Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study
Introduction
The routine use of patient reported outcome measures (PROMs) is of increasing interest, because PROMs may provide an effective way of monitoring patient valued outcomes. The use of PROMs might facilitate goalsetting with the patient in selecting health outcomes of the highest priority, and in determining what interventions are most likely to achieve those outcomes [1], [2]. PROMs data provide an added value to other measurements, such as joint mobility, as PROMs capture information regarding aspects of health problems that are important to patients. Physiotherapist use goalsetting for action planning, to set shared goals in consultation with the patient, and to examine to what extent the goals are achieved. PROMs may help the physiotherapist to identify goals, because patients are actively involved identifying their individual problems and goals which might increase their participation and satisfaction [2], [3], [4]. To interpret if goals have been achieved, it is important to compare PROMs scores before and after the intervention. Baseline, follow up scores, and mean change scores on the PROMs, or proportion of patients achieving a significant improvement based on the minimal clinically important difference (MCID) are frequently used metrics [5]. The MCID is defined as the minimal change that is important to the patient, and is considered an important parameter to enable a proper interpretation of change scores [6].
Outcome measures at the patient level can be aggregated into population measures for feedback on the management of groups of patients. In quality systems this information is often presented using quality indicators for reflection to a certain benchmark. Recently, it has been advocated that PROMs should be integrated with care delivery as a useful quality measurement [2], [4], [7]. Therefore, we started to study the actual use of PROMs in daily physiotherapy practice.
Physiotherapists in the Netherlands are expected to be familiar with the use of PROMS as in Dutch physiotherapy guidelines many PROMs are recommended. However, little is known about the actual use of PROMs, the relation between goals and PROMs used and what the outcomes on the PROMs are. Therefore, our study aimed to improve insight into how PROMs are used in current clinical practice. The research questions were: (1) to what extent do physiotherapists apply PROMs in patients with neck and back pain; (2) to what extent do the domains of goals correspond with the PROMs selected; and (3) what are the actual health outcomes indicated by the PROMs when comparing baseline and follow-up measures.
Section snippets
Setting and participants
Data was collected from February till November 2010. Recruitment of physiotherapist working in primary care practices took place at an open meeting during the annual congress of physiotherapy in 2009. Upon enrolment, physiotherapists received an instruction guide and additional information about the study purposes. Physiotherapists (n = 60) of 43 practices decided to participate in the study. Each participating practice formally provided written consent to participate and all patients were
Responses and characteristics of participants
A total number of 60 physiotherapists (19% female) participated; 23% of the physiotherapists were aged <39 years, 27% between 40 and 49 years and 52% of the physiotherapist were 50 years or older. The practices were all private practice clinics, 31% of the practices were solo practices and on average 3.3 therapists worked per practice. The participating physiotherapists comprised a representative sample when compared with national reference data [20]. Only the percentage of women differed: 19%
Discussion
Our study showed in general that PROMs were used for baseline and follow up measurements in the majority of patients. The selected domains of the goals matched the domain of the PROMs moderately. In 46% of the patients with a goal on pain reduction a VAS was used, whereas in 43% of the patients with a goal on activity or participation level a QBPDS, NDI or PSC was used.
The PROMs were used for more than 60% of the patients, which is high compared to other studies [22]. This might be explained by
Acknowledgements
The authors would like to thank all participating primary care practices for providing data. We thank statistician R. Akkermans for statistical advice and calculations, research assistant A. Schlief for her support, and R. Oostendorp for his valuable and constructive suggestions during the planning and development of this research work.
Ethical approval: Following the rules of the Medical Ethics Committee of Radboud university medical Center Nijmegen in the Netherlands, no ethics approval was
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