Beyond Proms: Ecological Momentary Computerized Adaptive Testing (Emcat)

Patient Reported Outcome Measures (PROM's) such as for instance the Oxford Knee Score (OKS), Hip Disability and Osteoarthritis Outcome Score (HOOS) or the Forgotten Joint Score (FJS) are popular instruments to assess patient outcome in clinical trials, however only in an episodic (e.g. monthly/quarterly) and retrospective manner instead of being momentary. Even in their short forms or when transferred from paper to digital, the patient adherence (response rate) and completion rate are low and decrease in longitudinal assessments as too many questions and answer options appear irrelevant at various stages of disease or recovery. This presentation explains how advanced technology, computerized adaptive testing (CAT) and an alternative method, ecological momentary assessment (EMA) together can overcome these limitations and promise to deliver a high frequency assessment of patient outcomes with only a few algorithmically (including artificial intelligence) selected and targeted questions. The combination, Ecological Momentary Computerised Adaptive Testing (EMCAT) make PROM questionnaires much shorter and tailored to an individual, based on their previous responses. This approach reduces the patient burden to respond, can increase the frequency of assessment (including daily) and thus help to capture short-term, including day-to-day changes in symptom severity which may be critical for timely intervention. The app-based tool and applications in various clinical studies are presented.