97 Quality assessment of patient reported outcome measures for patients with multiple ear complaints 5 Concept elicitation in PROMs refers to the process of systematically gathering information directly from patients about their experiences, symptoms, and perceptions related to a specific health condition or treatment. By actively involving patients in the development of the questionnaire, researchers can ensure that the questionnaire items accurately reflect the patients’ experiences and concerns. The majority of multiple complaint questionnaires assessed in this article lacked good design with concept elicitation and patient involvement, resulting in ongoing (crosscultural) validation of questionnaires. This might be a result the absence of clear guidelines for the development of PROMs, coupled with a prevalent missing focus on aligning patient perspectives, functionality, and the associated burden from a medical standpoint. The COSMIN reporting guideline is an important step towards being able to assess questionnaires on a higher qualitative level.10 The absence of detailed reporting, such as whether appropriate interview guides are used, whether interviews are recorded and transcribed verbatim, and the limited number of patients included in interviews or pilot testing, along with the absence of quality parameters for the interviews, may raise concerns about the reliability of the results. In essence, the overall assessment score for a given measurement property was derived by considering the lowest score among all the items, using the ‘worst score counts’ method. It’s worth noting that more favourable scores on these items might have been attainable had more comprehensive information been provided. inadequate reporting of details is a common shortcoming observed in many studies. While interpretability and feasibility are not considered formal measurement properties because they do not refer to the quality of an instrument they do play a pivotal role in the successful implementation of a PROM.28 Scores and change scores and Minimal Important change (MIC) should be available for relevant (sub) groups (e.g. for normative groups, subgroups of patients or the general population). The interpretability often receives insufficient attention was the conclusion of the COSMIN panel in the COSMIN taxonomy6 in 2010. Furthermore from the standpoint of a practicing clinician, a questionnaire should be quick to administer, concise, user-friendly, and cost-effective, especially in a busy clinical setting. Regrettably, many studies in this article have not placed sufficient emphasis on addressing interpretability and feasibility concerns. Although the current standard of questionnaire development by recent guidelines is high. The current level for applying PROMS to individuals though might be considered higher than on group level. Individual assessments require high measurement
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