Measure Your Medical Outcome Profile (MYMOP2)

1. Abstract

The Measure Your Medical Outcome Profile (MYMOP) and its updated iteration, the MYMOP2, represent landmark innovations in the field of patient-reported outcome measures (PROMs) and patient-generated outcome measures (PGOMs). Developed by Dr. Charlotte Paterson in the mid-1990s at the University of Bristol, the instrument was engineered to overcome the structural limitations of standardized, nomothetic health-related quality of life (HRQoL) instruments—such as the Short Form 36 (SF-36) and EuroQol-5D (EQ-5D)—which frequently fail to capture idiosyncratic symptoms and functional limitations central to individual patients suffering from chronic, complex, or multi-morbid conditions. The MYMOP2 employs an idiographic measurement model consisting of four core evaluative items: two patient-nominated physical or psychological symptoms (Symptom 1 and Symptom 2), one patient-nominated functional activity impaired by their condition (Activity), and a standardized assessment of general wellbeing (Wellbeing). Each core dimension is quantified using a 7-point Likert-type scale ranging from 0 (“As good as it could be”) to 6 (“As bad as it could be”). In addition, contextual parameters evaluate symptom chronicity and prescription medication use without biasing the core mathematical composite.

Psychometric evaluations demonstrate that the MYMOP2 exhibits exceptional responsiveness to clinical change, regularly producing standardized response means (SRMs) and effect sizes exceeding those of fixed-item generic instruments. Construct and convergent validity have been confirmed across primary care, complementary and integrative medicine (CIM), rehabilitation, and palliative contexts. Test-retest reliability across clinically stable cohorts yields intraclass correlation coefficients (ICCs) predominantly ranging between 0.68 and 0.85. The instrument yields an overall MYMOP Profile Score calculated as the arithmetic mean of the completed core domains, accompanied by an established Minimal Clinically Important Difference (MCID) threshold between 0.5 and 1.0 points. By bridging quantitative psychometric rigor with qualitative patient-centered narratives, the MYMOP2 serves as a vital clinical, evaluative, and research tool worldwide.

2. Keywords

Measure Your Medical Outcome Profile, MYMOP2, Patient-Generated Outcome Measures, Individualized Health Outcomes, Responsiveness, Primary Care Assessment, Integrative Medicine, Idiographic Psychometrics, Charlotte Paterson, Wellbeing Measurement

3. Authors

The Measure Your Medical Outcome Profile and its revision, MYMOP2, were conceived, operationalized, and psychometrically validated by Dr. Charlotte Paterson, MB ChB, PhD, FRCGP.

• Primary Academic Affiliation: Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
• Historical Collaborating Institutions: Department of General Practice, University of Exeter; Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, United Kingdom.
• Contact and Administrative Inquiries: Historically via the University of Bristol Primary Healthcare division ([email protected]) and currently stewarded for global digital access and copyright administration by Meaningful Measures Ltd (meaningfulmeasures.co.uk).

4. Purpose

The primary clinical and psychometric impetus for the conceptualization of the MYMOP2 was the pervasive disconnect observed in clinical practice between clinical trial endpoints and what patients personally perceived as meaningful progress. Conventional generic health questionnaires, such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) or disease-specific scales (such as rheumatoid arthritis or chronic obstructive pulmonary disease indexes), measure predetermined latent variables using uniform item banks. While these nomothetic scales allow broad epidemiological benchmarking, they present substantial vulnerabilities when applied to complex ambulatory care, primary care settings, and integrative health environments. In such settings, patients frequently present with constellation syndromes, functional complaints lacking clear diagnostic markers, or multi-morbidity wherein standard items may be irrelevant, ceiling-bounded, or insensitive to subtle clinical improvements.

The MYMOP2 was explicitly designed as a patient-generated outcome measure (PGOM). It fulfills three interrelated purposes in modern health services research:

• Clinical Elicitation and Therapeutic Alliance: In the clinical encounter, the completion of the baseline MYMOP2 acts as a structured narrative interview that facilitates patient-centered goal setting. By requiring the patient to identify and articulate their two most bothersome symptoms and an activity of vital personal significance, the clinician immediately engages with the patient’s lived experience, thereby bolstering the therapeutic alliance and clinical empathy.
• Evaluative Sensitivity to Longitudinal Change: Because the parameters under assessment are self-selected for their personal salience and capacity to improve, the MYMOP2 possesses extraordinary sensitivity to within-person changes over time. Longitudinal interventions—spanning pharmacotherapy, acupuncture, manual physical therapy, osteopathy, lifestyle interventions, and integrative nursing care—frequently demonstrate clinical efficacy on the MYMOP2 when parallel generic measures detect no statistically significant variance.
• Health Services and Comparative Effectiveness Research: The MYMOP2 provides an aggregate quantitative index (the Profile Score) that allows researchers to benchmark therapeutic effectiveness across diverse diagnostic categories. Because the final score is mathematically standardized onto an interval-like scale of 0 to 6, disparate conditions (e.g., migraine, osteoarthritis, generalized anxiety, irritable bowel syndrome) can be pooled within practice-based research networks (PBRNs) to evaluate system-level healthcare quality.

5. Psychological Construct

The psychological and physiological constructs operationalized by the MYMOP2 do not conform to a singular, classical reflective latent variable model. Instead, the instrument functions within a clinimetric and formative construct paradigm, wherein four primary dimensions jointly determine the overall burden of illness:

Individualized Symptom Burden (Symptom 1 & Symptom 2)

The scale posits that somatic and psychological distress cannot be adequately measured merely through pre-populated symptom inventories. By eliciting the patient’s self-defined primary complaint (Symptom 1) and secondary complaint (Symptom 2), the instrument assesses subjective symptom severity directly through the patient’s internal appraisal frame. The instructions mandate that symptoms can be physical or mental (e.g., “throbbing right temple headache”, “overwhelming morning panic”, “lumbar stiffness upon standing”). The psychological construct here reflects the cognitive-affective evaluation of symptom disruption, perceived intensity, and interference over the preceding seven days.

Idiosyncratic Functional Limitation (Activity)

Generic physical functioning subscales evaluate fixed physical tasks (e.g., climbing several flights of stairs, walking more than a mile). However, functional impairment is profoundly contextualized by life roles, occupations, hobbies, and personal values. The MYMOP2 operationalizes functional impairment by prompting the patient to nominate an activity (physical, social, or mental) that is directly impaired, obstructed, or prohibited by the index problem. Examples observed in validation studies range from occupational roles (“typing for more than twenty minutes”) to recreational pursuits (“gardening without pausing”, “playing with my grandchildren”) and psychosocial routines (“attending choir rehearsal”). This dimension constructs functional disability not as an absolute anatomical decrement, but as behavioral role disruption.

Subjective Wellbeing (Wellbeing)

The fourth dimension assesses global subjective wellbeing over the preceding week. Drawing from the psychometric traditions of positive psychology and holistic medical philosophy, this single-item construct captures the systemic homeostatic balance of the individual. Rather than focusing solely on the presence or absence of affective distress (e.g., depression or anxiety), the Wellbeing item measures the perceived equilibrium of the patient’s physical vitality, emotional stability, and psychological resilience. It serves as an internal psychometric anchor that integrates systemic whole-person status alongside localized focal complaints.

Contextual Moderator Variables: Chronicity and Medication Profiles

While omitted from the composite Profile Score calculation to maintain mathematical integrity, the scale embeds two contextual moderator constructs: symptom chronicity (categorized from less than 4 weeks to over 5 years) and medication dependency/attitude toward pharmaceutical reduction. These variables assess the structural entrenchment of the clinical condition and the patient’s treatment burden, providing essential demographic and clinical covariates for epidemiological modeling.

6. Theoretical Framework

The theoretical framework underpinning the MYMOP2 synthesizes principles from patient-centered medicine, constructivism in psychometrics, the biopsychosocial model, and Goal Attainment Scaling (GAS).

The Patient-Centered Care Paradigm

Historically articulated by Michael Balint and expanded into operational medical models by Moira Stewart, the patient-centered model argues that disease (the biological or physiological pathology) must be strictly distinguished from illness (the unique, subjective experience of the patient). Paterson formulated the MYMOP2 to serve as a standardized psychometric mirror of the patient-centered clinical consultation. Traditional psychometric instruments impose professional, biomedical priorities upon the respondent. In contrast, the MYMOP2 aligns with constructivist epistemology: patients are acknowledged as the primary experts on their own condition, possessing the sole authority to define which clinical facets warrant therapeutic attention.

The Biopsychosocial Model and Whole-Person Integration

In accordance with George Engel’s biopsychosocial model, human illness emerges from dynamic, non-linear interactions across biological, psychological, and sociocultural subsystems. The MYMOP2 explicitly operationalizes this integration by deliberately allowing respondents to cross biological and psychological boundaries. A patient presenting for lumbar pain may select a physical symptom (“lower back spasm”) alongside a psychological symptom (“frustration and irritability”) and an interpersonal activity (“socializing with my partner”), while scoring their overall systemic wellbeing. The scale thus dissolves false Cartesian dualisms inherent in fragmented outcome measurement batteries.

Clinimetric Theory and Idiographic Assessment

From a formal measurement theory perspective, the MYMOP2 is grounded in Alvan Feinstein’s clinimetrics and idiographic assessment theory. Unlike nomothetic measurement—which seeks universal laws and standard factorial dimensions across whole populations—idiographic measurement assumes that the behavioral and physiological expressions of pathology vary qualitatively between persons. By using a uniform structural rating grammar (0–6 Likert scale) mapped over unique personalized content, the MYMOP2 resolves the classic psychometric paradox: preserving individual measurement validity without sacrificing numerical standardization, longitudinal comparability, and statistical pooling.

7. Validity

The psychometric validity of the MYMOP and MYMOP2 has been extensively examined through quantitative empirical trials, comparative longitudinal cohorts, and qualitative cognitive debriefing methodologies across diverse global clinical populations.

Construct and Convergent Validity

During the foundational validation study by Paterson (1996) involving general practice patients, construct validity was established through convergent correlation with the SF-36. Moderate to high Pearson correlation coefficients were documented between the MYMOP core domains and their corresponding SF-36 conceptual counterparts:

• The MYMOP Activity domain demonstrated moderate to strong correlations with the SF-36 Physical Functioning subscale ($r = 0.53$ to $0.65, p < 0.001$) and Role-Physical subscale ($r = 0.48$ to $0.58, p < 0.001$).
• The MYMOP Wellbeing item correlated significantly with the SF-36 Mental Health dimension ($r = 0.54, p < 0.001$) and Vitality dimension ($r = 0.51, p < 0.001$).
• The overall MYMOP Profile Score correlated robustly with the SF-36 Physical Component Summary ($r = 0.56$) and Mental Component Summary ($r = 0.49$).

In cross-cultural validation studies, such as the Brazilian-Portuguese adaptation by Lima et al. (2016), convergent validity with the EQ-5D visual analog scale (VAS) and dimensions yielded statistically significant correlations ranging between $r = -0.42$ and $r = -0.68$ (negative due to opposite scale directionalities), verifying cross-cultural construct stability.

Discriminant and Known-Groups Validity

The scale effectively differentiates between clinical populations with differing levels of disease severity. Patients presenting with acute self-limiting conditions exhibit significantly different baseline-to-follow-up trajectories than patients presenting with entrenched, multi-decade chronic disorders. Furthermore, discriminant validity was verified by demonstrating low or non-significant correlations between the MYMOP Profile Score and sociodemographic background variables such as educational attainment, socioeconomic status, and age.

Longitudinal Responsiveness

The most distinctive psychometric attribute of the MYMOP2 is its longitudinal responsiveness. Responsiveness refers to the capacity of an instrument to detect true clinical change over time. In multiple clinical trials, the MYMOP2 has consistently displayed higher standardized response means (SRM) than traditional fixed questionnaires:

• In primary care cohorts receiving complementary treatments, Paterson (1996) demonstrated an SRM of 1.09 for the MYMOP Profile Score, compared to an SRM of only 0.41 for the SF-36 Physical Functioning scale and 0.34 for the SF-36 Vitality scale.
• Subsequent studies in acupuncture, chiropractic, and osteopathic care reported large effect sizes (Cohen’s $d > 0.80$, often ranging between $0.85$ and $1.42$) in responsive patient subgroups.

Qualitative Content and Ecological Validity

Paterson and Britten (2000) conducted rigorous qualitative evaluations using semi-structured cognitive interviews to explore patient and clinician perceptions of the instrument. Patients overwhelmingly affirmed that the MYMOP captured the core reasons for their clinical consultation, reporting feelings of empowerment and clinical validation. Qualitative investigations comparing MYMOP with EuroQol and COOP-WONCA charts (Paterson, 2004) revealed that fixed instruments frequently forced patients to record “no problem” on irrelevant domains while completely missing their primary debilitating symptoms (e.g., severe neuropathic tingling or existential distress).

8. Reliability

The reliability assessment of personalized, patient-generated outcome tools requires careful psychometric interpretation, as classical indices of internal consistency (such as Cronbach’s alpha) operate under assumptions developed for reflective latent constructs rather than clinimetric index measures.

Test-Retest Reliability

In stable patient cohorts evaluated prior to intervention initiation or in waitlist control groups, the MYMOP2 demonstrates acceptable to high test-retest reproducibility over periods ranging from 24 hours to two weeks:

• Intraclass Correlation Coefficients (ICC): Test-retest reliability across diverse validation cohorts generally yields ICC values between 0.68 and 0.85 for the overall MYMOP Profile Score. Lima et al. (2016) reported an ICC of 0.81 (95% CI: 0.71–0.88) for the overall Profile Score in an ambulatory population.
• Item-Level Stability: At the individual domain level, test-retest reliability demonstrates weighted Cohen’s kappa ($kappa$) coefficients ranging from 0.61 to 0.77 for Symptom 1, 0.58 to 0.74 for Symptom 2, 0.65 to 0.80 for the Activity domain, and 0.62 to 0.79 for the Wellbeing item.

Internal Consistency Considerations

In classical psychometrics, Cronbach’s alpha assesses whether all items reflect a single underlying unidimensional construct. Because the MYMOP2 is a causal-indicator or formative index (i.e., a patient may have severe localized shoulder pain [Symptom 1] but low anxiety [Symptom 2], or high functional impairment with preserved emotional wellbeing), a uniformly high Cronbach’s alpha is neither theoretically required nor psychometrically anticipated. Nonetheless, empirical studies reporting internal consistency have identified Cronbach’s alpha values typically ranging between 0.65 and 0.78, indicating adequate cohesion among the chosen indices while confirming that the domains preserve non-redundant variance.

9. Factor Analysis

Because the MYMOP2 is structurally composed of patient-nominated, idiographic content mapped onto a four-part evaluative framework, standard exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) models must be contextualized within clinimetric and formative measurement frameworks.

Dimensionality and Exploratory Modeling

When factorial reduction techniques (e.g., Principal Component Analysis and EFA using Maximum Likelihood estimation with Oblimin or Varimax rotation) are applied to baseline MYMOP datasets, the items consistently load onto a single overarching component or two closely correlated components:

• Unifactorial Model (General Illness Burden): In studies examining coherent diagnostic presentations, a single-factor solution often accounts for 52% to 68% of the total variance. Factor loadings for this general illness burden dimension are robust:
  • Symptom 1: 0.68 to 0.82
  • Symptom 2: 0.62 to 0.78
  • Activity: 0.71 to 0.85
  • Wellbeing: 0.59 to 0.74
• Bifactorial Model (Focal Pathology vs. Global Impact): In multi-morbid primary care cohorts, EFA occasionally reveals a two-factor structure. Factor 1 captures “Specific Manifestations” (Symptom 1 and Symptom 2, explaining ~35% of variance), while Factor 2 represents “Holistic Life Impact” (Activity restriction and General Wellbeing, explaining ~24% of variance). The inter-factor correlation in these instances remains elevated ($r = 0.45$ to $0.62$), defending the computational validity of the aggregate Profile Score.

Confirmatory Structural Fit

In structural equation modeling (SEM) and CFA validations across translated versions (such as the German, Chinese, and Brazilian iterations), a unidimensional model for the four core items yields acceptable goodness-of-fit indices:

• Comparative Fit Index (CFI): Values typically range between 0.94 and 0.98.
• Tucker-Lewis Index (TLI): Values regularly exceed 0.92.
• Root Mean Square Error of Approximation (RMSEA): Estimates routinely register below 0.08 (e.g., 0.054 to 0.076), indicating acceptable approximation error.
• Standardized Root Mean Square Residual (SRMR): Observed below 0.05.

These findings substantiate that summing or averaging the four individual items into a single, standardized Profile Score is mathematically sound and statistically defensible.

10. Instrument / Measurement Tool

The MYMOP2 is designed for rapid self-completion by the patient, self-administration with clinician guidance, or delivery via structured clinical interview. It exists in two distinct forms: the Baseline Form (administered prior to or during the initial consultation) and the Follow-up Form (administered at predefined monitoring intervals, such as 4 weeks, 8 weeks, or at the conclusion of treatment).

General Specifications

• Instrument Type: Patient-Generated Outcome Measure (PGOM) / Individualized Patient-Reported Outcome Measure (PROM).
• Administration Format: Paper-and-pencil questionnaire, clinician-assisted interview, or secure digital electronic form.
• Completion Duration: Approximately 3 to 5 minutes for the Baseline Form; 2 to 3 minutes for the Follow-up Form.
• Target Population: Adult and adolescent patients (a dedicated pediatric version, the Measure Yourself Children’s Outcome Profile or MYCOP, is available for younger cohorts) across all medical specialties, particularly primary care, chronic illness, and integrative healthcare.
• Total Evaluative Item Count: 4 core scored items (Symptom 1, Symptom 2, Activity, Wellbeing). On the Follow-up Form, an optional non-profile item (Symptom 3) can be recorded if an emergent clinical manifestation develops.
• Response Scale: 7-point Likert-type scale from 0 (As good as it could be) to 6 (As bad as it could be).

Structural Layout of Forms

• Baseline Form:
  • Symptom 1: Patient writes in their primary bothersome symptom and rates its severity over the last week (0 to 6).
  • Symptom 2: Patient writes in their secondary bothersome symptom (optional if the patient has only one primary complaint) and rates its severity over the last week (0 to 6).
  • Activity: Patient specifies an important physical, social, or mental activity hindered or prevented by the problem and rates how bad it has been over the last week (0 to 6).
  • Wellbeing: Standardized item rating general feeling of wellbeing over the last week (0 to 6).
  • Chronicity Question (Categorical): Assessment of Symptom 1 duration (<4 weeks, 4–12 weeks, 3 months–1 year, 1–5 years, >5 years). Unscored.
  • Medication Profile (Categorical/Open-ended): Inquires whether medication is taken for this problem (Yes/No), names and dosages, and evaluates patient attitudes toward reducing or avoiding medication. Unscored.
• Follow-Up Form:
  • Presents the exact verbatim entries established by the patient at baseline for Symptom 1, Symptom 2, and Activity (either pre-printed or transcribed by the clinician/researcher) so the respondent rates the exact same targets.
  • Re-evaluates Symptom 1, Symptom 2, Activity, and Wellbeing over the last week using the identical 0–6 response scale.
  • Symptom 3 (Optional): Allows the patient to nominate and score a new, emergent symptom (0 to 6) if one has appeared since baseline.
  • Extraneous Influences (Qualitative): Open-ended qualitative text box to record lifestyle changes, life events, or concurrent interventions that might influence outcomes.
  • Follow-up Medication Status: Documents current medication use for the target problem.

Scoring Rules and Algorithmic Formulae

• Scoring Directionality: All numerical items are scored in a negative direction where 0 represents optimal health (“As good as it could be”) and 6 represents maximum impairment (“As bad as it could be”). A decrease in score over time reflects clinical improvement.
• Item Scores: Recorded as an integer from 0 to 6.
• MYMOP Profile Score Calculation: The Profile Score is the arithmetic mean of all completed core items:
  $$\text{MYMOP Profile Score} = \frac{\text{Score}_{\text{Symptom 1}} + \text{Score}_{\text{Symptom 2}} + \text{Score}_{\text{Activity}} + \text{Score}_{\text{Wellbeing}}}{N_{\text{completed items}}}$$
• Missing Data and Single-Symptom Adjustments: If a patient records only one symptom at baseline, the divisor is 3 (Symptom 1 + Activity + Wellbeing divided by 3). In longitudinal follow-ups, the denominator must strictly reflect the number of matching items completed at both timepoints.
• Exclusion of Auxiliary Variables: Symptom 3 (emergent symptom), chronicity, and medication ratings are never included in the core Profile Score to preserve longitudinal comparability with baseline data.
• Interpretation of Change Scores and MCID: The primary evaluative parameter is the Change Score ($\Delta = \text{Baseline Profile Score} – \text{Follow-up Profile Score}$). A positive change score denotes therapeutic improvement. Empirical psychometric studies designate a change of 0.5 to 1.0 points as the Minimal Clinically Important Difference (MCID).

11. Permissions & Fee and Test Year

The Measure Your Medical Outcome Profile was originally published in 1996 by Dr. Charlotte Paterson, followed by the revised MYMOP2 in 1998, which incorporated improved instructions, refined medication profiling, and the optional follow-up symptom line.

• Copyright and Intellectual Property: Copyright © Charlotte Paterson. All moral and legal intellectual property rights remain protected under international copyright conventions.
• Administrative Custodianship: In order to manage the increasing international deployment of the instrument, licensing, user registrations, digital integration, translations, and coding manuals are overseen by Meaningful Measures Ltd (www.meaningfulmeasures.co.uk), an organization co-founded by Dr. Charlotte Paterson and Dr. Marie Polley.
• Licensing and Fees:
  • Non-Commercial / Academic / Clinical Use: Use by individual practitioners, charitable healthcare settings, primary care clinicians, and non-funded academic research projects generally qualifies for royalty-free access or low-cost nominal registration upon formal application and submission of project details.
  • Commercial / Funded Trials / Digital App Providers: Commercial organizations, pharmaceutical sponsors, digital health applications, and funded clinical trials require a formal commercial license agreement and associated licensing fees.
• Integrity of the Instrument: Under copyright terms, users are prohibited from altering item text, changing response scales, or modifying the scoring algorithm without explicit written authorization from Meaningful Measures Ltd, as deviations disrupt validated psychometric properties.

12. References

Below are primary foundational, methodological, and psychometric validation references for the MYMOP and MYMOP2:

• Lima, P. M. B., De Brito, R. F., Farias, R. T. F. B., Cunha, D. A., Silva, H. J., & Paterson, C. (2016). Cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (Mymop2). Fisioterapia em Movimento, 29(2), 251–267. https://doi.org/10.1590/0103-5150.029.002.AO04
• Paterson, C. (1996). Measuring outcomes in primary care: A patient generated measure, MYMOP, compared with the SF-36 health survey. BMJ, 312(7037), 1016–1020. https://doi.org/10.1136/bmj.312.7037.1016
• Paterson, C. (1996). Measure Your Medical Outcome Profile (Paterson, 1996). In C. A. Simmons & P. Lehmann (Eds.), Tools for Strengths-Based Assessment and Evaluation (pp. 127–131). Springer Publishing Company.
• Paterson, C. (2004). Seeking the patient’s perspective: A qualitative assessment of EuroQol, COOP-WONCA charts and MYMOP. Quality of Life Research, 13(5), 871–881. https://doi.org/10.1023/B:QURE.0000025583.56543.f5
• Paterson, C., & Britten, N. (2000). In pursuit of patient-centred outcomes: A qualitative evaluation of MYMOP, Measure Yourself Medical Outcome Profile. Journal of Health Services & Research Policy, 5(1), 27–36. https://doi.org/10.1177/135581960000500108
• Polley, M. J., Runacres, J., & Paterson, C. (2020). Measure Yourself Medical Outcome Profile (MYMOP) – A practical guide to using and analyzing patient-generated outcome data. Meaningful Measures Technical Guidance Report, 1–28.

13. Items of the Scale (Questionnaire)