In Reply: Patient-Reported Outcome Measures in Neurosurgery: A Review of the Current Literature

To the Editor: We thank Schiavolin et al for their comments1 on our article2 and their contributions to the discussion on the utility of PROMs in neurosurgery. As we point out in the paper, our review is limited by the search terms we have used, and we agree that this may have overrepresented certain areas of neurosurgical practice. A major difficulty with this topic is the vast number of studies that utilize PROMs in different contexts, and evaluating their relevance to PROMs in neurosurgery. If we consider the EQ-5D for stroke, this instrument may be used in the context of a hospital admission for stroke (without a neurosurgical intervention), in patients who have undergone a neurosurgical intervention (craniotomy or endovascular treatment), or in patients who have had no contact with a neurosurgical service but have been evaluated for some other aspect of the condition, for example medication use. The challenge is therefore not only to identify the relevant studies but also to organize them in such a way that their utility in devising neurosurgical PROMs can be evaluated. Another challenge is the great variety of items that can be evaluated by a PROM and establishing how one item assessed on a particular PROM relates to the same or similar item on another. For example, pain, disability, wellbeing, anxiety, and economic status can all be interpreted in different ways and there may, in addition, be sociocultural idiosyncrasies which may be difficult to incorporate into a generic instrument. The ultimate goal is to improve the quality of care in neurosurgical patients in the population in which we work. It could be argued that local centers are best positioned to identify the needs of their respective populations and develop their own PROMs based on local factors. Due to the vast literature, one strategy may be to study PROMs within a defined subspecialty area, for example neuro-oncology. In summary, we acknowledge the limitations of our review, and hope that it will encourage further debate on how to embrace this complex but important dimension to the practice of neurosurgery. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.