Internal Consistency Reliability of Patient-Reported Outcomes Measurement Information System Measures Used in Symptom Cluster Research: A Systematic Review and Reliability Generalization Meta-Analysis
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Abstract
Background: Patients with acute and chronic conditions often experience multiple symptoms known as symptom clusters. The Patient-Reported Outcomes Measurement Information System (PROMIS) is widely used to assess health status across various conditions, but its suitability for identifying symptom clusters remains unclear. Therefore, we examined the internal consistency reliability of PROMIS tools used to measure symptom clusters in adults through a systematic review and a reliability generalization meta-analysis.
Methods: We searched four electronic databases (PubMed, CINAHL, ProQuest, and Embase) for relevant articles published through December 31, 2024, including studies that measured symptom clusters in adults using at least one PROMIS measure. Meta-regression using a random effects model was performed to assess study heterogeneity, and funnel plots were employed to evaluate publication bias.
Results: The systematic review included 24 studies of 27,982 subjects with or without diseases in community, inpatient, and outpatient settings. Twenty PROMIS domains were used for symptom cluster research, and anxiety and depression were the most frequently used domains. In our reliability generalization meta-analysis of four studies, Cronbach’s alpha coefficients indicated good internal consistency reliability across five PROMIS domains (anxiety, depression, fatigue, pain, and sleep disturbance), with an average reliability of 0.91.
Conclusion: PROMIS measures may be reliable for assessing symptom clusters in adults and could serve as valuable tools for researchers and clinicians in patient assessment and symptom management. Nevertheless, future research should rigorously examine the reliability and validity of PROMIS tools in this context.
Trial Registration Information: CRD42022373953 (PROSPERO).
1. Miaskowski C, Dodd M, Lee K (2004). Symptom clusters: the new frontier in symptom management research. J Natl Cancer Inst Monogr, 32:17-21.
2. Barsevick AM (2007). The elusive concept of the symptom cluster. Oncol Nurs Forum, 34 (5):971-980.
3. Miaskowski C (2016). Future directions in symptom cluster research. Semin Oncol Nurs, 32 (4):405-415.
4. Badger TA, Heitkemper M, Lee KA, et al (2014). An experience with the Patient-Reported Outcomes Measurement In-formation System: pros and cons and unanswered questions. Nurs Outlook, 62 (5):332-338.
5. Alonso J, Bartlett SJ, Rose M, et al (2013). The case for an international patient-reported outcomes measurement infor-mation system (PROMIS®) initiative. Health Qual Life Outcomes, 11:210.
6. Gruber-Baldini AL, Velozo C, Romero S, et al (2017). Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Qual Life Res, 26 (7):1915-1924.
7. Rothrock NE, Amtmann D, Cook KF (2020). Development and validation of an interpretive guide for PROMIS scores. J Patient Rep Outcomes, 4 (1):16.
8. Cella D, Riley W, Stone A, et al (2010). The Patient-Reported Outcomes Measure-ment Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol, 63 (11):1179-1194.
9. Yount SE, Cella D, Blozis S (2019). PRO-MIS®: Standardizing the patient voice in health psychology research and practice. Health Psychol, 38 (5):343-346.
10. Terwee CB, Zuidgeest M, Vonkeman HE, et al (2021). Common patient-reported out-comes across ICHOM Standard Sets: the potential contribution of PROMIS®. BMC Med Inform Decis Mak, 21 (1):259.
11. Kroenke K, Haggstrom D, Monahan P, et al. (2018). Does Sharing Patient-Reported Outcomes with Doctors Improve Patient Symp-toms?. Patient-Centered Outcomes Re-search Institute (PCORI). https://doi.org/10.25302/5.2018.ME.140312043
12. Corwin EJ, Moore SM, Plotsky A, et al (2017). Feasibility of combining com-mon data elements across studies to test a hypothesis. J Nurs Scholarsh, 49 (3):249-258.
13. Jones FJS, Ezzeddine FL, Herman ST, et al (2020). A feasibility assessment of func-tioning and quality-of-life patient-reported outcome measures in adult epi-lepsy clinics: A systematic review. Epilep-sy Behav, 102:106704.
14. Kalantar-Zadeh K, Lockwood MB, Rhee CM, et al (2022). Patient-centred ap-proaches for the management of un-pleasant symptoms in kidney disease. Nat Rev Nephrol, 18(3):185-198.
15. Evans JP, Smith A, Gibbons C, et al (2018). The National Institutes of Health Pa-tient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK. Patient Relat Outcome Meas, 9:345-352.
16. Cooper H (2015). Research synthesis and meta-analysis: A step-by-step approach. 5th ed. Sage publications, Inc.
17. Elsman EBM, Butcher NJ, Mokkink LB, et al (2022). Study protocol for developing, piloting and disseminating the PRISMA-COSMIN guideline: a new reporting guideline for systematic reviews of out-come measurement instruments. Syst Rev, 11 (1):121.
18. Prinsen CAC, Mokkink LB, Bouter LM, et al (2018). COSMIN guideline for systemat-ic reviews of patient-reported outcome measures. Qual Life Res, 27 (5):1147-1157.
19. Breazeale S, Conley S, Jeon S, et al (2022). Symptom cluster profiles following traumatic orthopaedic injuries. Injury, 53 (7):2524-2532.
20. Lee L, Ross A, Griffith K, et al (2020). Symptom clusters in breast cancer survi-vors: A latent class profile analysis. Oncol Nurs Forum, 47 (1):89-100.
21. Shensa A, Sidani JE, Dew MA, et al (2018). Social media use and depression and anxiety symptoms: A cluster analysis. Am J Health Behav, 42 (2):116-128.
22. Starcevic V, Baggio S, Berle D, et al (2019). Cyberchondria and its relationships with related constructs: A network analy-sis. Psychiatr Q, 90 (3):491-505.
23. de Graaff AM, Cuijpers P, Leeflang M, et al (2021). A systematic review and meta-analysis of diagnostic test accuracy stud-ies of self-report screening instruments for common mental disorders in Ara-bic-speaking adults. Glob Ment Health (Camb), 8:e43.
24. Barrientos-Trigo S, Gil-García E, Romero-Sánchez JM, et al (2019). Evaluation of psychometric properties of instruments measuring nursing-sensitive outcomes: a systematic review. Int Nurs Rev, 66(2):209-223.
25. Whiting PF, Rutjes AW, Westwood ME, et al (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic ac-curacy studies. Ann Intern Med, 155 (8):529-536.
26. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, et al (2006). Assessing heter-ogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods, 11 (2):193-206.
27. Pustejovsky JE, Rodgers MA (2019). Testing for funnel plot asymmetry of standard-ized mean differences. Res Synth Methods, 10 (1):57-71.
28. Egger M, Davey SG, Schneider M, et al (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315 (7109):629-634.
29. Sterne JA, Egger M (2001). Funnel plots for detecting bias in meta-analysis: guide-lines on choice of axis. J Clin Epidemiol, 54 (10):1046-1055.
30. Conley S, Jeon S, Proctor DD, et al (2018). Longitudinal changes in symptom clus-ter membership in inflammatory bowel disease. J Nurs Scholarsh, 50 (5):473-481.
31. Conley S, Proctor DD, Jeon S, et al (2017). Symptom clusters in adults with in-flammatory bowel disease. Res Nurs Health, 40 (5):424-434.
32. Henneghan A, Wright ML, Bourne G, et al (2021). A cross-sectional exploration of cytokine-symptom networks in breast cancer survivors using network analysis. Can J Nurs Res, 53 (3):303-315.
33. Reeve BB, Tan X, Chen RC, et al (2018). Symptom and function profiles of men with localized prostate cancer. Cancer, 124 (13):2832-2840.
34. Stone AL, Holley AL, Dieckmann NF, et al (2019). Use of the PROMIS-29® to iden-tify subgroups of mothers with chronic pain. Health Psychol, 38 (5):422-430.
35. Vivier H, Ross EJ, Cassisi JE (2020). Classi-fication of gastrointestinal symptom patterns in young adults. BMC Gastroen-terol, 20 (1):326.
36. Katzan IL, Schuster A, Bain M, et al (2019). Clinical symptom profiles after mild-moderate stroke. J Am Heart Assoc, 8 (11):e012421.
37. Kent ML, Giordano NA, Rojas W, et al (2022). Multidimensional perioperative recovery trajectories in a mixed surgical cohort: A longitudinal cluster analysis utilizing National Institutes of Health Patient-Reported Outcome Measure-ment Information System measures. Anesth Analg, 134 (2):279-290.
38. Lapin B, Davin S, Stilphen M, et al (2022). Stratification of spine patients based on self-reported clinical symptom classes. Spine J, 22 (7):1131-1138.
39. Lee LJ, Son H, Wallen GR, et al (2023). Symptom clusters in family caregivers of hematopoietic stem cell transplanta-tion recipients: Loneliness as a risk fac-tor. Transplant Cell Ther, 29 (1):50.e1-50.e8.
40. Lee LJ, Wehrlen L, Wallen GR, et al (2021). Symptom clusters and influencing fac-tors in family caregivers of individuals with cancer. Cancer Nurs, 44 (6):E547-E555.
41. Li H, Lockwood MB, Schlaeger JM, et al (2023). Tryptophan and kynurenine pathway metabolites and psychoneuro-logical symptoms among breast cancer survivors. Pain Manag Nurs, 24 (1):52-59.
42. Matura LA, Fargo JD, Boyle K, et al (2022). Symptom phenotypes in pulmonary ar-terial hypertension: The PAH "symp-tome". Pulm Circ, 12(3):e12135.
43. McDowell L, Casswell G, Bressel M, et al (2021). Symptom burden, quality of life, functioning and emotional distress in survivors of human papillomavirus as-sociated oropharyngeal cancer: An Aus-tralian cohort. Oral Oncol, 122:105560.
44. Patidar KR, Thacker LR, Wade JB, et al (2017). Symptom domain groups of the Patient-Reported Outcomes Measure-ment Information System tools inde-pendently predict hospitalizations and re-hospitalizations in cirrhosis. Dig Dis Sci, 62 (5):1173-1179.
45. Lapin B, Li Y, Englund K, et al (2024). Health-related quality of life for pa-tients with post-acute COVID-19 syn-drome: Identification of symptom clusters and predictors of long-term outcomes. J Gen Intern Med, 39 (8):1301-1309.
46. Goto T, Saligan LN, Juneau P, et al (2024). Characterization of cancer survivors clustered by subjective and objective cognitive function scores. Cancer Med, 13 (12):e7255.
47. Han CJ, Saligan L, Crouch A, et al (2023). Latent class symptom profiles of colorectal cancer survivors with cancer-related cognitive impairment. Support Care Cancer, 31 (10):559.
48. Troost JP, Gipson DS, Carlozzi NE, et al (2019). Using PROMIS® to create clinically meaningful profiles of ne-phrotic syndrome patients. Health Psy-chol, 38 (5):410-421.
49. Rimmele DL, Schrage T, Lebherz L, et al (2021). Profiles of patients' self-reported health after acute stroke. Neurol Res Pract, 3 (1):43.
50. Ameringer S, Elswick RK Jr, Menzies V, et al (2016). Psychometric evaluation of the Patient-Reported Outcomes Measure-ment Information System fatigue-short form across diverse populations. Nurs Res, 65 (4):279-289.
51. Stone AA, Broderick JE, Junghaenel DU, et al (2016). PROMIS fatigue, pain intensity, pain interference, pain behavior, physi-cal function, depression, anxiety, and anger scales demonstrate ecological va-lidity. J Clin Epidemiol, 74:194-206.
52. Vilagut G, Forero CG, Adroher ND, et al (2015). Testing the PROMIS® Depres-sion measures for monitoring depres-sion in a clinical sample outside the US. J Psychiatr Res, 68:140-150.
53. Schalet BD, Rothrock NE, Hays RD, et al (2016). Validity of PROMIS physical function measures in diverse clinical samples. J Clin Epidemiol, 73:112-118.
54. Elsener S, Steinemann N, Wertli MM, et al (2025). A COSMIN systematic review of generic patient-reported outcome measures in Switzerland. Qual Life Res, 34:1869-1884.
55. Waltz CF, Strickland O, Lenz ER, et al (2016). Measurement in Nursing and Health Research. 5th ed. Springer Publishing Company, New York.
56. DeVellis RF (2016). Scale development: Theory and applications. 4th ed. Sage Publications, Inc.
57. Yu L, Buysse DJ, Germain A, et al (2011). Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behav Sleep Med, 10 (1):6-24.
58. Davis LL, Kroenke K, Monahan P, et al (2016). The SPADE symptom cluster in primary care patients with chronic pain. Clin J Pain, 32 (5):388-393.
59. Feng LR, Dickinson K, Kline N, et al (2016). Different phenotyping approaches lead to dissimilar biologic profiles in men with chronic fatigue after radiation therapy. J Pain Symptom Manage, 52 (6):832-840.
2. Barsevick AM (2007). The elusive concept of the symptom cluster. Oncol Nurs Forum, 34 (5):971-980.
3. Miaskowski C (2016). Future directions in symptom cluster research. Semin Oncol Nurs, 32 (4):405-415.
4. Badger TA, Heitkemper M, Lee KA, et al (2014). An experience with the Patient-Reported Outcomes Measurement In-formation System: pros and cons and unanswered questions. Nurs Outlook, 62 (5):332-338.
5. Alonso J, Bartlett SJ, Rose M, et al (2013). The case for an international patient-reported outcomes measurement infor-mation system (PROMIS®) initiative. Health Qual Life Outcomes, 11:210.
6. Gruber-Baldini AL, Velozo C, Romero S, et al (2017). Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Qual Life Res, 26 (7):1915-1924.
7. Rothrock NE, Amtmann D, Cook KF (2020). Development and validation of an interpretive guide for PROMIS scores. J Patient Rep Outcomes, 4 (1):16.
8. Cella D, Riley W, Stone A, et al (2010). The Patient-Reported Outcomes Measure-ment Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol, 63 (11):1179-1194.
9. Yount SE, Cella D, Blozis S (2019). PRO-MIS®: Standardizing the patient voice in health psychology research and practice. Health Psychol, 38 (5):343-346.
10. Terwee CB, Zuidgeest M, Vonkeman HE, et al (2021). Common patient-reported out-comes across ICHOM Standard Sets: the potential contribution of PROMIS®. BMC Med Inform Decis Mak, 21 (1):259.
11. Kroenke K, Haggstrom D, Monahan P, et al. (2018). Does Sharing Patient-Reported Outcomes with Doctors Improve Patient Symp-toms?. Patient-Centered Outcomes Re-search Institute (PCORI). https://doi.org/10.25302/5.2018.ME.140312043
12. Corwin EJ, Moore SM, Plotsky A, et al (2017). Feasibility of combining com-mon data elements across studies to test a hypothesis. J Nurs Scholarsh, 49 (3):249-258.
13. Jones FJS, Ezzeddine FL, Herman ST, et al (2020). A feasibility assessment of func-tioning and quality-of-life patient-reported outcome measures in adult epi-lepsy clinics: A systematic review. Epilep-sy Behav, 102:106704.
14. Kalantar-Zadeh K, Lockwood MB, Rhee CM, et al (2022). Patient-centred ap-proaches for the management of un-pleasant symptoms in kidney disease. Nat Rev Nephrol, 18(3):185-198.
15. Evans JP, Smith A, Gibbons C, et al (2018). The National Institutes of Health Pa-tient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK. Patient Relat Outcome Meas, 9:345-352.
16. Cooper H (2015). Research synthesis and meta-analysis: A step-by-step approach. 5th ed. Sage publications, Inc.
17. Elsman EBM, Butcher NJ, Mokkink LB, et al (2022). Study protocol for developing, piloting and disseminating the PRISMA-COSMIN guideline: a new reporting guideline for systematic reviews of out-come measurement instruments. Syst Rev, 11 (1):121.
18. Prinsen CAC, Mokkink LB, Bouter LM, et al (2018). COSMIN guideline for systemat-ic reviews of patient-reported outcome measures. Qual Life Res, 27 (5):1147-1157.
19. Breazeale S, Conley S, Jeon S, et al (2022). Symptom cluster profiles following traumatic orthopaedic injuries. Injury, 53 (7):2524-2532.
20. Lee L, Ross A, Griffith K, et al (2020). Symptom clusters in breast cancer survi-vors: A latent class profile analysis. Oncol Nurs Forum, 47 (1):89-100.
21. Shensa A, Sidani JE, Dew MA, et al (2018). Social media use and depression and anxiety symptoms: A cluster analysis. Am J Health Behav, 42 (2):116-128.
22. Starcevic V, Baggio S, Berle D, et al (2019). Cyberchondria and its relationships with related constructs: A network analy-sis. Psychiatr Q, 90 (3):491-505.
23. de Graaff AM, Cuijpers P, Leeflang M, et al (2021). A systematic review and meta-analysis of diagnostic test accuracy stud-ies of self-report screening instruments for common mental disorders in Ara-bic-speaking adults. Glob Ment Health (Camb), 8:e43.
24. Barrientos-Trigo S, Gil-García E, Romero-Sánchez JM, et al (2019). Evaluation of psychometric properties of instruments measuring nursing-sensitive outcomes: a systematic review. Int Nurs Rev, 66(2):209-223.
25. Whiting PF, Rutjes AW, Westwood ME, et al (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic ac-curacy studies. Ann Intern Med, 155 (8):529-536.
26. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, et al (2006). Assessing heter-ogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods, 11 (2):193-206.
27. Pustejovsky JE, Rodgers MA (2019). Testing for funnel plot asymmetry of standard-ized mean differences. Res Synth Methods, 10 (1):57-71.
28. Egger M, Davey SG, Schneider M, et al (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315 (7109):629-634.
29. Sterne JA, Egger M (2001). Funnel plots for detecting bias in meta-analysis: guide-lines on choice of axis. J Clin Epidemiol, 54 (10):1046-1055.
30. Conley S, Jeon S, Proctor DD, et al (2018). Longitudinal changes in symptom clus-ter membership in inflammatory bowel disease. J Nurs Scholarsh, 50 (5):473-481.
31. Conley S, Proctor DD, Jeon S, et al (2017). Symptom clusters in adults with in-flammatory bowel disease. Res Nurs Health, 40 (5):424-434.
32. Henneghan A, Wright ML, Bourne G, et al (2021). A cross-sectional exploration of cytokine-symptom networks in breast cancer survivors using network analysis. Can J Nurs Res, 53 (3):303-315.
33. Reeve BB, Tan X, Chen RC, et al (2018). Symptom and function profiles of men with localized prostate cancer. Cancer, 124 (13):2832-2840.
34. Stone AL, Holley AL, Dieckmann NF, et al (2019). Use of the PROMIS-29® to iden-tify subgroups of mothers with chronic pain. Health Psychol, 38 (5):422-430.
35. Vivier H, Ross EJ, Cassisi JE (2020). Classi-fication of gastrointestinal symptom patterns in young adults. BMC Gastroen-terol, 20 (1):326.
36. Katzan IL, Schuster A, Bain M, et al (2019). Clinical symptom profiles after mild-moderate stroke. J Am Heart Assoc, 8 (11):e012421.
37. Kent ML, Giordano NA, Rojas W, et al (2022). Multidimensional perioperative recovery trajectories in a mixed surgical cohort: A longitudinal cluster analysis utilizing National Institutes of Health Patient-Reported Outcome Measure-ment Information System measures. Anesth Analg, 134 (2):279-290.
38. Lapin B, Davin S, Stilphen M, et al (2022). Stratification of spine patients based on self-reported clinical symptom classes. Spine J, 22 (7):1131-1138.
39. Lee LJ, Son H, Wallen GR, et al (2023). Symptom clusters in family caregivers of hematopoietic stem cell transplanta-tion recipients: Loneliness as a risk fac-tor. Transplant Cell Ther, 29 (1):50.e1-50.e8.
40. Lee LJ, Wehrlen L, Wallen GR, et al (2021). Symptom clusters and influencing fac-tors in family caregivers of individuals with cancer. Cancer Nurs, 44 (6):E547-E555.
41. Li H, Lockwood MB, Schlaeger JM, et al (2023). Tryptophan and kynurenine pathway metabolites and psychoneuro-logical symptoms among breast cancer survivors. Pain Manag Nurs, 24 (1):52-59.
42. Matura LA, Fargo JD, Boyle K, et al (2022). Symptom phenotypes in pulmonary ar-terial hypertension: The PAH "symp-tome". Pulm Circ, 12(3):e12135.
43. McDowell L, Casswell G, Bressel M, et al (2021). Symptom burden, quality of life, functioning and emotional distress in survivors of human papillomavirus as-sociated oropharyngeal cancer: An Aus-tralian cohort. Oral Oncol, 122:105560.
44. Patidar KR, Thacker LR, Wade JB, et al (2017). Symptom domain groups of the Patient-Reported Outcomes Measure-ment Information System tools inde-pendently predict hospitalizations and re-hospitalizations in cirrhosis. Dig Dis Sci, 62 (5):1173-1179.
45. Lapin B, Li Y, Englund K, et al (2024). Health-related quality of life for pa-tients with post-acute COVID-19 syn-drome: Identification of symptom clusters and predictors of long-term outcomes. J Gen Intern Med, 39 (8):1301-1309.
46. Goto T, Saligan LN, Juneau P, et al (2024). Characterization of cancer survivors clustered by subjective and objective cognitive function scores. Cancer Med, 13 (12):e7255.
47. Han CJ, Saligan L, Crouch A, et al (2023). Latent class symptom profiles of colorectal cancer survivors with cancer-related cognitive impairment. Support Care Cancer, 31 (10):559.
48. Troost JP, Gipson DS, Carlozzi NE, et al (2019). Using PROMIS® to create clinically meaningful profiles of ne-phrotic syndrome patients. Health Psy-chol, 38 (5):410-421.
49. Rimmele DL, Schrage T, Lebherz L, et al (2021). Profiles of patients' self-reported health after acute stroke. Neurol Res Pract, 3 (1):43.
50. Ameringer S, Elswick RK Jr, Menzies V, et al (2016). Psychometric evaluation of the Patient-Reported Outcomes Measure-ment Information System fatigue-short form across diverse populations. Nurs Res, 65 (4):279-289.
51. Stone AA, Broderick JE, Junghaenel DU, et al (2016). PROMIS fatigue, pain intensity, pain interference, pain behavior, physi-cal function, depression, anxiety, and anger scales demonstrate ecological va-lidity. J Clin Epidemiol, 74:194-206.
52. Vilagut G, Forero CG, Adroher ND, et al (2015). Testing the PROMIS® Depres-sion measures for monitoring depres-sion in a clinical sample outside the US. J Psychiatr Res, 68:140-150.
53. Schalet BD, Rothrock NE, Hays RD, et al (2016). Validity of PROMIS physical function measures in diverse clinical samples. J Clin Epidemiol, 73:112-118.
54. Elsener S, Steinemann N, Wertli MM, et al (2025). A COSMIN systematic review of generic patient-reported outcome measures in Switzerland. Qual Life Res, 34:1869-1884.
55. Waltz CF, Strickland O, Lenz ER, et al (2016). Measurement in Nursing and Health Research. 5th ed. Springer Publishing Company, New York.
56. DeVellis RF (2016). Scale development: Theory and applications. 4th ed. Sage Publications, Inc.
57. Yu L, Buysse DJ, Germain A, et al (2011). Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behav Sleep Med, 10 (1):6-24.
58. Davis LL, Kroenke K, Monahan P, et al (2016). The SPADE symptom cluster in primary care patients with chronic pain. Clin J Pain, 32 (5):388-393.
59. Feng LR, Dickinson K, Kline N, et al (2016). Different phenotyping approaches lead to dissimilar biologic profiles in men with chronic fatigue after radiation therapy. J Pain Symptom Manage, 52 (6):832-840.
| Files | ||
| Issue | Vol 55 No 1 (2026) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v55i1.20968 | |
| Keywords | ||
| Symptom management Internal consistency reliability Systematic review Meta-analyses | ||
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How to Cite
1.
Jun J, Sung C, Park C. Internal Consistency Reliability of Patient-Reported Outcomes Measurement Information System Measures Used in Symptom Cluster Research: A Systematic Review and Reliability Generalization Meta-Analysis. Iran J Public Health. 2026;55(1):1-13.
