270 Chapter 9 PROMIS The PROMIS pediatric measures, especially the Computerized Adaptive Tests (CAT), are promising in reducing the burden of completing PROMs. In Chapter 7, we assessed the psychometric properties of the PROMIS pediatric measures, were it was shown that these measures were reliable and feasible for use in clinical practice. The validity and reliability of the PROMIS pediatric measures were comparable to the validation studies of the Dutch-Flemish PROMIS group (30, 31). However, a known problem of the PROMIS pediatric measures is that the number of PROMIS items administered is still relatively high. Especially, patients with no problems or complaints have to answer the maximum amount of items to reach the CAT stopping rule (SE ≤ 3.2 and/or a maximum of 12 items). This problem arises due to limited availability of items on the high or low end of the scale and patients with no complaints are therefore more difficult to measure reliably (32). Future research is necessary to optimize the CAT stopping rule and to further reduce the burden of completing PROMs in clinical care (32, 33). Despite this limitation, the PROMIS pediatric measures have been implemented in the KLIK PROM portal and are used by some health care teams in clinical care and/ or research (34-36). The experiences of the first groups using PROMIS in the KLIK PROM portal are mixed. The groups are positive about the idea of PROMIS; shorter PROMs that are more tailored to the individual. However, problems with the CAT stopping rules hinder successful implementation in clinical practice. In addition, studies showed that individual item feedback is essential for clinicians to start the conversation with patients, to understand the PROMIS domain scores, and to easily detect problems (37). In a CAT, not all items of an item bank are administered to patients which can lead to confusion with interpreting the feedback. In addition, domain scores are not always understood. Therefore, clinicians need more training in interpreting the results and the use of this new method of administering PROMs. The use of the PROMIS measures is in line with a shift towards the use of generic PROMs (38). Recently, Kennisplatform Uitkomstgerichte Zorg (www. platformuitkomstgerichtezorg.nl) published an advice report for a generic PROM core set for children and adults, in which the use of the PROMIS measures is advised (39). Worldwide standardization of PROMs will facilitate the uptake as it realizes the comparisons between different patient populations and the general population (40). Therefore, Kennisplatform Uitkomstgerichte Zorg advises to use the generic
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