Reducing barriers to Patient Reported Outcome Measures for people with cognitive impairments

Publication date: Available online 8 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jessica M. Kramer, Ariel Schwartz
The field of rehabilitation has increasingly called for the use of patient reported outcome measures (PROMs) in research and practice. Given that many rehabilitation clients present with conditions associated with cognitive impairments, it is imperative to reduce barriers to PROM use for this population. The purpose of this paper is develop a comprehensive understanding of cognitive accessibility that can prospectively inform the design of PROMs. We put forth the following definition of cognitive accessibility for PROMs: Cognitive accessibility is present when assessment design anticipates respondent variability in cognitive abilities and, to the greatest extent possible, reduces cognitive demands and/or supports cognitive processes to enable respondents with a range of cognitive abilities to interpret and respond to assessment items as intended. Our operationalization of cognitive accessibility in measurement in the field of rehabilitation is informed by two assumptions: 1) cognitive accessibility results from an interaction between the individual's capacities and the demands of the assessment and assessment context, and 2) individuals with cognitive impairments have the right to be involved in decisions about their lives, including healthcare decisions. This paper proposes three design features that can be optimized for cognitive accessibility: content, layout, and administration procedures. We end with a discussion of next steps that the field of rehabilitation measurement can undertake to advance our understanding of cognitive accessibility.



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