Raats Jochem H, Ponds Noa H M, Brameier D T, Bain P A, Schuijt H J, van der Velde D, Weaver M J
Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis St, Boston, MA, 02115, USA.
Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.
Qual Life Res. 2025 Jan;34(1):89-99. doi: 10.1007/s11136-024-03766-1. Epub 2024 Aug 23.
Patient-reported outcome measures (PROMs) are widely used in medicine. As older adults, who may rely on a proxy caregiver for answers due to cognitive impairment, are representing an increasing share of the traumatically injured patient population, proxy-reported outcome measures (proxROMs) offer a valuable alternative source of patient-centered information although its association with PROMs is unclear. The objective of this scoping review is to discuss all available literature comparing PROM and proxROMs in adult patients with musculoskeletal trauma to guide future research in this field.
The PRISMA extension for Scoping Reviews was used to guide this review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched without date limit for articles comparing PROM and proxROMs in setting of musculoskeletal trauma. Abstract and full-text screening were performed by two independent reviewers. Variables included study details, patient and proxy characteristics, and reported findings on agreement between PROMs and proxROMs.
Of 574 unique records screened, 13 were included. Patient and proxy characteristics varied greatly, while patients' cognitive status and type of proxy perspective were poorly addressed. 18 different PROMs were evaluated, mostly reporting on physical functioning and disability (nine, 50%) or quality of life (six, 33%). Injury- and proxy-specific tools were rare, and psychometric properties of PROMs were often not described. Studies reported moderate to good agreement between PROMs and proxROMs. There is less agreement on subjective outcome measures (e.g., depression score) compared to observable items, and proxy bias results in in worse outcomes compared to patient self-reports.
Current literature, though limited, demonstrates moderate to good agreement between injured patients' self- and proxy-reports. Future studies should be mindful of current guidelines on proxy reporting when developing their studies and consider including neglected populations such as cognitively impaired patients to improve clinical validity.
患者报告结局测量指标（PROMs）在医学中被广泛使用。由于认知障碍可能依赖代理照顾者回答问题的老年人，在创伤患者群体中所占比例日益增加，代理报告结局测量指标（proxROMs）提供了以患者为中心的有价值的信息来源，尽管其与PROMs的关联尚不清楚。本范围综述的目的是讨论所有比较成年肌肉骨骼创伤患者中PROM和proxROMs的现有文献，以指导该领域的未来研究。
使用PRISMA范围综述扩展版来指导本综述。对MEDLINE、Embase、科学网和Cochrane对照试验中央注册库进行检索，不限日期，查找比较肌肉骨骼创伤背景下PROM和proxROMs的文章。由两名独立评审员进行摘要和全文筛选。变量包括研究细节、患者和代理特征，以及报告的关于PROM和proxROMs一致性的结果。
在筛选的574条独特记录中，纳入了13条。患者和代理特征差异很大，而患者的认知状态和代理视角类型很少被提及。评估了18种不同的PROM，大多报告身体功能和残疾情况（9种，50%）或生活质量（6种，33%）。针对损伤和代理的特定工具很少见，且PROM的心理测量特性常常未被描述。研究报告PROM和proxROM之间存在中度至良好的一致性。与可观察项目相比，主观结局测量指标（如抑郁评分）的一致性较低，与患者自我报告相比，代理偏差导致结局更差。
现有文献虽然有限，但表明受伤患者的自我报告和代理报告之间存在中度至良好的一致性。未来研究在开展研究时应注意当前关于代理报告的指南，并考虑纳入认知障碍患者等被忽视的人群，以提高临床有效性。
