Thomas 2016.

Study characteristics
Methods	Randomised trial, Canada
Participants	54 families
Interventions	This trial’s purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence‐based tools with non‐evidence based screening, and (2) ascertain whether the four tools can be completed in 10‐min pre‐visit on a computer.   Intervention features Single complex feedback (multiple PROMs at a single time)  PROM(s) used as intervention: Parents’ Evaluation of Developmental Status (PEDS), the PEDS‐Developmental Milestones (PEDS‐DM), the Modified Checklist for Autism in Toddlers (M‐CHAT) and PHQ9 (maternal depression) Constructs measured: Symptoms, Functioning Instrument categories/domains: Domain/Disease specific (child development, autism, mental health)   Administration features Where PROMs administered: Clinical setting (e.g. waiting room, office, etc)  How administered: Self‐administered Format of PROMs questionnaire(s): Electronic   Feedback features Format of PROMs feedback: Electronic How often information fed back: Once Who information fed back to: Clinicians, Patients Information fed back: Scores
Outcomes	Main outcomes: Parents’ Evaluation of Developmental Status (PEDS), PEDS‐Developmental Milestones (PEDS‐DM), Modified Checklist for Autism in Toddlers (M‐CHAT), maternal depression (PHQ9).
Notes	Funding not disclosed. The study period was not reported. Conflicts of interest were not reported.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated method.
Allocation concealment (selection bias)	Low risk	Allocation was done by research assistant by computer to ‘usual care’ or evidence‐based screening.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Neither the participants nor family physicians could be blinded due to the nature of the intervention.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Due to nature of the intervention blinding of outcomes not possible: PROM used for feedback also used to assess outcome, patients were aware they received the intervention.
Baseline outcome measurements similar	Unclear risk	Not clearly reported.
Baseline characteristics similar	High risk	The usual care and evidence based care groups were very similar in gestational age at birth and age at screening (17.84 and 17.59 months). They differed markedly in female gender (40%, 62%)
Incomplete outcome data (attrition bias) All outcomes	High risk	In the ‘usual care’ group four (16%) and in the evidence‐based tools group 18 (62%) were identified as having a possible developmental problem.
Was study protected against contamination	High risk	As the physician or research associate were aware that the patient was a participant in the study.
Selective reporting (reporting bias)	Low risk	All relevant outcomes in the methods section are reported in the results section.