15 General Introduction 1 numbers of patients with the target condition offer valuable insights. At the symptom, functioning, and perceived health levels, patients themselves are the primary experts. The most effective way to gather information from clinicians or patients about relevant items is through focus groups or in-depth interviews. The items should be clear, relevant, and easy for respondents to understand. In practice, steps three and four are intertwined, it is a continuous process of evaluation and adaptation. In step five, scoring issues need to be addressed. Here, it is determined how the responses will be scored and whether any scoring rules or scales need to be established. Step six is about pilot testing the instrument. This involves testing the instrument on a small group of people to identify any potential issues, such as ambiguous questions or scoring inconsistencies. The feedback from this step helps refine the instrument. The final step is field-testing, where the instrument is tested in a larger group to ensure it works as intended in real-world settings. This step also helps evaluate the instrument’s validity and reliability on a broader scale, providing insights into how it performs with a diverse population. Measurement properties of a PROM The different properties of a PROM need to be investigated to ensure its quality. The COSMIN classified and defined the terminology and definitions of measurement properties.17 Figure 2 shows this COSMIN taxonomy, with terms for various measurement properties and their interrelationships. In short Reliability is defined as ‘the degree to which the measurement is free from measurement error’. Validity is defined as ‘the degree to which an instrument truly measures the construct(s) it purports to measure’. And Responsiveness is defined as ‘the ability of an instrument to detect change over time in the construct to be measured’. Implementation of a PROM Acknowledging the importance of individuals’ perspectives on their ear complaints and the impact on the quality of life, it is important to get the PROM implemented into routine care. The implementation of PROMs into routine care is known as a challenging process, as it requires a shift in the clinical practice and changes in the individual behaviour of both healthcare providers and patients.18 The registration of PROMs and other outcome values brings in an administrative burden and if not managed well, this can encroach on the valuable time healthcare
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