symptoms, and quality of life. These measures are completed by the patient and provide valuable information about the patient's perspective and experience of their condition. PROMs are increasingly used in clinical practice and research to improve patient-centered care, patient engagement, and shared decision-making. This review also briefly covers the creation process, testing for reliability and validity, and interpreting the results of the use of clinical scales and PROMs in clinical and research settings in headache disorders. The first step in creating a clinical scale or PROM is to define the purpose of the scale and the population it is intended to assess. The next step is to identify the domains or areas that the scale will assess. Then, the items or questions that will be included in the scale need to be developed. These items should be relevant to the defined purpose and population of the scale and should be worded clearly and concisely. After the items have been developed, the scale or PROM can be administered to a sample of individuals in the target population. This allows researchers to assess the reliability and validity of the scale or PROM, as well as to make any necessary revisions.
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Affiliation(s)
- Pınar Yalinay Dikmen
- Department of Neurology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Aynur Ozge
- Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Schwedt TJ, Tassorelli C, Silberstein SD, Szperka CL, Kurth T, Pozo-Rosich P, Amin FM, Lipton RB, Dodick DW, Ashina M, Diener HC, Terwindt GM. Guidelines of the International Headache Society for Clinic-Based Headache Registries, 1 st edition. Cephalalgia 2022; 42:1099-1115. [PMID: 35514209 PMCID: PMC10141527 DOI: 10.1177/03331024221099035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinic-based headache registries collect data for a wide variety of purposes including delineating disease characteristics, longitudinal natural disease courses, headache management approaches, quality of care, treatment safety and effectiveness, factors that predict treatment response, health care resource utilization, clinician adherence to guidelines, and cost-effectiveness. Registry data are valuable for numerous stakeholders, including individuals with headache disorders and their caregivers, healthcare providers, scientists, healthcare systems, regulatory authorities, pharmaceutical companies, employers, and policymakers. This International Headache Society document may serve as guidance for developing clinic-based headache registries. Use of registry data requires a formal research protocol that includes: 1) research aims; 2) methods for data collection, harmonization, analysis, privacy, and protection; 3) methods for human subject protection; and 4) publication and dissemination plans. Depending upon their objectives, headache registries should include validated headache-specific questionnaires, patient reported outcome measures, data elements that are used consistently across studies (i.e., "common data elements"), and medical record data. Amongst other data types, registries may be linked to healthcare and pharmacy claims data, biospecimens, and neuroimaging data. Headache diagnoses should be made according to the International Classification of Headache Disorders diagnostic criteria. The data from well-designed headache registries can provide wide-ranging and novel insights into the characteristics, burden, and treatment of headache disorders and ultimately lead to improvements in the management of patients with headache.
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Affiliation(s)
| | - Cristina Tassorelli
- Headache Science & Neurorehabilitation Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
- Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia (I)
| | | | - Christina L. Szperka
- Division of Neurology, Children’s Hospital of Philadelphia & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d’Hebron University Hospital & Headache Research Group, Vall d’Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard B. Lipton
- Department of Neurology, Department of Epidemiology and Population Health, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Houts CR, Wirth RJ, McGinley JS, Gwaltney C, Kassel E, Snapinn S, Cady R. Content Validity of HIT-6 as a Measure of Headache Impact in People With Migraine: A Narrative Review. Headache 2019; 60:28-39. [PMID: 31811654 PMCID: PMC7003926 DOI: 10.1111/head.13701] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 01/03/2023]
Abstract
Background The short‐form Headache Impact Test (HIT‐6) is a widely used patient‐reported outcome measure that assesses the negative effects of headaches on normal activity. It was developed using the general headache population and prior to the establishment of the now well‐accepted FDA patient‐reported guidance. Objective The objective of this narrative review was to examine existing qualitative research in patients with migraine and headache, providing insight into the relevance and meaningfulness of HIT‐6 items to the lives of migraine patients. Methods Articles were identified through database searches (National Library of Medicine and Google Scholar) and review of reference lists of candidate articles. Results A total of 3227 articles were identified through database and hand searching. Of these, 12 contained patient‐ or expert‐generated qualitative information regarding headache patients’ experience (8 specific to migraine [episodic and chronic] patients and 4 citing general headache patients). The combined publications described a total of 283 patient interviews. Overarching themes and specific information were identified that provide support of the relevance of content for each HIT‐6 item to migraine patients’ lives. Identified effects of headaches on patients with migraine included limitations in daily activities, needing to lie down during headaches, feeling tired, being irritated by headaches, difficulty concentrating, and the experience of pain. Further, previous research specific to the HIT‐6 indicated that patients understood the instructions, items, and response scales as intended by the instrument authors. Conclusions This narrative literature review demonstrates qualitative research support for the relevance of the items of the HIT‐6 in migraine patients, supporting its ongoing use in clinical migraine research and practice.
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Affiliation(s)
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | | | | | - Eric Kassel
- Lundbeck Seattle BioPharmaceuticals, Inc., Bothell, WA, USA
| | - Steven Snapinn
- Lundbeck Seattle BioPharmaceuticals, Inc., Bothell, WA, USA
| | - Roger Cady
- Lundbeck Seattle BioPharmaceuticals, Inc., Bothell, WA, USA
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Haywood KL, Mars TS, Potter R, Patel S, Matharu M, Underwood M. Assessing the impact of headaches and the outcomes of treatment: A systematic review of patient-reported outcome measures (PROMs). Cephalalgia 2018; 38:1374-1386. [PMID: 28920448 PMCID: PMC6024352 DOI: 10.1177/0333102417731348] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/25/2017] [Accepted: 06/12/2017] [Indexed: 01/03/2023]
Abstract
Aims To critically appraise, compare and synthesise the quality and acceptability of multi-item patient reported outcome measures for adults with chronic or episodic headache. Methods Systematic literature searches of major databases (1980-2016) to identify published evidence of PROM measurement and practical properties. Data on study quality (COSMIN), measurement and practical properties per measure were extracted and assessed against accepted standards to inform an evidence synthesis. Results From 10,903 reviewed abstracts, 103 articles were assessed in full; 46 provided evidence for 23 PROMs: Eleven specific to the health-related impact of migraine (n = 5) or headache (n = 6); six assessed migraine-specific treatment response/satisfaction; six were generic measures. Evidence for measurement validity and score interpretation was strongest for two measures of impact, Migraine-Specific Quality of Life Questionnaire (MSQ v2.1) and Headache Impact Test 6-item (HIT-6), and one of treatment response, the Patient Perception of Migraine Questionnaire (PPMQ-R). Evidence of reliability was limited, but acceptable for the HIT-6. Responsiveness was rarely evaluated. Evidence for the remaining measures was limited. Patient involvement was limited and poorly reported. Conclusion While evidence is limited, three measures have acceptable evidence of reliability and validity: HIT-6, MSQ v2.1 and PPMQ-R. Only the HIT-6 has acceptable evidence supporting its completion by all "headache" populations.
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Affiliation(s)
- Kirstie L Haywood
- Warwick Research in Nursing, Department
of Health Sciences, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
| | - Tom S Mars
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- Warwick Clinical Trials Unit, Warwick
Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
| | - Rachel Potter
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- Warwick Clinical Trials Unit, Warwick
Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
| | - Shilpa Patel
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- Warwick Clinical Trials Unit, Warwick
Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
| | - Manjit Matharu
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- Headache Group, UCL Institute of
Neurology, Queen Square, London, UK
| | - Martin Underwood
- On behalf of the CHESS team; Warwick
Clinical Trials Unit, Warwick Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
- Warwick Clinical Trials Unit, Warwick
Medical School, The
University
of Warwick, Gibbet Hill, Coventry, UK
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Smelt AFH, Louter MA, Kies DA, Blom JW, Terwindt GM, van der Heijden GJMG, De Gucht V, Ferrari MD, Assendelft WJJ. What do patients consider to be the most important outcomes for effectiveness studies on migraine treatment? Results of a Delphi study. PLoS One 2014; 9:e98933. [PMID: 24932784 PMCID: PMC4059644 DOI: 10.1371/journal.pone.0098933] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background The outcome measures most frequently used in studies on the effectiveness of migraine treatment are whether the patient is free of pain, nausea, and free of photophobia/phonophobia within two hours. However, no patient-centred outcome measures are available. Therefore, we performed an online Delphi procedure to compile a list of outcome measures deemed most important to migraine patients. Methods From a large database of migraine patients, we randomly selected 150 males and 150 females patients. We asked the open-ended question: ‘If a new medicine was developed for migraine attacks, what would you wish the effect of this medication to be?’ In the second and third rounds, we presented the answers of the first round and asked the patients to rate the importance of each item. Results The initial response rate was 56% (n = 169). In the subsequent rounds the response rates were 90% (n = 152), and 97% (n = 147), respectively. Patients wanted their attack medication to treat the headache within 30 min, to prevent the attack from getting worse, to ensure they could function properly within 1 h, and prevent the recurrence of symptoms during the same day. Conclusions The currently used outcome measures in migraine research do not sufficiently reflect the wishes of patients. Patients want the medication to work faster, to take away pain at an earlier stage, to make them able to function properly quickly, and to prevent recurrence. These aspects should be considered in future evaluation of new attack medication for migraine.
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Affiliation(s)
- Antonia F. H. Smelt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Mark A. Louter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis A. Kies
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert J. M. G. van der Heijden
- Department of Social Dentistry, Academic Center of Dentistry Amsterdam, VU Amsterdam University and University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michel D. Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem J. J. Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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