Frequently Asked Questions
I have seen several versions of MYMOP, and one that is called MYMOP2. How do I know which version to use?
There have only been two versions in common use. The first was available after the paper was published in the BMJ in 1996, and this was revised to MYMOP2 after the second validation study in 1999. No revisions have taken place since then, so the versions headed MYMOP2, available on this website, can simply be referred to as MYMOP.
Can I remove the patient name and address from the top of MYMOP, as we are using research numbers only in our study?
Yes. Any of the patient identification at the top of the questionnaire can be removed or changed. Be careful that the layout of the scoring questions doesn’t change in the process.
Can I remove the medication questions from the bottom of the questionnaire?
If you must. These questions were added to the first version of MYMOP because interviews with patients who were using MYMOP showed that reducing medication was an important aim and outcome for some people. Without recording medication change MYMOP was erroneously scoring people as having had no benefit from a treatment. This happened when patients chose to reduce their medication (e.g. painkillers) instead of reducing their symptom(e.g. pain). However validation work on the medication questions has shown that they are not very good at measuring medication change. As the medication questions are scored separately to the main MYMOP scores it is possible to leave them off, or to decide not to analyse them fully. However important treatment effects may be missed, especially if MYMOP is being used to evaluate non-drug interventions.
A medication change questionnaire has been developed which can replace this section of MYMOP.
Can I change the wording or layout of the questionnaire?
No. Apart from the two exceptions discussed above the questionnaire may not be changed in any way. Validation studies apply to the questionnaire in its present form, and interviews with patients show that even small changes in wording can lead to very different responses. Any adaptations must be given a different name, and will require a new process of testing and validation.
Has MYMOP been validated for use in children?
No. My own experience is that children of about 11 and over can use it. Younger children need a parent or carer to help them, and the results must then be seen as combining both patient and helper perspectives. In this case it is important that the same person helps the child each time. However as there has been no validation done in children MYMOP may not be the best questionnaire to use.
How do you prevent or control for patients (unconsciously) trying to show their therapist in a favourable light when completing the follow-up?
The tendency to want to please the practitioner has to be accepted as a potential problem. Completing the follow-up without seeing the previous scores should help, though there is some evidence that patients can actually measure change in their condition better if they DO see their previous scores. Validation studies, which have involved interviewing patients and practitioners who are using MYMOP, have found this to be an infrequent problem. Some patients may in fact use it as a way to demonstrate they are not much better which is easier than actually saying that.
Is it OK to phone the patient and fill out the follow up form via questioning on the phone?
MYMOP has not been validated or tested out like this, so I don't know. I would expect that people may give different scores when asked over the phone, compared to when they circle the numbers on the forms themselves, though how much difference there would be for a group I don't know. The only way to tell would be to do both and compare: an interesting study but probably not one you want to do! If it were necessary, in practical terms, to do it over the phone you would have to describe that in your writing up of results and leave a question as to how much that may have changed the results.
Questions about completing MYMOP.
What if the presenting complaint of the patient is an issue like addiction would it still qualify to be written down as the main symptom?
Yes addiction could be symptom one. It is important that it is written in a way that allows people to score it as getting better or worse...so addiction would be OK if that was how it was experienced rather than a yes/no assessment. Alternatively the person could use something that was a consequence of addiction and was particularly bothering him/her, maybe the motivating factor for getting help, like 'being unable to sleep' or ' being unable to get through a day without a fix, or 'doing nothing except looking for drugs'. The main thing is that MYMOP should reflect the main concerns of the patient, the main thing they want your help with.
Why do symptom 1 and symptom 2 have to relate to the same problem?
MYMOP is a problem specific measure. The reason that all items should relate to the same problem is that if the scores are going to be amalgamated into the profile score (the mean of the scored items) then it doesn't make sense for them to relate to different things. For example if symptom1 is headache and symptom2 is a painful toe then the intervention may cure the headache but the toe may get worse. In this scenario the profile score would show no change and this would not be a useful measure of treatment outcome. So MYMOP is a problem-specific measure, but the patient decides what constitutes the parameters of the problem.
What if the patient thinks they are the same problem and I don’t?
For example if the patient writes down neck pain as their symptom 1, and low back pain as their symptom 2, because in their minds they are linked, and the practitioner does not think they are linked, what should the practitioner do?
If the patient thinks they are linked they can go on one form, whatever you think.
How do we enter a patient who has more than two fairly major symptoms, such as asthma, irritable bowel syndrome etc. and where the patient can't decide which is causing them most distress?
If there is more than one problem and the patient can't prioritise then all you can do is do two MYMOP forms: one for each problem.
As a holistic practitioner, when I am treating someone with multiple significant problems, both my patient and I find it very restricting to focus on one problem.
I agree it is restricting for holistic practice, but I think you may find people can feel OK about it if they see the symptom/problem that is measured on MYMOP as a marker or flag for the wider picture. So if the patient starts out being desperate about not being able to sleep, and has lots of other symptoms too, and the homeopath sees the sleep problem as only part of the wider picture, then measuring improvement in sleep should reflect the wider improvement, even though it doesn't fully explain it.
What shall I do if one problem gets better only to be replaced by another problem?
If one problem resolves and is replaced by another, then start a new MYMOP and enjoy the confirmation that at least something has got better!
The question that asks "Are you taking any medication for this problem? Please circle: YES/NO". Does "this problem" refer to symptom 1 or symptom 2?
Symptom 1 and 2 must both relate to the same problem, in the patient's eyes, and the medication relates to this same problem too, so it could relate to either symptom.
Within a consultation, when is the best time to complete MYMOP?
This depends on the type of consultation and therapy, and is different for initial MYMOP forms and follow-ups.
Initial MYMOP forms are usually best completed after the patient and practitioner have discussed the problem fully, but before any ‘hands on’ treatment. It fits naturally into the moment when the practitioner thinks he/she knows what the main problems are, and wants to check that out with the patient. Alternatively it can be completed right at the end of the consultation.
Follow-up forms are best completed before a consultation, or right at the beginning of one, as they fit naturally with the enquiry of ‘how are you?’
Questions about analysis of MYMOP data
I have heard there is a computer programme that will analyse the data. Is this true and is a copy available?
No! It is easiest to type the results onto some sort of spreadsheet, for example Excel, or use a simple statistics programme. Click here for an example of MYMOP_spreadsheet (Office document, 26kB). Just clear the data and add your own! You may want to add some extra columns for other data you have collected.
Should MYMOP scores be treated as categorical or continuous data?
Because MYMOP uses a scale that only has labels at each end, it is generally accepted that it can be treated as continuous data, thus using the mean and standard deviation.
Should I analyse each bit of MYMOP separately, symptom 1, symptom2, activity, wellbeing; or should I just use the profile score?
The profile score is useful, as an average of all the others, but it does lose information in the process. It is good to describe the changes in Symptom 1&2, Activity, and Wellbeing separately as well as the profile when you are presenting your results. With some chronic conditions it may be hard to get a big symptom improvement, but if wellbeing improves that may be very important to the patient. Conversely with more acute or responsive conditions treatment may change the symptoms and activity scores dramatically, and the wellbeing may change less because so many social and personal things affect it.
How should I present the changes in MYMOP scores?
Of most interest is the average (mean) change in MYMOP score, plus the amount of individual variation in the change. How you present these depends on whether you have just a few individual patients, or you have one or more big groups of patients.
If you have just a few patients you can present the profile results for each individual in a table. The columns might be something like: Patient’sresearch number / Profile score time 1 / Profile score time 2/ Change in profile score (Time 1 – time 2).
You can then add a last row in which you put the average scores and average change. You can summarise that in a sentence which says something like 'The average change in MYMOP profile score was 2.5 points improvement and the range was from 2 points deterioration to 5 points improvement. You can repeat this for each dimension of MYMOP: symptom 1 etc. Click here for an example of a Table of MYMOP scores: MYMOP sample table (Office document, 31kB)
If you have bigger groups of patients you will probably use a spreadsheetand lay that out in the same way as the table above. However with a spreadsheet we usually keep adding columns for all the different dimensions we need, like symptom 1, 2 etc, as well as adding columns for other data like age, sex, duration of problem. This ends up with a very wide table that you don't need to print out. A simple MYMOP spreadsheet can be accessed here MYMOP_spreadsheet (Office document, 26kB). The spreadsheet programme will then calculate the mean (average) for the change in profile score, and the change in all the other scores. It will provide the maximum and minimum changes too so you have the range of change. It will also calculate a more statistical way of describing the individual variation, called the Standard Deviation. This group data is then usually presented as something like 'The mean change in MYMOP profile score was 2.5 (SD 1.5), and the range was from -2 to +5, where improvement is a positive change.' Another way of presenting the individual variation is with a histogram graph of the change scores.
You can help people to know what a 2.5 point improvement indicates by reminding them that the scale was a seven-point scale.
Also look at how authors have presented their results in the papers given as references on this website.
If I get a mean change of 2 in the MYMOP profile score, how do I know if this is a big change or not?
It is useful to consider two different types of significance: clinical significance and statistical significance.
A change in score is clinically significant when it represents a change that is of importance to the individual patient concerned. Using a seven point score such as MYMOP, the clinically minimal important difference for the change score is between 0.5-1.0. This means that any change below 0.5 does not represent a change of any importance to the patient, and any change above 1 probably does. In-between 0.5 and 1.0 we are uncertain.[Guyatt GH, Juniper EF, Walter S, Griffith L, Goldstein RS. Interpreting treatment effects in randomised trials. British Medical Journal 1998;316:690-693.]
Whether a change is statistically significant is more to do with how likely it is that the change could have happened by chance. Its calculation and what it means in the context of your own study requires some statistical knowledge.
I only have 10 patients in my study, but they completed a MYMOP score every week, how can I make the most of this data?
Repeated measures overtime are valuable data, though they are complicated to analyse statistically. At the most simple level you can just take the first scores and one other set of scores after x number of weeks, or x number of treatments, and calculate the change in scores, as above [see the paper by Hill1999 in the reference list] However you can also make individual charts of the pattern of change for each patient and write them up as more individual case studies or stories. The reference Paterson & Britten 2000in the MYMOP publications list shows some MYMOP charts, but you can write up their cases as you wish.