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Title: Improving the measurement of patient-reported outcomes in patients with psychosis
Author: Reininghaus, Ulrich
ISNI:       0000 0004 2699 8809
Awarding Body: Queen Mary, University of London
Current Institution: Queen Mary, University of London
Date of Award: 2011
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Background: Patient-reported outcomes (PROs) are widely used to evaluate the care of patients with psychosis. However, there have been concerns that PROs may overlap considerably, be affected by the psychosis, and poorly corroborated by observer ratings. Addressing shortcomings in the measurement of PROs, this study aimed: first, to reliably score PROs according to their multidomain structure; second, to investigate the extent to which PROs provide distinct information independent from overlap across measures; third, to detect bias in PRO items attributable to psychiatric symptoms and cognitive deficits; and, fourth, to assess the relationship of PROs with observer-rated outcomes. Method: The study applied confirmatory factor and item response analysis to individual and pooled datasets obtained from 13 studies that had used the following PROs in psychotic patients: the Lancashire Quality of Life Profile (LQOLP), Manchester Short Assessment of Quality of Life (MANSA), Camberwell Assessment of Need (CAN), Client Satisfaction Questionnaire (CSQ), Patient Satisfaction Questionnaire (PSQ), and Helping Alliance Scale (HAS). Results: There was evidence of high structural validity with regard to total scores of most measures, including the LQOLP, MANSA, CSQ, and HAS. However, this largely did not hold for specific domain scores. Low precision across the full range of scores was observed for all measures. Most measures provided distinct information with high discriminant validity independent from overlap with other PRO measures. Structural Abstract 3 validity was only slightly reduced by bias attributable to symptoms and cognitive deficits. Finally, high convergent validity was found for CAN clinician and patient ratings and high discriminant validity for HAS clinician and patient ratings. Conclusions: The findings suggest that PROs can provide distinct information and may concur with observer ratings. The study provides an approach to overcome important shortcomings of PROs in patients with psychosis. This may inform the use and further development of PROs in psychotic patients.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Medicine