Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review.
OBJECTIVE
Patient-reported outcomes (PROs; self-report assessments) are increasingly important in evaluating medical care and treatment efficacy. Electronic administration of PROs via computer is becoming widespread. This article reviews the literature addressing whether computer-administered tests are equivalent to their paper-and-pencil forms.


METHODS
Meta-analysis was used to synthesize 65 studies that directly assessed the equivalence of computer versus paper versions of PROs used in clinical trials. A total of 46 unique studies, evaluating 278 scales, provided sufficient detail to allow quantitative analysis.


RESULTS
Among 233 direct comparisons, the average mean difference between modes averaged 0.2% of the scale range (e.g., 0.02 points on a 10-point scale), and 93% were within +/-5% of the scale range. Among 207 correlation coefficients between paper and computer instruments (typically intraclass correlation coefficients), the average weighted correlation was 0.90; 94% of correlations were at least 0.75. Because the cross-mode correlation (paper vs. computer) is also a test-retest correlation, with potential variation because of retest, we compared it to the within-mode (paper vs. paper) test-retest correlation. In four comparisons that evaluated both, the average cross-mode paper-to-computer correlation was almost identical to the within-mode correlation for readministration of a paper measure (0.88 vs. 0.91).


CONCLUSIONS
Extensive evidence indicates that paper- and computer-administered PROs are equivalent.
Gwaltney
Chad J
CJ
Brown University, Providence, RI, USA, and PRO Consulting, Pittsburgh, PA, USA. chad_gwaltney@brown.edu
Shields
Alan L
AL
Shiffman
Saul
S
D034201:Computers, Handheld; D003625:Data Collection / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D013223:Statistics as Topic