PRO-Bookmarking to Estimate Clinical Thresholds for Patient-reported Symptoms and Function

Area of Science:

• Health outcomes research
• Psychometrics
• Patient-reported outcomes

Background:

• Interpreting patient-reported outcome (PRO) scores is crucial for understanding their value.
• Traditional methods for deriving cut scores may not always be sufficient.
• PRO-Bookmarking offers an alternative qualitative approach to score interpretation.

Purpose of the Study:

• To introduce and describe the PRO-Bookmarking method for deriving cut scores and qualitative modifiers for PRO measures.
• To highlight the value of PRO-Bookmarking in providing credible evidence for the common-language meaning of PRO score ranges.

Main Methods:

• PRO-Bookmarking involves stakeholders identifying score ranges that define different PRO levels.
• Clinical vignettes representing different PRO levels are created using subsets of items and responses.
• Stakeholders individually "bookmark" thresholds between vignettes, followed by moderated discussion to reach consensus.

Main Results:

• The method provides credible evidence on the semantic meaning of PRO score ranges.
• It supplements other interpretative methods, especially when external standards are lacking.
• Stakeholder engagement ensures a common-language understanding of PRO scores.

Conclusions:

• PRO-Bookmarking is a valuable qualitative method for enhancing the interpretability of PRO scores.
• It is particularly useful for PRO measures lacking clear external reference standards.
• Further research is needed on its application, context of use, and clinical utility.