Department of Paediatrics, University of Melbourne, Parkville, Australia.
International Consortium of Health Outcome Measures, Boston, Massachusetts.
JAMA Netw Open. 2024 Jun 3;7(6):e2416760. doi: 10.1001/jamanetworkopen.2024.16760.
The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way.
To develop a core set of outcome measures for specific neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, specific learning disorders, and motor disorders, that may be used across a range of geographic and cultural settings.
An international working group composed of clinical and research experts and service users (n = 27) was convened to develop a standard core set of accessible, valid, and reliable outcome measures for children and adolescents with NDDs. The working group participated in 9 video conference calls and 8 surveys between March 1, 2021, and June 30, 2022. A modified Delphi approach defined the scope, outcomes, included measures, case-mix variables, and measurement time points. After development, the NDD set was distributed to professionals and service users for open review, feedback, and external validation.
The final set recommends measuring 12 outcomes across 3 key domains: (1) core symptoms related to the diagnosis; (2) impact, functioning, and quality of life; and (3) common coexisting problems. The following 14 measures should be administered at least every 6 months to monitor these outcomes: ADHD Rating Scale 5, Vanderbilt ADHD Diagnostic Rating Scale, or Swanson, Nolan, and Pelham Rating Scale IV; Affective Reactivity Index; Children's Communication Checklist 2; Colorado Learning Disabilities Questionnaire; Children's Sleep Habits Questionnaire; Developmental-Disability Children's Global Assessment Scale; Developmental Coordination Disorder Questionnaire; Family Strain Index; Intelligibility in Context Scale; Vineland Adaptive Behavior Scale or Repetitive Behavior Scale-Revised and Social Responsiveness Scale; Revised Child Anxiety and Depression Scales; and Yale Global Tic Severity Scale. The external review survey was completed by 32 professionals and 40 service users. The NDD set items were endorsed by more than 70% of professionals and service users in the open review survey.
The NDD set covers outcomes of most concern to patients and caregivers. Use of the NDD set has the potential to improve clinical practice and research.
越来越多的人认识到,使用基于证据的标准化结果测量是指导精神健康临床决策的关键。然而,这些措施在临床实践中的实施受到了阻碍,因为人们不清楚应该测量什么,以及如何以可靠和标准化的方式进行测量。
为特定的神经发育障碍(NDD),如注意力缺陷/多动障碍(ADHD)、沟通障碍、特定学习障碍和运动障碍,制定一套核心的结果测量工具,这些工具可能在一系列地理和文化环境中使用。
一个由临床和研究专家以及服务使用者(n=27)组成的国际工作组被召集起来,为患有 NDD 的儿童和青少年制定一套可及、有效和可靠的核心结果测量工具。该工作组于 2021 年 3 月 1 日至 2022 年 6 月 30 日期间参加了 9 次视频电话会议和 8 次调查。经过改良的德尔菲法确定了范围、结果、纳入的测量工具、病例组合变量和测量时间点。在开发之后,将 NDD 套分发给专业人员和服务使用者进行公开审查、反馈和外部验证。
最终的套组建议在 3 个关键领域测量 12 个结果:(1)与诊断相关的核心症状;(2)影响、功能和生活质量;(3)常见的共存问题。以下 14 项措施应至少每 6 个月进行一次,以监测这些结果:ADHD 评定量表 5、范德比尔特 ADHD 诊断评定量表或斯旺森、诺兰和佩勒姆评定量表 IV;情感反应指数;儿童沟通检查表 2;科罗拉多学习障碍问卷;儿童睡眠习惯问卷;发育性残疾儿童全球评估量表;发育协调障碍问卷;家庭紧张指数;语境理解量表;文兰适应性行为量表或重复行为量表修订版和社会反应量表;修订后的儿童焦虑和抑郁量表;以及耶鲁总体抽动严重程度量表。外部审查调查由 32 名专业人员和 40 名服务使用者完成。在公开审查调查中,NDD 套组的项目得到了超过 70%的专业人员和服务使用者的认可。
NDD 套组涵盖了患者和照顾者最关心的结果。使用 NDD 套组有可能改善临床实践和研究。