Scoping review of measures of treatment burden in patients with multimorbidity: advancements and current gaps

Daniel Mendoza-Quispe, Silvana Perez-Leon, Christoper A. Alarcon-Ruiz, Andrea Gaspar, María Sofía Cuba-Fuentes, Joseph R. Zunt, Victor M. Montori, Juan Carlos Bazo-Alvarez, J. Jaime Miranda

Research output: Contribution to journalReview articlepeer-review


Objectives: To identify, assess, and summarize the measures to assess burden of treatment in patients with multimorbidity (BoT-MMs) and their measurement properties. Study Design and Setting: MEDLINE via PubMed was searched from inception until May 2021. Independent reviewers extracted data from studies in which BoT-MMs were developed, validated, or reported as used, including an assessment of their measurement properties (e.g., validity and reliability) using the COnsensus-based Standards for the selection of health Measurement INstruments. Results: Eight BoT-MMs were identified across 72 studies. Most studies were performed in English (68%), in high-income countries (90%), without noting urban-rural settings (90%). No BoT-MMs had both sufficient content validity and internal consistency; some measurement properties were either insufficient or uncertain (e.g., responsiveness). Other frequent limitations of BoT-MMs included absent recall time, presence of floor effects, and unclear rationale for categorizing and interpreting raw scores. Conclusion: The evidence needed for use of extant BoT-MMs in patients with multimorbidity remains insufficiently developed, including that of suitability for their development, measurement properties, interpretability of scores, and use in low-resource settings. This review summarizes this evidence and identifies issues needing attention for using BoT-MMs in research and clinical practice.

Original languageEnglish
Pages (from-to)92-105
Number of pages14
JournalJournal of Clinical Epidemiology
StatePublished - Jul 2023
Externally publishedYes


  • Chronic disease
  • Cost of illness
  • Multimorbidity
  • Patient-reported outcome measures
  • Scoping review
  • Surveys and questionnaires


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