Advancing Global Data Collection for Women with Bleeding Disorders: Early Insights from the PROBE WBD Module

Brennan F, Clearfield E, Kucher A, Colle Y, Brito del Pino Mouro A, Wilton P, Skouw-Rasmussen N, Ziemele BM, Rotellini D, Delaney M, Curtis RG, O’Mahony B, Page D, Iorio A, Germini F, Skinner MW. Advancing global data collection for women with bleeding disorders: early insights from the PROBE WBD module. Haemophilia. 2026;32:4-224. Abstract PP-399. doi:10.1111/hae.70232.

Introduction

Since 2014, the PROBE (Patient Reported Outcomes, Burdens, and Experiences) Study has generated global patient-reported data to compare health outcomes and quality of life (QoL) across people with haemophilia and control populations. However, PROBE was originally designed primarily for men, leaving a substantial knowledge gap for women with bleeding disorders (WBD), including women and girls with haemophilia A or B, carriers, and those who have or had the potential to menstruate. Limited comparative Quality of Life (QoL) data, together with a longstanding pattern of underdiagnosis and misdiagnosis, highlight the need for a dedicated data-collection framework. This project aims to expand PROBE to better capture the lived experiences and health outcomes of WBD.

 Methods 

Building on earlier PROBE analyses, a structured enhancement process began in 2024. A targeted literature review and conceptual framework exercise identified domains insufficiently captured in the current PROBE instrument, including menstrual bleeding patterns, gynaecological complications, access to care, emergency room utilisation, reproductive decision-making, and impacts on social and leisure activities. Eleven new WBD-specific questions were developed and integrated following consultation with a global expert working group representing the World Federation of Hemophilia (WFH), European Haemophilia Consortium (EHC), Coalition of the Americas (CoA), National Bleeding Disorders Foundation (NBDF), and Canadian Hemophilia Society (CHS). Of the 64 pilot participants, 33% completed the WBD module. The module launched as an online exploratory pilot on International Women’s Day 2025.

 Results

Preliminary data reveals significant unmet needs among WBD. Participants reported a mean age of diagnosis of 20.45 years, with some reporting up to nine emergency department visits in the previous 12 months. The reported average menstrual period length was 10.6 days. Respondents also described moderate to significant impacts of their bleeding diagnosis and symptoms on decisions regarding childbearing and participation in social or leisure activities. Early findings from carriers, individuals with factor and platelet disorders, and those with extremely rare bleeding disorders underscore the diversity and severity of challenges experienced.

 Conclusion 

Early insights from the WBD module reinforce the necessity of integrating a dedicated WBD component into the core PROBE study. Enhanced, inclusive data collection will support more accurate understanding and inform targeted advocacy, research, management, and treatment strategies for this underserved population.

Poster: HERE

Patient-Reported Outcomes in Hemophilia in Kosovo: Results from the PROBE Questionnaire

Svirca I, Kukaj E, Svirca L, Rotellini D, Harvey-Simi K, et al. Patient-reported outcomes in hemophilia in Kosovo: results from the PROBE questionnaire. Haemophilia. 2026;32:4-224. Abstract PP-317. doi:10.1111/hae.70232.

Introduction

National-level patient-reported outcomes (PROs) for people with hemophilia (PWH) in Kosovo are limited. The PROBE (Patient-Reported Outcomes, Burdens and Experiences) questionnaire captures treatment patterns, pain, function, and health status.

The aim is to characterize the Kosovo cohort with PROBE and compare key outcomes between severe and moderate/mild hemophilia contextualized against a local control group with no bleeding disorder (PwNBD).

 Methods 

We conducted a cross-sectional analysis of participants in Kosovo who completed PROBE during the National Bleeding Disorders Foundation and Kosovo Hemophilia Foundation (KHF) World Federation of Hemophilia (WFH) twinning program. A formal framework of cooperation between KHF, WFH, and the Ministry of Health of Kosovo was executed. Data were collected between April 2023 and May 2024. Outcomes included treatment regimen, acute and chronic pain, missed work or school, EQ-5D index, and PROBE total score. Participants were grouped as Severe, Moderate/Mild, or PwNBD, and results were summarized descriptively.

 Results

Thirty-three participants were included in the initial pilot data collection: Severe (n=6), Moderate/Mild (n=13), and No BD/Carriers (n=12). Acute pain was reported by 66.7% of Severe versus 46.2% of Moderate/Mild participants; chronic pain by 50.0% versus 53.9%. Mean days missed from work or school in the previous six months were higher in the PWH group than in PwNBD. The EQ-5D index (mean) was 0.558 in Severe, 0.859 in Moderate/Mild, and 0.950 in PwNBD. PROBE total scores (mean) were 0.794, 0.843, and 0.906, respectively, indicating worse reported outcomes in hemophilia groups versus controls. Additional patient characteristics are described in Table 1.

 Conclusion 

Using the PROBE instrument to measure quality of life, individuals with severe hemophilia in Kosovo reported lower health status (EQ-5D) and higher burden (PROBE score) with greater functional impact (missed work/school) than those with moderate/mild disease, and both groups fared worse than the PwNBD control group. Only one-third of Severe participants were on regular prophylaxis, with half relying on intermittent regimens and some reporting no treatment availability. Findings highlight persistent unmet needs in access to regular prophylaxis, pain management, and joint health. Ongoing data collection will support longitudinal evaluation to guide national health policy for PWH.

 

Table. Patient Characteristics

SevereModerate / MildPwNBD
n (%) / Mean (SD)95% CIn (%) / Mean (SD)95% CIn (%) / Mean (SD)95% CI
n61312
Age average29.5 (8.90)22.377 – 36.62329.46 (8.47)24.856 – 34.06736.25 (11.17)29.932 – 42.568
Years of Education average12.17 (3.76)9.158 – 15.17512.62 (3.20)10.876 – 14.35514.92 (4.33)12.467 – 17.366
Hemophilia A4 (66.67 %)7 (53.85%)n/a
Treatment Regiment
Regular Prophylaxis2 (33.33%)2 (15.39%)n/a
Interm. PROXY3 (50%)3 (23.08%)n/a
On Demand03 (23.08%)n/a
No treatment available1 (16.67%)0n/a
Married3 (50%)9 (69.23%)10 (83.33%)
Children4 (66.67 %)5 (38.46%)8 (66.67%)
Used a mobility device in last 12 months2 (33.33%)00
Pain med Frequency
Never (0% of the time)2 (33.33%)1 (7.69%)6 (50%)
Rarely (1–5% of the time)03 (23.08%)3 (25%)
Occasionally (6–25% of the time)2 (33.33%)6 (46.15%)1 (8.33%)
Sometimes (26%–50% of the time)1 (16.67%)3 (23.08%)2 (16.67%)
Frequently (51%–75% of the time)1 (16.67%)00
Very Frequently (76%–99% of the time)000
All the time (100%)000
Acute pain4 (66.67 %)6 (46.15%)6 (50%)
Mean number of activities where Acute Pain Occurs1.33 (1.37)0.234 – 2.4331.38 (1.73)0.518 – 2.2520.08 (0.28)-0.138 – 0.304
Mean number of activities where Acute Pain interferes2.67 (2.43)0.725 – 4.6081.69 (2.58)1.179 – 3.9880.17 (0.55)-0.146 – 0.479
Chronic pain3 (50%)7 (53.85%)4 (33.33%)
Mean number of activities where Chronic Pain Occurs1.17  (1.34)0.0915 – 2.2421.38 (1.60)0.518 – 2.2520.50 (0.87)0.0100 – 0.990
Mean number of activities where Chronic Pain Interferes1.50 (1.80)0.0575 – 2.9421.85 (2.48)0.500 – 3.1920.82 (1.34)0.0731 – 1.594
Chronic pain in a target joint4 (66.67 %)6 (46.15%)n/a
ADL affected4 (66.67 %)7 (53.85%)2 (16.67%)
Mean number of ADL’s effected2.17 (2.19)0.413 – 3.9211.77 (2.29)0.523 – 3.0150.25 (0.60)-0.087 – 0.587
Employment and Education
Unemployed/ long-term disability/ not a student2 (33.33%)1 (7.69%)0
Unemployed due to health2/2 (100%)1/1 (100%)0/2 (0%)
Working full time / working part time2 (33.33%)11 (84.62%)7 (58.33%)
Work part-time due to health02/5 (40%)3/3 (100%)
Retired000
Retirement due to health000
Stay at home parent1 (16.67%)02 (16.67%)
Student (full time or part-time)3 (50%)3 (23.08%)4 (33.33%)
Education/Career decision due to health3 (50%)3 (23.08%)0
Average of missed days of school or/and work25.67 (42.81)-8.587 – 59.92010.85 (10.41)5.190 – 16.5037.42 (10.75)1.334 – 13.499
Joint Surgery  or Other Procedure2 (33.33%)3 (23.08%)1 (8.33%)
Mean of Joint Surgery  or Other Procedure1.17 (2.19)-0.587 – 2.9210.31 (0.61)-0.022 – 0.6370.08 (0.28)-0.073 – 0.240
EQ5D0.558 (0.296)0.322 – 0.7950.859 (0.169)0.767 – 0.9500.95 (0.07)0.913 – 0.988
PROBE score0.794 (0.105)0.710 – 0.8770.843 (0.108)0.784 – 0.9010.906 (0.07)0.864 – 0.948
Annual Bleed Rate
01 (16.67%)4 (30.77%)n/a
100n/a
2-301 (7.69%)n/a
4-704 (30.77%)n/a
8-103 (50%)1 (7.69%)n/a
11-151 (16.67%)0n/a
16-301 (16.67%)1 (7.69%)n/a
More than 3002 (15.39%)n/a
Bleeding in last 2 weeks5 (83.33%)6 (46.15%)n/a
Target Joints/Problem Joints5 (83.33%)11 (84.62%)n/a
Mean number of Target Joints/Problem Joints4.00 (3.16)1.470 – 6.5302.54 (2.68)1.083 – 3.994n/a
Joint with a reduced Range of motion5 (83.33%)8 (61.54%)n/a
Mean number of joints with a reduced Range of Motion3.00 (2.24)1.211 – 4.7891.77 (1.89)0.743 – 2.795n/a
Life threatening bleed in the last 12 months4 (66.67 %)2 (15.39%)n/a
Mean number of Life threatening bleed in the last 12 months1.00 (1.00)0.200 – 1.8000.31 (0.72)-0.085 – 0.700n/a

 

 

Poster: HERE

Development of a refined data dashboard for PROBE: Enhancing data interpretation and advocacy support for national patient organizations

Kucher A, Clearfield E, Curtis RG, Delaney M, Germini F, Iorio A, O’Mahony B, Page D, Rotellini D, Skinner MW. Development of a refined data dashboard for PROBE: enhancing data interpretation and advocacy support for national patient organizations. Haemophilia. 2026;32:4-224. Abstract FP-038 (514). doi:10.1111/hae.70232.

Introduction

The PROBE (Patient-Reported Outcomes, Burdens and Experiences) study has collected standardized quality-of-life (QoL) data from people with hemophilia (PWH) and without a bleeding disorder since 2014, supported by a dashboard available since 2016. The dashboard allows the visualization of aggregated data. As more patient organizations participate in semi-annual data collection, there is an increasing need for more flexible, intuitive, and visually rich tools to interpret PROBE data and to support local reporting, advocacy, and scientific communications.

Aim is to develop and implement a new interactive dashboard using Microsoft Power BI that (1) improves visualization and interpretation of PROBE QoL data, (2) facilitates preparation of abstracts, reports, and presentations on progress and gaps within national hemophilia communities, and (3) provides a foundation for future PROBE modules for women with bleeding disorders, von Willibrand disease, and other rare bleeding and platelet disorders.

 Methods 

We redesigned the existing PROBE dashboard using Power BI, drawing on feedback from NMOs, clinicians, and patient partners. The dashboard, updated monthly, connects to the central PROBE database. Key PROBE metrics, including EQ-5D-5L, are organized into themed pages: Demographics; Mobility and Activities of Daily Living (ADL); Pain (Chronic and Acute); Employment and Education; Surgery and Co-morbid Conditions; Severity and Inhibitor Status; Treatment; Joints; and PROBE and EQ-5D-5L utility scores. Sections allow users to filter and stratify data (e.g., by age, severity, inhibitor status, country, or collection period) and to export figures and summary tables.

 Results

The PROBE dashboard provides interactive charts and tables that allow users to quickly identify patterns in QoL, including mobility limitations, pain burden, employment and education status, treatment patterns, and joint outcomes. Deep-dive views within each theme support more detailed discussions (e.g., comparing outcomes by severity or inhibitor status) and help patient organizations generate data-driven messages for advocacy and clinical quality improvement. The ability to export standardized visuals and summary statistics simplifies the preparation of national or multi-country reports describing QoL trends and progress, that could be used for research and advocacy.

 Conclusion 

The PROBE dashboard offers patient organizations an enhanced, user-friendly way to interpret QoL data. By improving access to clear, interpretable PROBE and EQ-5D-5L indicators, the dashboard supports global efforts to monitor outcomes, inform policy, and strengthen patient-centered care worldwide.

Presentation: HERE

Adapting the Patient Reported Outcomes Burdens and Experiences (PROBE) Study to Measure Quality of Life in People with von Willebrand Disease (VWD)

Clearfield E, Brennan F, Kucher A, Skouw-Rasmussen N, Ziemele B, Rotellini D, Delaney M, Curtis RG, O’Mahony B, Page D, Iorio A, Germini F, Skinner MW. Adapting the Patient Reported Outcomes Burdens and Experiences (PROBE) Study to Measure Quality of Life in People With von Willebrand Disease (VWD).Poster presented at: WFH 2026 World Congress; 2026 Apr 19–22; Kuala Lumpur, Malaysia. Poster PP-322.

Introduction

The coreVWD Initiative identified a core outcome set for clinical trials for von Willebrand disease (VWD); quality of life (QoL) was included as a core outcome. There is currently no disease-specific patient reported outcome measure (PROM) to assess QoL for people with VWD (PwVWD). A mapping exercise of the coreVWD results to the Patient Reported Outcomes Burdens and Experiences (PROBE) study identified coverage of some core outcomes, but gaps remained on key outcomes agreed to by the multi-stakeholder panel. PROBE is an established QoL survey currently available only for people with hemophilia, carriers, and healthy controls. Our objective is to adapt PROBE for use by PwVWD by creating a VWD-specific section and updating current items to reflect the experience of living with and managing VWD.

 Methods 

This is a protocol for a qualitative study. PROM development consists of semi-structured interviews with PwVWD, which will be recorded and transcribed. Thematic analysis will be performed to develop a conceptual framework for QoL for PwVWD. The framework will be mapped to the current PROBE instrument to identify which concepts are already included and what needs to be added in a VWD module. New/updated items will be tested in cognitive debriefing interviews, with a focus on relevance and respondent understanding to move to a content validated adapted instrument. This work is planned as a two-year project with the updated instrument available at the end of Year 1. In Year 2, the adapted questionnaire will undergo online programming, translation, and further psychometric testing such as test-retest and face validity studies.

 Results

Ethical approval has been obtained. Recruitment for interviews has begun. A thematic overview of new concepts and items requiring adaptation will be presented.

 

 Conclusion 

As more clinical trials for new products and expanding indications are initiated, the adapted PROBE instrument will be an important tool to measure QoL in PwVWD and use in registries such as the World Bleeding Disorders Registry (WBDR). Data from the robust, established PROBE database can serve to benchmark on key QoL indicators, such as pain and interference in activities of daily living, and compare to PROBE scores from people with hemophilia.

Poster: HERE

Bridging the Gap: Real-World Quality of Life Differences Between People With and Without Hemophilia in Malta

Chatzifragkou I., Gauci J. S., Gauci J. M., Cilia J., Gatt A., Kucher, A., Skinner, M. W. (2025, August). Bridging the gap: real-world quality of life differences between people with and without hemophilia in Malta. (2026), Abstract PO079. Haemophilia, 32: 4-224. https://doi.org/10.1111/hae.70195

Introduction

The Patient-Reported Outcomes, Burdens and Experiences (PROBE) questionnaire captures the real-world impact of hemophilia from the patient perspective. Malta is an island with a population of ∼620, 000 people. This analysis presents Malta’s results as part of PROBE, comparing people with hemophilia (PwH) to people without bleeding disorders (PWoBD).

 Methods 

This was a cross-sectional, observational study. The PROBE questionnaire includes demographic, clinical, and health-related quality of life domains. Comparisons were descriptive, as the study was not powered for inferential testing.

 Results

10 PwH and 10 PWoBD participated. Average age of PwH was 38.6 ± 15.4 years compared to 55.6 ± 12.9 years among PWoBD, with similar education levels (14.1 ± 4.3 vs. 15.8 ± 4.8 years, respectively). Most PwH (60%) had hemophilia A, with half reporting severe disease (factor <1%), 30% moderate, and 10% mild. Regular prophylaxis was used by 50% of PwH, while 20% received intermittent prophylaxis, 20% on-demand treatment.

75% of PwH were married, though none had children, vs 90% of PWoBD who were married with 80% of whom had children. Mobility limitations were reported by 10% of PwH, and 50% used pain medication at least occasionally. Acute pain was reported by 50% of PwH and chronic pain by 60%, often localized to problem joints (50%). By contrast, only two PWoBD (20%) reported acute pain and one reported chronic pain. Activities of daily living were affected in 40% of PwH, and health-related decisions about education or career were influenced in 40% as well. Among PwH, 10% were unemployed due to health, 70% were working full- or part-time.

Bleeding episodes remained moderate: 30% of PwH reported bleeding within the previous 2 weeks, and 50% had problem joints. Limitations in joint movement were observed in 30% of PwH, and 60% had undergone joint surgery, compared with only 10% among PWoBD. PwH missed an average of 43.5 ± 109.7 days of work/school versus 4.5 ± 5.4 days among PWBD. Quality
of life (QOL) measures reflected the same disparity: the EQ-5D index averaged 0.79 ± 0.18 in PwH versus 0.94 ± 0.05 in PWoBD, and the PROBE score was 0.82 ± 0.17 compared with 0.97 ± 0.03.

 Conclusion 

Findings reveal that Maltese PwH experience a substantially lower QOL compared with PWoBD, driven by higher pain prevalence, more frequent bleeding, reduced mobility, and significant productivity losses.

Abstract: HERE

Mapping outcomes to coreVWD: moving toward a fully reportable core outcome set to improve access to treatment for people with von Willebrand Disease (VWD)

Clearfield, E., Ayoub, E., Ziemele, B., Delaney, M., Youttananukorn, T., Coffin, D., Brennan, F., Kucher, A., Skinner, M. W., & James, P. (2025, August). Mapping outcomes to coreVWD: Moving toward a fully reportable core outcome set to improve access to treatment for people with von Willebrand disease (VWD) [Poster presentation]. National Bleeding Disorders Foundation (NBDF) Annual Conference, Atlanta, GA, United States.

Objective

The VWD treatment landscape is expanding; to assess upcoming products for efficacy and cost-effectiveness, outcomes must be harmonized across clinical trials, registries, and post-market studies. The coreVWD Initiative (Clearfield, Haemophilia 2024) convened a multi-stakeholder group to align on a recommended core outcome set important to decision-makers across the product lifecycle. Outcomes were prioritized for prophylaxis, perioperative treatment, and for women, girls, and people with the potential to menstruate (WGPPM); adverse events were also considered. To fully utilize these recommendations, we must now identify how to most efficiently measure, collect and report them.  

 Aims

Using coreVWD as a benchmark, to map the core outcomes identified to those currently collected in prominent ongoing studies and identify points of overlap and gaps to be covered by updated or new measurement tools.  

 Methods 

We compared the coreVWD core outcomes to the World Federation of Hemophilia’s World Bleeding Disorders Registry (WBDR) and myWBDR app datasets and to variables collected in the Patient Reported Outcomes Burdens and Experiences (PROBE) Study, a quality-of-life study for people with hemophilia  

 Results

Frequency of bleeds and bleeds requiring treatment are well covered by WBDR, myWBDR, and PROBE, but other descriptions of bleeding are only captured dependent on what Bleeding Assessment Tool (BAT) is used (Table). Information about perioperative bleed control is only collected in WBDR. All three tools could better cover the core outcomes if they enhanced or added a section for WGPPM on menstrual bleeding and pregnancy experiences. 

 Conclusion 

coreVWD prioritized outcomes important to patients; the coreVWD outcomes will require both patient and clinically reported data. This initial analysis provides a foundation to assess completeness and fitness for purpose. Future research will assess data gaps and explore possible revisions to allow WBDR, myWBDR, or PROBE to capture additional coreVWD outcomes. Comprehensively collecting patient-important outcomes will support treatment advances for people with VWD. 

Abstract: HERE (TBA)

Development of a WGPPM-Focused PROBE Survey: Addressing Underrepresentation in Patient-Reported Outcomes and Quality of Life Research

Kucher, A., Skinner, M. W., Clearfield, E., Brennan, F., Rotellini, D., Colle, Y., & Wilton, P. A. (2025). Development of a WGPPM-Focused PROBE Survey: Addressing underrepresentation in patient-reported outcomes and quality of life research [Poster presentation]. National Bleeding Disorders Foundation (NBDF) Annual Conference, Atlanta, GA, United States.

Objective

Women, Girls, and People with the Potential to Menstruate (WGPPM), including those with von Willebrand disease (VWD), platelet function disorders, rare coagulation factor deficiencies, and other rare bleeding disorders, remain significantly underrepresented in research related to patient-reported outcomes (PROs) and health-related quality of life (HRQoL). Existing tools such as the Patient Reported Outcomes, Burdens, and Experiences (PROBE) survey—originally developed in 2012—have primarily focused on individuals with hemophilia A or B and carriers, with data also collected from individuals without a bleeding disorder (NoBD) serving as a control group. However, the unique experiences, burdens, and health impacts specific to WGPPM have not been fully captured in existing survey instruments.

 Methods 

To address this gap, a targeted literature review using PubMed was conducted to identify key concepts influencing the quality of life in WGPPM. In parallel, the study team contributed historical examples of related surveys for review. These sources were analyzed to identify novel domains and items, which were then organized into a conceptual framework. This framework was compared against the existing PROBE questionnaire to assess gaps in content coverage. Based on this analysis, the PROBE instrument was revised to include concepts relevant to WGPPM. The development process was undertaken in collaboration with key stakeholders, including the World Federation of Hemophilia, Coalition of the Americas, European Haemophilia Consortium, and the National Bleeding Disorders Foundation, all of whom contributed to a dedicated working group guiding this initiative.

 Summary

The updated framework expands the PROBE instrument with an additional 13 questions which include several WGPPM-specific concepts, such as access to healthcare (including specialty care), emergency department utilization, and bleeding episodes unique to this population, including menstruation and gynecological complications. Additional domains address reproductive decision-making, including considerations around family planning, as well as the social and emotional impact of living with a bleeding disorder—particularly as it pertains to leisure activities and interpersonal relationships. Furthermore, the revised tool allows for improved representation of individuals with rare and often overlooked bleeding disorders.

 Conclusion 

The WGPPM-specific PROBE exploratory pilot was launched in early 2025 through an online platform. It is anticipated that this pilot will generate comprehensive and representative data to better understand the lived experiences of WGPPM. These findings will inform future efforts in research, advocacy, clinical care, and health policy, while also serving as the basis for subsequent updates to the PROBE questionnaire to ensure its continued inclusivity and relevance.

Abstract: HERE

Feasibility of Administering the Patient Reported Outcomes, Burdens and Experiences (PROBE) Questionnaire Through the Canadian Bleeding Disorders Registry (CBDR) and Comparison of Data From the Two Sources

F. GerminiC. CossaE. Trinari, et al. “ Feasibility of Administering the Patient Reported Outcomes, Burdens and Experiences (PROBE) Questionnaire Through the Canadian Bleeding Disorders Registry (CBDR) and Comparison of Data From the Two Sources.” Haemophilia (2025): . https://doi.org/10.1111/hae.70117

Introduction

The Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire can be used to measure quality of life in persons with haemophilia (PWH) and is integrated in the Canadian Bleeding Disorders Registry (CBDR). This offers the opportunity to compare the same data inputted by patients in PROBE and their treating team in CBDR.

Aim

Our objectives were to assess the feasibility of collecting PROBE data through CBDR and to compare the data collected from these two sources.

Methods

We conducted a prospective observational study among PWH using MyCBDR. Participants were invited to digitally complete the PROBE questionnaire at baseline and to repeat it at 6 and 12 months. Additional data were passively collected through CBDR. Data from PROBE and CBDR were compared using Kappa agreement, intraclass correlation (ICC) and Pearson correlation.

Results

A total of 142 PWH participated. Recruitment ratios were 21.1% and 12.0% for the two phases. Retention rates were 40.8% at 6 months and 32.4% at 12 months.

Three hundred thirteen subjects were involved in the comparison between PROBE and CBDR data. The agreement was good to very good (κ > 0.75) or the correlation very strong, with the exception of the history of inhibitor (κ = 0.57), recent bleeds (κ = 0.48) and current treatment regimen (κ = 0.57).

Conclusions

The integration of PROBE with CBDR is feasible and PROBE is a reliable tool for routine PRO data collection. Its use in clinical practice may improve data quality and personalized and patient-centred care.

View Poster: HERE

Mapping outcomes to coreVWD: moving toward a fully reportable core outcome set to improve access to treatment for people with von Willebrand Disease (VWD)

Clearfield, E., Ayoub, E., Ziemele, B., Delaney, M., Youttananukorn, T., Coffin, D., Brennan, F., Kucher, A., Skinner, M. W., & James, P. (2025). Mapping outcomes to coreVWD: Moving toward a fully reportable core outcome set to improve access to treatment for people with von Willebrand Disease (VWD) [Abstract]. ISTH. https://www.rpthjournal.org/issue/S2475-0379(24)X0006-0

Background 

The VWD treatment landscape is expanding; to assess upcoming products for efficacy and cost-effectiveness, outcomes must be harmonized across clinical trials, registries, and post-market studies. The coreVWD Initiative (Clearfield, Haemophilia 2024) convened a multi-stakeholder group to align on a recommended core outcome set important to decision-makers across the product lifecycle. Outcomes were prioritized for prophylaxis, perioperative treatment, and for women, girls, and people with the potential to menstruate (WGPPM); adverse events were also considered. To fully utilize these recommendations, we must now identify how to most efficiently measure, collect and report them.  

 Aims 

Using coreVWD as a benchmark, to map the core outcomes identified to those currently collected in prominent ongoing studies and identify points of overlap and gaps to be covered by updated or new measurement tools.  

 Methods 

We compared the coreVWD core outcomes to the World Federation of Hemophilia’s World Bleeding Disorders Registry (WBDR) and myWBDR app datasets and to variables collected in the Patient Reported Outcomes Burdens and Experiences (PROBE) Study, a quality-of-life study for people with hemophilia.   

 Results 

Frequency of bleeds and bleeds requiring treatment are well covered by WBDR, myWBDR, and PROBE, but other descriptions of bleeding are only captured dependent on what Bleeding Assessment Tool (BAT) is used (Table). Information about perioperative bleed control is only collected in WBDR. All three tools could better cover the core outcomes if they enhanced or added a section for WGPPM on menstrual bleeding and pregnancy experiences. 

 Conclusion 

coreVWD prioritized outcomes important to patients; the coreVWD outcomes will require both patient and clinically reported data. This initial analysis provides a foundation to assess completeness and fitness for purpose. Future research will assess data gaps and explore possible revisions to allow WBDR, myWBDR, or PROBE to capture additional coreVWD outcomes. Comprehensively collecting patient-important outcomes will support treatment advances for people with VWD. 

Mapping of coreVWD core outcomes to WBDR, myWBDR, and the PROBE Study Data Elements 
Type of Study coreVWD core set WFH WBDR Section 

(Clinician-reported) 

myWBDR Section 

(Patient-reported) 

PROBE Study* Question 

(Patient-reported) 

All  Severity of bleeds BAT Score1,2 Patient-reported bleed   
Duration of bleeds BAT Score1,2   
Bleeds requiring treatment BAT Score1,2, Treatment History Patient-reported bleed Treatment product and treatment regimen 
Prophylaxis Treatment Frequency of bleeds Bleeding Events Assessment Patient-reported bleed Number of bleeds in last year, and last two weeks 
Mucocutaneous bleeds BAT Score1,2 (focused on epistaxis and mouth bleeding), Bleeding Events Assessment Patient-reported bleed  
Musculoskeletal bleeds BAT Score1, Bleeding Events Assessment Patient-reported bleed Problem joints and range of motion 
Bleed control: non-surgical bleeds requiring additional treatment BAT Score1,2, Treatment Module Patient-reported bleed, Patient-reported treatment Treatment product and treatment regimen 
Quality of life (QOL) EQ-5D-5L EQ-5D-5L EQ-5D-5L 
Perioperative 

 Treatment 

Re-admission to hospital    
Ability to undergo invasive diagnostic or surgical procedures BAT Score2,3  Treatment regimen and question about invasive procedures 
Bleed control: with prophylaxis prior to surgery BAT Score2, Treatment Module Patient-reported bleed, Patient-reported treatment  
Bleed control: without prophylaxis prior to surgery BAT Score2, Treatment Module   
Number of administrations needed to treat surgical bleeds    
WGPPM 

Health 

Menstrual blood loss BAT Score1,2,3, Bleeding Events Assessment, Hospital Admission Module Patient-reported bleed   
Menstrual period duration BAT Score1,3   
Heavy menstrual bleeding requiring treatment BAT Score1,2,3 Patient-reported bleed   
Need for blood transfusion from menstrual blood loss BAT Score1,2,3  Invasive procedures 
Postpartum hemorrhage BAT Score1,2,3, Hospital Admission Module, Pregnancy Module Patient-reported bleed  Health problems and conditions 
Need for blood transfusion peri-partum BAT Score1,2,3  Invasive procedures 
Adverse Events Inhibitor development VWF Inhibitor History, Inhibitor Assessment Module  Current inhibitor and question about ever having an inhibitor 
Thromboembolic events Adverse Events Module  Health problems and conditions 
Mortality Mortality Section   
Pregnancy: serious adverse event in mother Pregnancy Module Patient-reported bleed  

Empty cells represent data gaps. Grayed cells indicate partial coverage or that outcome can be derived from data dependent on type of assessment used and/or detail provided in open text boxes.  
1 BAT Scores assessed Self-BAT
2 BAT Scores assessed by ISTH BAT
3 BAT Scores assessed by MCMDM-1
*PROBE is collected as part of the myWBDR PRO module, or can be administered independently
PROBE is a quality-of-life study, further description of what should be included as QOL for those with VWD is needed 

Abstract: HERE

Comparing Health Outcomes for Women and Girls with Hemophilia and No Bleeding Disorder – Insights from the Patient Reported Outcomes Burdens and Experiences (PROBE) Study

Skinner M. W., Kucher A., Clearfield E., Curtis R. G., Germini F., Iorio A., Nichol M., Page D., Stonebraker J. Development of Women, Girls, and People Who Have or Had the Potential to Menstruate (WGPPM) questionnaire for PROBE study. (2025), Book of Abstracts. Haemophilia, 31: 21-109. https://doi.org/10.1111/hae.70032

Objective

There is limited comparative quality-of-life (QoL) data for women and girls with hemophilia A or B who have the potential to menstruate (WGwH). To advance management and treatment it is essential to collect patient-reported health outcomes data.  The validated PROBE questionnaire collects health-related QoL data from WGwH, including carriers, and women and girls who have the potential to mensurate without a bleeding disorder (NoBD) who serve as a control group. We compared the QoL of WGwH with NoBD.

Methods

This was a cross-sectional study from the PROBE database. We included WGwH ≥ age 13 who self-reported hemophilia A or B, as a carrier with a factor level <40%, or NoBD that were identified in the PROBE database. We used descriptive statistics to provide a summary of participant characteristics (Table 1).

Results

From 2015 to 2024, 232 WGwH indicated that they had severe (n=70), moderate (n=26) or mild (n=136) factor deficiency and 407 NoBD were available for comparison. Prophylaxis use was 65.71% in WGwH classified as severe, 19.23% in moderate, and 5.15% in mild. Use of mobility aids was 14.29% in severe, 38.46% in moderate, 14.71% in mild WGwH, and 8.85% in NoBD. Participants with moderate and mild hemophilia reported that this condition impacted important QoL metrics for: chronic pain (CP), target/problem joints (TJ/PJ), reduced joint range of motion (ROM) and difficulties with activities of daily living (ADL) (CP 61.54%, 44.85%; TJ/PJ 50%, 21.32%; ROM 50.0%, 19.85%; ADL 46.15%, 21.32% respectively). See Table 1.

Conclusions

Our study suggests a worse QoL for WGwH compared to NoBD, with a worsening trend with increasing severity. This analysis confirms prior research (Chai-Adisakosopha Haemophilia 2020) showing that non-severe hemophilia is not benign.  WGwH are affected by their bleeding disorders. PROBE data collection for WGwH and further analysis are on-going.

Table 1. Participant Characteristics
SevereModerateMildNo BD
n17026136407
Age (SD)37.19 (11.52)41.69 (14.77)45.09 (14.83)44.58 (14.75)
Years of education (SD)15.87 (4.87)15.4 (3.88)15.84 (4.5)16.87 (4.47)
Hemophilia A165 (92.86%)21 (80.77%)118 (86.76%)n/a
Regular prophylaxis46 (65.71%)5 (19.23%)7 (5.15%)n/a
Intermediate prophylaxis5 (7.14%)8 (30.77%)7 (5.15%)n/a
Episodic (On-demand) treatment12 (17.14%)7 (26.92%)64 (47.06%)n/a
No treatment available3 (4.29%)4 (15.38%)36 (26.47%)n/a
Married50 (71.43%)19 (73.08%)97 (71.32%)304 (74.69%)
Have children56 (80.0%)19 (73.08%)107 (78.68%)284 (69.78%)
Used a mobility aid or assistive device (past 12 months)10 (14.29%)10 (38.46%)20 (14.71%)36 (8.85%)
Reported acute pain (past 12 months)30 (42.86%)15 (57.69%)73 (53.68%)149 (36.61%)
Reported chronic pain (past 12 months)27 (38.57%)16 (61.54%)61 (44.85%)158 (38.82%)
Currently have a Target Joint(s) or Problem Joint(s)230 (42.86%)13 (50.0%)29 (21.32%)n/a
Report chronic pain in a Target Joint(s) or Problem Joint(s)218 (60%)7 (53.85%)15 (65.52%)n/a
Currently have Joint(s) with reduced Range of Motion (ROM)29 (41.43%)13 (50.0%)27 (19.85%)n/a
Ever had Joint Surgery or Other Invasive Procedure23 (32.86%)15 (57.69%)59 (43.38%)129 (31.7%)
Current difficulty with Activities of Daily Living (ADL) affected21 (30.0%)12 (46.15%)29 (21.32%)70 (17.2%)
Unemployed or on long-term disability (not a student)5 (7.14%)3 (11.54%)3 (2.21%)15 (3.69%)
Working full or part-time39 (55.71%)5 (19.23%)87 (63.97%)239 (58.72%)
Retired3 (4.29%)2 (7.69%)15 (11.03%)40 (9.83%)
Stay at home parent11 (15.71%)2 (7.69%)8 (5.88%)39 (9.58%)
Student (full or part-time)13 (18.57%)4 (15.38%)14 (10.29%)52 (12.78%)
Average days missed school or work due to health (SD)29.74 (86.41)24.8 (72.62)15.45 (49.03)10.5 (48.13)
EQ-5D-5L0.8670.8060.6500.897
PROBE Score0.8480.7660.8170.872
Annual Bleed Rate
017 (24.29%)4 (15.38%)74 (54.41%)n/a
15 (7.14%)2 (7.69%)24 (17.65%)n/a
2-323 (32.86%)7 (26.92%)15 (11.03%)n/a
4-79 (12.86%)5 (19.23%)11 (8.09%)n/a
8-103 (4.29%)4 (15.38%)0n/a
11-154 (5.71%)2 (7.69%)3 (2.21%)n/a
16-304 (5.71%)1 (3.85%)4 (2.94%)n/a
More than 303 (4.29%)02 (1.47%)n/a
Bleeding in the past 2 weeks25 (35.71%)7 (26.92%)16 (11.76%)n/a
Life threatening bleed (past 12 months)10 (14.29%)5 (19.23%)4 (2.94%)n/a
1. WGwH who self-report having hemophilia or as carriers with a factor level <40.

2. Beginning with PROBE questionnaire Version 3, the generic question asking about target joints was revised to ask about ‘Problem Joint(s)’.  A Problem Joint is defined as having chronic joint pain and/or limited range of movement due to compromised joint integrity (e.g. chronic synovitis and/or hemophilic arthropathy), with or without persistent bleeding.

Oral Presentation: HERE