PRO instrument and its types - Pubrica
                     PRO 
INSTRUMENT  
AND ITS TYPES
An Academic presentation by
Dr. Nancy Agens, Head, Technical Operations, 
Pubrica  Group:
www.pubrica.com
Email: [email protected]
Today's 
Discussion
Outlin
e Introduction Population Specific
PRO Instrument Dimension Specific  
Types of PRO Individualized PRO 
Instruments  Generic Instrument  Summary Items
PRO Instrument  Utility Measures
Disease Specific
Introductio
n
Patient-Reported Outcomes (PROs) is “ a unique health status indicator that reveals the 
 current and past scenarios of a ones health condition by the patient them self, without any 
 other interpretation.
“Patient-Reported Outcome” (PRO) is considered a broad phenomenon, encompassing 
 various factors of perceiving and quantifying a person’s health status, which includes  
health related quality of life (HRQOL), social well being and clinical trials.
This self- appraisal system is high essential to identify the best practices of a health care 
 that is qualified to be a good outcome leading to a patient centered health care system .
PRO 
Instrument
A PRO instrument is a rating scale that critically evaluates the health outcomes, 
 satisfaction scores etc in a patients viewpoint.
PRO instruments are considered as a primordial quality indicator for health care 
 service, which gives valuable insights to the policy makers, demand market and  
clinical researchers.
Literature has identified several crucial factors for development of a PRO 
 instrument namely
1. Study parameters should hold strong literature support
Contd..
2. Should possess a conceptual structure
3. Should be drafted based on a end-point model
4. Study must possess ideal number of study items
5. The model should conceal identity of the patients
6. Reproducible at any given point of time
7. The questionnaire should be simplified and understandable to the patients
The universal availability of the content is expected to bring upon striking changes in the 
 policies by the regulatory authorities, drug developers, researchers, technologists and 
 be used for advanced clinical trials over the time.
Types of PRO 
Instruments
Generic Individualized
Disease specific  Summary items 
Population specific  Utility 
 Dimension measures
specific
Generic PRO 
Instrument
Generic PRO instruments are used to measure broad health aspects, illness outcomes 
and  are applicable for a wide spectrum of patient groups and population across the 
countries.
The key benefits of generic PRO instrument is that they are ideally suitable to evaluate large 
 number of health disorders and can be used for comparative studies among different  
patient groups, treatment methods to determine the competency of the models.
This instrument is less sensitive as compared to other models.
Classic examples may include SF-36, which studies the physical and mental component  
of health in an 8-dimensional scoring matrix, Psychological General Well-Being Index.
Disease 
Specific
This instrument aims to estimate the patient's view of a specific disease or disorder
Specific instruments are made developed targeting specific health ailments.
For example: Rheumatoid Arthritis Quality of Life questionnaire (RAQoL) developed 
 to evaluate the patient purview of health care and quality of life with Rheumatoid  
Arthritis, activity limitations, emotional function, and environmental vulnerability.
Population 
Specific
Population-specific instrument are developed targeting a specific demographic group 
 and geographic groups.
The term “Population specific” can be classified based on disease condition, treatment 
 methods, population and geography.
The population specific PRO is a sensitive tool is developed in precise manner to 
 obtain information’s in a narrowed window.
Example: The Child Health and Illness Profile/CHIP developed for adolescents; 
 Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR)
Dimension 
Specific
Dimension-specific instrument evaluates a particular aspect of a person’s health.
The classic examples are physical function, psychological wellness, personal 
 strengths, global health perspectives, specific role based perceptions.
This instrument is resourceful in providing specific information as compared to the 
 generic or population specific PRO instruments and they are highly competent.
It provides wide range of reliable data for a better interpretation.
Individualized PRO 
Instrument
Individualized instruments enable patients to frame their own choice of items and can 
 evaluate the significance of individual items.
It basically responds to the concerns of the individual patient and not based on any
health standard.
Therefore individualized instruments are known to have higher content validity.
Classic example of this PRO instrument is: The Patient Generated Index where the  
respondents are asked to list the five most important areas of their lives; 
Schedule for  the Evaluation of Individual Quality of Life (SEIQoL)
Summary 
Items
Summary item is a versatile PRO instrument where respondents are asked to 
 consolidate the varied aspect of health condition via a single item.
It is less time consuming and is used to get inputs from large sample groups of a 
 general population leading to ample correlative evidences.
Summary item restricts the specific inferences that can be made on a specific health 
 disorder, which is due to its conciseness.
Example: Questions in General Household Survey; the General Household Survey for 
 England and Wales on chronic illness and disability.
Utility 
Measures
Utility measures, involves choice or values pertaining to an individual health 
 condition and represents it as a single index/score.
This PRO instrument evaluates the overall strength of health status in a society and is 
 used for cost-utility analysis.
It is used to compare treatment methods of different health problems and its
economic evaluation.
Example: The EuroQol EQ-5D contains five items namely mobility, 
pain/discomfort  and anxiety/depression; Utility measure for major, unipolar 
depression.
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