scholarly journals A Comparison of Latent Variable and Psychological Network Models in Mental and Physical Health Symptom Data: Common Output Metrics and Factor Structure

2021 ◽  
Author(s):  
Joshua Starr ◽  
Carl F. Falk
Keyword(s):  
Physical Health ◽  
Factor Structure ◽  
Latent Variable ◽  
Graphical Model ◽  
Detection Algorithm ◽  
Measurement Information ◽  
Test Form ◽  
Factor Loadings ◽  
Patient Reported ◽  
Mental And Physical Health

In mental health research, psychological network modeling such as the Gaussian graphical model (GGM) has emerged as an alternative to latent variable modeling such as confirmatory factor analysis (CFA). Recent simulation studies have found that centrality indices from the GGM are partially redundant with factor loadings from a CFA. Follow-up analyses on the GGM, such as exploratory graph analysis (EGA) can sort items into communities that may represent hypothesized factors. However, previous comparisons of centrality indices with factor loadings and the ability of EGA to recover hypothesized factor structure have not been done with real mental and physical health symptom data. We compared GGM and CFA using data based on 16 test forms from Wave 1 of the Patient Reported Outcomes Measurement Information System (PROMIS; N’s = 6,261 to 9,022) designed to measure 9 mental and physical health domains. Using techniques appropriate for handling missing data, we fit a CFA model and a regularized GGM to each test form. We also applied the Walktrap community detection algorithm from EGA. We found weaker correspondence between centrality indices and factor loadings than found by previous research, yet in a similar pattern of correspondence. EGA recommended a factor structure discrepant with PROMIS domains in most cases. Physical Function typically split into two or more clusters; Anger, Anxiety, Depression, and Fatigue often joined as one; and some single-item communities emerged. In real mental and physical health data, strength centrality may offer new information despite being highly related to factor loadings, and EGA provides additional insight on factor and test form composition.

scholarly journals Longitudinal Analysis of Patient-Reported Outcomes in Clinical Trials: Applications of Multilevel and Multidimensional Item Response Theory

Psychometrika ◽  
2021 ◽  
Author(s):  
Li Cai ◽  
Carrie R. Houts
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Latent Variable ◽  
Patient Reported Outcomes ◽  
Multilevel Models ◽  
Latent Variable Models ◽  
Trial Data ◽  
Regulatory Science ◽  
Measurement Information ◽  
Patient Reported

AbstractWith decades of advance research and recent developments in the drug and medical device regulatory approval process, patient-reported outcomes (PROs) are becoming increasingly important in clinical trials. While clinical trial analyses typically treat scores from PROs as observed variables, the potential to use latent variable models when analyzing patient responses in clinical trial data presents novel opportunities for both psychometrics and regulatory science. An accessible overview of analyses commonly used to analyze longitudinal trial data and statistical models familiar in both psychometrics and biometrics, such as growth models, multilevel models, and latent variable models, is provided to call attention to connections and common themes among these models that have found use across many research areas. Additionally, examples using empirical data from a randomized clinical trial provide concrete demonstrations of the implementation of these models. The increasing availability of high-quality, psychometrically rigorous assessment instruments in clinical trials, of which the Patient-Reported Outcomes Measurement Information System (PROMIS®) is a prominent example, provides rare possibilities for psychometrics to help improve the statistical tools used in regulatory science.

scholarly journals How should we define clinically significant improvement on Patient-Reported Outcomes Measurement Information System (PROMIS) for patients undergoing Knee Meniscal Surgery?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0045
Author(s):  
Yining Lu ◽  
Benedict Nwachukwu ◽  
Alexander Beletsky ◽  
Bhavik Patel ◽  
Adam Yanke ◽  
...  
Keyword(s):  
Mental Health ◽  
Information System ◽  
Physical Health ◽  
Patient Reported Outcomes ◽  
Measurement Information ◽  
Outcomes Measurement ◽  
Patient Reported ◽  
Meniscal Surgery ◽  
Measurement Information System ◽  
Clinically Significant

Objectives: The Patient-Reported Outcomes Measurement Information System (PROMIS) attempts to optimize patient reported outcome (PRO) instruments by utilizing item response theory (IRT) and computer adaptive testing (CAT). Relatively little is known about clinically significant outcome (CSO) improvements on the PROMIS Physical Function (PF) CAT. The objective of this study is to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient-acceptable symptom state (PASS) of the PROMIS PF CAT in arthroscopic meniscal surgery. Methods: The PROMIS PF CAT, Short Form-12 Health Survey (SF-12 physical health [PCS] and mental health [MCS]), Veterans Rand-12 Health Survey (VR-12 physical health [PH] and mental health [MH]), and the Marx Activities Ratings Scale were administered pre- and post- operatively to patients undergoing arthroscopic meniscal surgery. Six months postoperatively, patients graded their knee function based on a domain-specific anchor question. Answers to the anchor questions were dichotomized to indicate achievement of SCB and MCID. A satisfaction anchor question was used to indicate achievement of PASS. Receiver operating characteristic (ROC) analysis determined the relevant psychometric values. Cutoff analysis was performed to find preoperative PRO scores predicting CSO achievement. Results: Sixty patients (N = 27, 45% female) were included, with mean age of 45.0 ± 14.0 years and average follow up of 24.0 + 1.2 weeks. The most common indication for knee arthroscopy was partial meniscectomy (N = 53; 88.3%) followed by meniscal repair (N = 7; 11.7%). MCID on PROMIS PF was calculated to be 2.08 (AUC: 0.75, 95% CI: 0.57 - 0.94). Net score improvement equivalent to achievement of SCB was found to be 7.41 (AUC: 0.77, 95% CI: 0.55 – 0.99). PASS was found to be 45.47 (AUC: 0.89, 95% CI: 0.79-0.99). Preoperative score below 37.6 on the PROMIS PF CAT predicted achievement of MCID (AUC: 0.76, 95% CI: 0.64-0.88), while scores above 41.7 predicted achievement of PASS (AUC: 0.76, 95% CI: 0.63-0.89). Absence of pre-existing arthritis and higher baseline functional status were also found to be statistically significant predictors of achieving CSOs. Conclusion: Our study defined MCID, SCB, and PASS, for the PROMIS PF CAT. We found that a pre-operative score below 37.6 was predictive for achieving a meaningful clinical change with surgery, while a pre-operative score above 41.7 was predictive of achievement of an acceptable post-operative health state. [Table: see text][Table: see text][Table: see text][Figure: see text]

Assessment of Disease-Specific and General Patient-Reported Outcome Measures of Hearing Health

2018 ◽  
Vol 158 (4) ◽  
pp. 702-709 ◽  
Author(s):  
Suresh Mohan ◽  
C. Eduardo Corrales ◽  
Bevan Yueh ◽  
Jennifer J. Shin
Keyword(s):  
Mental Health ◽  
Hearing Loss ◽  
Physical Health ◽  
Inner Ear ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Measurement Information ◽  
Item Score ◽  
Patient Reported ◽  
Disease Specific

Objective To assess disease-specific (Inner EAR) and general (Patient-Reported Outcomes Measurement Information System [PROMIS]) health status in patients reporting hearing loss and whether there is enough correlation between scales such that the general instrument alone could suffice. Study Design Correlation analysis of prospective cohort data. Setting Tertiary care academic medical center. Methods Adults presenting with a chief complaint of hearing loss completed the Inner EAR scale and the PROMIS instrument. Summary statistics, including means, percentiles, and measures of variance, were calculated. The Spearman ρ statistic was used to test the null hypothesis that there were no correlations between the Inner EAR composite or global score and PROMIS scores. Results The mean Inner EAR composite score was 35.6, while the global item had a mean score of 4.8. Mean PROMIS-10 scores were 16.0 for physical health and 15.3 for mental health. The global item and social item had mean scores of 3.6 and 3.8, respectively. Inner EAR composite scores were significantly correlated with the PROMIS mental health summary scores (Spearman ρ = 0.3, P = .0066) and the PROMIS social item score (Spearman ρ = 0.4, P = .0005). The Inner EAR global item was moderately correlated with the PROMIS social item score (Spearman ρ = 0.3, P = .0118), while there was no significant correlation between the Inner EAR global item and the PROMIS physical health, mental health, or global item scores. Conclusions Inner EAR and a subset of PROMIS scores have weak to moderate correlations. Disease-specific assessment still confers independent value.

Educational inequality in patient-reported outcomes but not mortality among cardiac patients: Results from the national DenHeart survey with register follow-up

2020 ◽  
Vol 48 (7) ◽  
pp. 781-790
Author(s):  
Anne V. Christensen ◽  
Knud Juel ◽  
Ola Ekholm ◽  
Lars Thrysoee ◽  
Charlotte B. Thorup ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Health ◽  
Hospital Discharge ◽  
Educational Level ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Cardiac Events ◽  
Patient Reported ◽  
Mental And Physical Health

Aims: This study aimed to explore whether educational level is associated with mental and physical health status, anxiety and depression symptoms and quality of life at hospital discharge and predicts cardiac events and all-cause mortality 1 year after hospital discharge in patients with ischaemic heart disease, arrhythmias, heart failure or heart valve disease. Methods: The DenHeart survey is cross-sectional and combined with data from national registers. Information on educational level and co-morbidity at hospital discharge and cardiac events and mortality 1-year post-discharge was obtained from registers. Patient-reported outcomes included SF-12, Hospital Anxiety and Depression Scale and HeartQoL. Multivariate linear and logistic regression and Cox proportional hazards regression models were used. Results: A total of 13,145 patients were included. A significant educational gradient was found in patient-reported mental and physical health status, anxiety and depression symptoms and quality of life, with lower educational groups reporting worse outcomes in adjusted analyses. No association was found between educational level and risk of cardiac events or all-cause mortality within 1 year after hospital discharge in adjusted analyses. Conclusions: In a large population of patients with cardiac disease a significant educational gradient was found in mental and physical health and quality of life at hospital discharge. There was, however, no association between educational level and risk of cardiac events or mortality 1 year after hospital discharge.

scholarly journals A comparison of physical function instruments in psoriatic arthritis: HAQ-DI vs MDHAQ vs PROMIS10 global physical health

Rheumatology ◽  
2020 ◽  
Author(s):  
Marilyn T Wan ◽  
Jessica A Walsh ◽  
Ethan T Craig ◽  
M Elaine Husni ◽  
Jose U Scher ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Physical Health ◽  
Physical Function ◽  
Potential Effect ◽  
Measurement Information ◽  
Change Scores ◽  
Patient Reported ◽  
The Usa ◽  
The Mean ◽  
Research Consortium

Abstract Objectives Physical function is a core outcome in PsA. We examined the construct validity and responsiveness of three commonly used instruments to assess physical function in PsA: HAQ disability index (HAQ-DI), MultiDimensional HAQ (MDHAQ) and the Patient-Reported Outcomes Measurement Information System (PROMIS®) Global-10. Methods Between 2016 and 2019, patients with PsA were enrolled in the Psoriatic Arthritis Research Consortium longitudinal cohort study in the USA. Correlations were calculated at baseline and among change scores using Spearman’s correlation coefficient. Standardized response means were calculated. Agreement with the 20% improvement cut-off was used to determine the potential effect of using MDHAQ or the PROMIS Global-10 physical health (GPH) subscore in place of HAQ-DI when assessing the ACR20. Results A total of 274 patients were included in the analysis. The mean age of patients was 49 years and 51% were male. At baseline, the mean HAQ-DI was 0.6 (s.d. 0.6; range 0–3), the mean MDHAQ was 1.8 (s.d. 1.6; range 0–10) and the mean GPH T-score was 43.4 (s.d. 9.3; range 0–100). All three instruments were strongly correlated at baseline (rho 0.75–0.85). Change scores were moderately correlated (rho 0.42–0.71). Among therapy initiators, the mean change between two visits in HAQ-DI, MDHAQ and GPH was −0.1 (s.d. 0.4), −0.2 (s.d. 1.2) and 2.5 (s.d. 6.1), respectively. The standardized response means were 0.18, 0.16 and 0.41, respectively. Conclusion The three instruments tested are not directly interchangeable but have overall similar levels of responsiveness.

Sign in / Sign up

Export Citation Format

Share Document