Mode of administration does not cause bias in patient-reported outcome results: a meta-analysis
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Technological advances in recent decades have led to the availability of new modes to administer patient-reported outcomes (PROs). To aid selecting optimal modes of administration (MOA), we undertook a systematic review to determine whether differences in bias (both size and direction) exist among modes.
We searched five electronic databases from 2004 (date of last comprehensive review on this topic) to April 2014, cross-referenced and searched reference lists. Studies that compared two or more MOA for a health-related PRO measure in adult samples were included. Two reviewers independently applied inclusion and quality criteria and extracted findings. Meta-analyses and meta-regressions were conducted using random-effects models.
Of 5100 papers screened, 222 were considered potentially relevant and 56 met eligibility criteria. No evidence of bias was found for: (1) paper versus electronic self-complete; and (2) self-complete versus assisted MOA. Heterogeneity for paper versus electronic comparison was explained by type of construct (i.e. physical vs. psychological). Heterogeneity for self-completion versus assisted modes was in part explained by setting (clinic vs. home); the largest bias was introduced when assisted completion occurred in the clinic and follow-up was by self-completion (either electronic or paper) in the home.
Self-complete paper and electronic MOA can be used interchangeably for research in clinic and home settings. Self-completion and assisted completion produce equivalent scores overall, although heterogeneity may be induced by setting. These results support the use of mixed MOAs within a research study, which may be a useful strategy for reducing missing PRO data.
KeywordsSystematic review Patient-reported outcome Mode of administration Bias
We thank HR and LG for their contribution to this project as volunteers. We also acknowledge the support from our faculty librarian, Matthew Davis, in developing the search strategy.
C.R., D.C., R.M.B. and M.K. are supported by the Australian Government through Cancer Australia. No additional funding was sought for this review.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
This article is a secondary analysis of published literature. It does not contain any studies with human participants or animals performed by any of the authors.
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