Rothrock Nan E, Drandarov Anastasiya, Kaat Aaron J, Mosher Hannah, Prado Juliano, Heng Marilyn
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA.
University of Miami Miller School of Medicine, Miami, FL, USA.
Qual Life Res. 2025 Apr;34(4):1159-1166. doi: 10.1007/s11136-024-03881-z. Epub 2024 Dec 24.
Bookmarking is a qualitative method used to assign descriptive labels to ranges of patient-reported outcome (PROM) scores. We aimed to evaluate variability between bookmarking samples and test score ranges where there was variability in expert opinion in previous studies.
We conducted two bookmarking sessions with patients who experienced orthopaedic fractures (n = 11) and one session with orthopaedic clinicians (n = 10). Participants reviewed vignettes comprised of PROM items and responses that represented hypothetical patients with a range of severity. Vignettes were constructed for PROMIS Upper Extremity Function, Physical Function, and Pain Interference measures. Participants placed bookmarks between vignettes that reflected different levels of severity (e.g., mild, moderate). The score reflecting the midpoint between vignettes was used as the recommended threshold between categories. We evaluated the variability in thresholds across participants, bookmarking panels, and previous studies.
Although patients and clinicians were not unanimous, the majority agreed on thresholds separating levels of severity for PROMIS Upper Extremity (≥ 40 = within normal limits, 30-39 = mild, 23-29 = moderate, < 23 = severe), PROMIS Physical Function (≥ 46 = within normal limits, 38-45 = mild, 26-37 = moderate, < 26 = severe), and PROMIS Pain Interference (≤ 50 = within normal limits, 51-60 = mild, 61-68 = moderate, > 68 = severe).
Testing new vignette scores within the same patient population enables more nuanced testing of score ranges without clear consensus and provides additional evidence for recommending thresholds for severity categories. These thresholds can be utilized to help interpret PROMIS scores from patients receiving orthopaedic care.
书签法是一种定性方法，用于为患者报告结局（PROM）分数范围赋予描述性标签。我们旨在评估书签样本与测试分数范围之间的变异性，此前研究中专家意见存在变异性。
我们对经历过骨科骨折的患者（n = 11）进行了两次书签法评估，并对骨科临床医生（n = 10）进行了一次评估。参与者查看了由PROM项目和代表不同严重程度的假设患者的回答组成的 vignettes。针对PROMIS上肢功能、身体功能和疼痛干扰测量构建了vignettes。参与者在反映不同严重程度（如轻度、中度）的vignettes之间放置书签。反映vignettes之间中点的分数用作类别之间的推荐阈值。我们评估了参与者、书签小组和先前研究中阈值的变异性。
尽管患者和临床医生意见并不一致，但大多数人对PROMIS上肢（≥40 = 正常范围，30 - 39 = 轻度，23 - 29 = 中度，<23 = 重度）、PROMIS身体功能（≥46 = 正常范围，38 - 45 = 轻度，26 - 37 = 中度，<26 = 重度）和PROMIS疼痛干扰（≤50 = 正常范围，51 - 60 = 轻度，61 - 68 = 中度，>68 = 重度）的严重程度分级阈值达成了一致。
在同一患者群体中测试新的vignette分数能够对尚无明确共识的分数范围进行更细致入微的测试，并为推荐严重程度类别的阈值提供额外证据。这些阈值可用于帮助解释接受骨科护理患者的PROMIS分数。
