Patient- and caregiver-reported 23-item SymTrak scales were validated for monitoring clinically actionable symptoms and impairments associated with multiple chronic conditions (MCCs) in older adults. Items capture physical and emotional symptoms and impairments in physical and cognitive functioning. An abbreviated SymTrak is desirable when response burden is a concern.
Develop and validate the 8-item SymTrak.
Design and Participants
Secondary analysis of SymTrak validation study; 600 participants (200 patient-caregiver dyads; 200 patients without an identified caregiver).
Demographic questions, SymTrak, and Health Utility Index Mark 3 (HUI3).
SymTrak-8 demonstrated good fit to a one-factor model using confirmatory factor analysis (CFA). Concurrent criterion validity was supported by high standardized linear regression coefficients (STB) between baseline SymTrak-8 total score (independent variable) and baseline HUI3 preference-based overall HRQOL utility score (dependent variable; 0 = death, 1 = perfect health), after adjusting for demographics, comorbid conditions, and medications, with strength comparable to SymTrak-23 (STB = − 0.81 and − 0.84, respectively, for SymTrak-8 and SymTrak-23, when patient-reported; and − 0.60 and − 0.62, respectively, when caregiver-reported). Coefficient alpha (0.74; 0.76) and 24-h test–retest reliability (0.83; 0.87) were high for SymTrak-8 for patients and caregivers, respectively. The convergent correlation between brief and parent SymTrak scales was high (0.94). SymTrak-8 demonstrated approximate normality and a linear relationship with SymTrak-23 and HUI3. Importantly, a 3-month change in SymTrak-8 was sensitive to detecting the criterion (3-month reliable change categories; improved, stable, declined in HUI3 overall utility), with results comparable to SymTrak-23.
SymTrak-8 total score demonstrates internal reliably, test–retest reliability, criterion validity, and sensitivity to change that are comparable to SymTrak-23. Thus, patient- or caregiver-reported SymTrak-8 is a viable option for identifying and monitoring the aggregate effect of symptoms and functional impairments in patients with multimorbidity when response burden is a concern.
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Monahan PO, Kroenke K, Callahan CM, et al. Development and feasibility of SymTrak, a multi-domain tool for monitoring symptoms of older adults in primary care. J Gen Intern Med. 2019;34(6):915-922.
Monahan PO, Kroenke K, Callahan CM, et al. Reliability and validity of SymTrak, a multi-domain tool for monitoring symptoms of older adults with multiple chronic conditions. J Gen Intern Med. 2019;34(6):908-914.
Schneider KM, O'Donnell BE, Dean D. Prevalence of multiple chronic conditions in the United States' Medicare population. Health Qual Life Outcomes. 2009;7:82.
Leroy L, Bayliss E, Domino M, et al. The Agency for Healthcare Research and Quality Multiple Chronic Conditions Research Network: overview of research contributions and future priorities. Med Care. 2014;52 Suppl 3:S15-22.
Sha MC, Callahan CM, Counsell SR, Westmoreland GR, Stump TE, Kroenke K. Physical symptoms as a predictor of health care use and mortality among older adults. Am J Med. 2005;118(3):301-306.
Callahan CM, Weiner M, Counsell SR. Defining the domain of geriatric medicine in an urban public health system affiliated with an academic medical center. J Am Geriatr Soc. 2008;56(10):1802-1806.
Kroenke K. Studying symptoms: sampling and measurement issues. Ann Intern Med. 2001;134(9 Pt 2):844-853.
Kessler RC, Zhao S, Katz SJ, et al. Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. Am J Psychiatry. 1999;156:115-123.
Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12:34-43.
Adelman RD, Greene MG, Ory MG. Communication between older patients and their physicians. Clin Geriatr Med. 2000;16(1):1-24, vii.
Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions. Universal health outcome measures for older persons with multiple chronic conditions. J Am Geriatr Soc. 2012;60(12):2333-2341.
Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1:54.
Muthen LK, Muthen BO. Mplus User’s Guide. Eighth Edition. Los Angeles, CA: Muthen & Muthen; 1998-2017.
Hu L-T, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1-55.
Liu SF, Tu DS. On the applications of Fisher's least significant difference (LSD) procedure in three-arm clinical trials with survival endpoints. Drug Inf J. 2008;42(1):81-91.
Coste J, Guillemin F, Pouchot J, Fermanian J. Methodological approaches to shortening composite measurement scales. J Clin Epidemiol. 1997;50(3):247-252.
Goetz C, Coste J, Lemetayer F, et al. Item reduction based on rigorous methodological guidelines is necessary to maintain validity when shortening composite measurement scales. J Clin Epidemiol. 2013;66(7):710-718.
Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153(21):2474-2480.
Kroenke K, Talib TL, Stump TE, et al. Incorporating PROMIS symptom measures into primary care practice - a randomized clinical trial. J Gen Intern Med. 2018;33(8):1245-1252.
Davis LL, Kroenke K, Monahan P, Kean J, Stump TE. The SPADE symptom cluster in primary care patients with chronic pain. Clin J Pain. 2016;32(5):388-393.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12(9):964-973.
Kroenke K, Arrington ME, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Intern Med. 1990;150(8):1685-1689.
Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989;86(3):262-266.
Kroenke K, Spitzer R, Williams JB, et al. Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994;3(9):774-779.
Khan AA, Khan A, Harezlak J, Tu W, Kroenke K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics. 2003;44(6):471-478.
US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608.
Rooth MA. The Prevalence and Impact of Vision and Hearing Loss in the Elderly. N C Med J. 2017;78(2):118-120.
Chia E-M, Mitchell P, Rochtchina E, Foran S, Golding M, Wang JJ. Association Between Vision and Hearing Impairments and Their Combined Effects on Quality of Life. Arch Ophthalmol. 2006;124(10):1465-1470.
Vancampfort D, Koyanagi A, Ward PB, et al. Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. Int J Behav Nutr Phys Act. 2017;14(1):6.
Kroenke K, Monahan PO, Kean J. Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice. J Clin Epidemiol. 2015;68(9):1085-1092.
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
Nunes BP, Flores TR, Mielke GI, Thume E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130-138.
Fabbri E, Zoli M, Gonzalez-Freire M, Salive ME, Studenski SA, Ferrucci L. Aging and Multimorbidity: New Tasks, Priorities, and Frontiers for Integrated Gerontological and Clinical Research. J Am Med Dir Assoc. 2015;16(8):640-647.
Garin N, Koyanagi A, Chatterji S, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205-214.
Pefoyo AJ, Bronskill SE, Gruneir A, et al. The increasing burden and complexity of multimorbidity. BMC Public Health. 2015;15:415.
Bahler C, Huber CA, Brungger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15:23.
Cassell A, Edwards D, Harshfield A, et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2018;68(669):e245-e251.
Palladino R, Tayu Lee J, Ashworth M, Triassi M, Millett C. Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries. Age Ageing. 2016;45(3):431-435.
Besser J, Stropahl M, Urry E, Launer S. Comorbidities of hearing loss and the implications of multimorbidity for audiological care. Hear Res. 2018;369:3-14.
Eckerblad J, Theander K, Ekdahl A, et al. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr. 2015;15:1.
Eckerblad J, Theander K, Ekdahl AW, Jaarsma T. Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study. J Adv Nurs. 2016;72(11):2773-2783.
Gould CE, O'Hara R, Goldstein MK, Beaudreau SA. Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. Int J Geriatr Psychiatry. 2016;31(10):1105-1115.
Helbig AK, Stockl D, Heier M, et al. Relationship between sleep disturbances and multimorbidity among community-dwelling men and women aged 65-93 years: results from the KORA Age Study. Sleep Med. 2017;33:151-159.
Jones SM, Amtmann D, Gell NM. A psychometric examination of multimorbidity and mental health in older adults. Aging Ment Health. 2016;20(3):309-317.
Portz JD, Kutner JS, Blatchford PJ, Ritchie CS. High Symptom Burden and Low Functional Status in the Setting of Multimorbidity. J Am Geriatr Soc. 2017;65(10):2285-2289.
Quinones AR, Markwardt S, Thielke S, Rostant O, Vasquez E, Botoseneanu A. Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity. J Gerontol A Biol Sci Med Sci. 2018;73(2):204-210.
Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: A systematic review and meta-analysis. J Affect Disord. 2017;221:36-46.
Sharpe L, McDonald S, Correia H, et al. Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults. BMC Psychiatry. 2017;17(1):166.
Stubbs B, Vancampfort D, Veronese N, et al. Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries. Psychol Med. 2017;47(12):2107-2117.
Vancampfort D, Koyanagi A, Hallgren M, Probst M, Stubbs B. The relationship between chronic physical conditions, multimorbidity and anxiety in the general population: A global perspective across 42 countries. Gen Hosp Psychiatry. 2017;45:1-6.
Villarreal AE, Grajales S, Lopez L, Britton GB, Panama Aging Research Initiative. Cognitive Impairment, Depression, and Cooccurrence of Both among the Elderly in Panama: Differential Associations with Multimorbidity and Functional Limitations. Biomed Res Int. 2015;2015:718701.
Wang YM, Song M, Wang R, et al. Insomnia and Multimorbidity in the Community Elderly in China. J Clin Sleep Med. 2017;13(4):591-597.
Ryan A, Wallace E, O'Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes. 2015;13:168.
Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;3:CD006560.
Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176.
Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis. 1985;38(1):27-36.
Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727-1736.
Janssen MF, Pickard AS, Golicki D, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717-1727.
Kroenke K. A practical and evidence-based approach to common symptoms: a narrative review. Ann Intern Med. 2014;16(8):579-586.
Aktas A, Walsh D, Rybicki L. Symptom clusters: myth or reality? Palliat Med. 2010;24(4):373-385.
This work was supported by a National Institute on Aging R01 award to P.O.M. (R01 AG043465). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Institute on Aging.
Conflict of Interest
All authors have no financial or non-financial interests. Patrick O. Monahan is Chief Technology Officer and has 3% equity ownership (valued at $3000) in a for-profit company called RestUp. The purpose of RestUp is to use internet and mobile technology to connect caregivers and care seekers. The RestUp caregivers are paid hourly, as 1099 contractors, by care seekers, and RestUp earns its income by receiving a percentage of each hour worked. The present paper has no overlap with the RestUp company; the SymTrak tool developed in the paper is not used in the RestUp company; and none of the activities of the RestUp company are involved in any way with this paper or the SymTrak tool.
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Monahan, P.O., Kroenke, K. & Stump, T.E. SymTrak-8 as a Brief Measure for Assessing Symptoms in Older Adults. J GEN INTERN MED (2020). https://doi.org/10.1007/s11606-020-06329-5
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