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Ecological Momentary Computerised Adaptive Testing


Patient-reported outcome measures (PROMs) are questionnaires that measure important elements of health that cannot be observed directly, for example, pain, nausea, or depression. PROMs are important in clinical practice, to tell whether a treatment has made somebody feel better, or in research to compare how effective different treatments are.

A problem with PROMs is that we usually only ask patients to complete them at infrequent and arbitrary time points (e.g. before surgery, at 6 weeks, and again at 3 months). This means that day-to-day changes in symptoms are often missed. This is potentially a big problem in conditions where symptom severity changes from day to day or with certain activities. These conditions include arthritis, mental health issues, inflammatory skin disease, and many cancers.


We are developing a new technique to collect PROM responses more frequently. It is called Ecological Momentary Computerised Adaptive Testing (EMCAT). EMCAT works by using artificial intelligence to make PROM questionnaires much shorter and tailored to an individual, based on their previous responses. By making PROMs shorter, we think that people could complete them at frequent time points (e.g. every day) by using a smartphone app. This will help us capture day-to-day changes in symptom severity. EMCAT has potential benefits for both clinical research (as an outcome measure in clinical trials) and clinical practice (as a tool for clinicians to remotely monitor their patients).

We have received funding from the British Society for Surgery of the Hand, the Federation of European Societies for the Surgery of the Hand, and AOUK to build a smartphone app that uses EMCAT to measure symptoms in people with thumb-base osteoarthritis and in people who have had hand injuries. We will be testing the app in a mix-methods study that is recruiting patients with these conditions in Buckinghamshire and Cardiff. The study is sponsored by the University of Oxford, it has been approved by the Cambridge East Research Ethics Committee, and is supported by the NIHR Clinical Research Network.

We are very open to collaboration with researchers from other fields who think EMCAT might benefit their area of study, and with researchers who are interested in complementary measurement and monitoring strategies (e.g. wearable technology and sensors). We would also love to hear from junior researchers who might be interested in pursuing a PhD in EMCAT.


The study protocol can be found here.


For more information please contact Conrad Harrison.

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