Methods for interpreting change over time in patient-reported outcome measures

Interpretation guidelines are needed for patient-reported outcome (PRO) measures’ change scores to evaluate efficacy of an
intervention and to communicate PRO results to regulators, patients, physicians, and providers. The 2009 Food and Drug Administration
(FDA) Guidance for Industry Patient–Reported Outcomes (PRO) Measures: Use in Medical Product Development to Support Labeling Claims (hereafter referred to as the final FDA PRO Guidance) provides some recommendations for the interpretation of change in PRO scores as evidence of treatment efficacy.

This article reviews the evolution of the methods and the terminology used to describe and aid in the communication of meaningful
PRO change score thresholds.

Anchor- and distribution-based methods have played important roles, and the FDA has recently stressed the importance of cross-sectional
patient global assessments of concept as anchor-based methods for estimation of the responder definition, which describes
an individual-level treatment benefit. The final FDA PRO Guidance proposes the cumulative distribution function (CDF) of responses as a useful method to depict the effect of treatments across
the study population.

While CDFs serve an important role, they should not be a replacement for the careful investigation of a PRO’s relevant responder
definition using anchor-based methods and providing stakeholders with a relevant threshold for the interpretation of change
over time.