Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study

doi:10.1016/j.physio.2016.01.001

Physiotherapy

Volume 103, Issue 1, March 2017, Pages 66-72

https://doi.org/10.1016/j.physio.2016.01.001 Get rights and content

Abstract

Objectives

Routine use of patient reported outcome measures (PROMs) may provide an effective way of monitoring patient valued outcomes. In this study we explored (1) the current use of PROMs; (2) to what extent the goals correspond with the selected PROMs; (3) the health outcomes based on PROMs.

Design

Observational clinical cohort study.

Setting

Dutch primary care physiotherapy practices (n = 43).

Participants

Patients (n = 299) with neck pain or low back pain.

Main outcome measures

The number of PROMs used per patient were calculated. The International Classification of Functioning, Disability and Health was used to map the patients’ goals and the percentages of PROMS selected that match the domains of the goals were calculated. Health outcomes were assessed using two approaches for estimating the minimal clinically important difference (MCID).

Results

Repeated measurements with the Visual Analogue Scale, the Patient Specific Complaints questionnaire, the Quebec Back Pain Disability Scale, or the Neck Disability Index were completed by more than 60% of the patients. The PROMs used matched in 46% of the cases with goals for pain improvement, and in 43% with goals set at activity/participation level. The mean differences between baseline and follow up scores for all PROMs were statistically significant. Improvements of patients based on MCID varied from 57% to 90%.

Conclusions

PROMs were used in the majority of the patients, showed improved health outcomes and fitted moderately with goals. The results of this study can be used for future research assessing the routine use of outcome measurements with PROMs.

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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New Zealand osteopaths’ use of patient-reported outcome measures with patients who have chronic low back pain: A cross-sectional survey
2024, International Journal of Osteopathic Medicine
Patient-Reported Outcome Measures (PROMs) are instruments that capture patients' perspectives of their own health status and quality of life. As part of rising advocacy for their use in clinical practice, PROMs are said to hold promise for the management of long-term conditions. This study aimed to describe and explore New Zealand osteopaths’ use of PROMs for patients with chronic low back pain.
An online survey was adapted to investigate New Zealand osteopaths’ use of PROMs with patients who have chronic LBP. Topics included frequency of use, purposes for use, and determinants to use. Respondents were recruited via anonymous and non-randomised sampling across multiple platforms. Frequencies, means, and standard deviations were calculated for all numerical data. Content analysis was used to analyse textual data on determinants to use.
In total, 79 osteopaths were included in data analysis. These respondents most often used PROMs to monitor patients’ pain intensity (80%) and sometimes also functional disability (27%). Although the respondents had some regard for their capability to use PROMs, they also claimed to be constrained by limited time and social or professional norms. Respondents were more attentive to the consequences of PROMs for patients than for other stakeholders.
Although New Zealand osteopaths may use PROMs to monitor the burden of chronic LBP, they probably do not use PROMs for the multidimensional assessment of pain or psychosocial factors. New Zealand osteopaths may be most receptive to adopting PROMs if they are presented with relevant interventions and evidence of their benefits for patients.
The utilisation and attitudes to patient reported outcome measures by Australian osteopaths: A cross sectional study
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Citation Excerpt :
The low utilisation of PROMs in Australian practice may result in poorer patient care healthcare [6,9,10]. The use of PROMs provides a clearer indication of patient progress with treatment and can be used to identify patients that are not making substantial progress in functional outcomes [4,28]. Failure to adequately identify this may lead to over-treatment or delayed referral.
Patient-reported outcome measures (PROMs) provide information on patients’ views of their symptoms, functional status, health related quality of life and are an important part of evidence-informed practice and patient-centred care. The utilisation of and attitudes to PROMs by Australian osteopaths is unknown.
An online survey was designed to investigate the self-reported utilisation of PROMs by Australian osteopaths, including the frequency of use, the types of PROMs used, the features of PROMs are most useful, the attitudes towards PROMs, and the barriers and enablers for use of PROMs. The survey was a 14-item questionnaire that used a 5-point Likert scale or required free text answers. The effect of gender and years in practice was analysed using Mann-Whitney U tests. Effect sizes were calculated where possible.
166 (male = 69, female = 97) osteopaths participated in the survey. Nearly half (47.6%) reported that pain scales were used ‘frequently’ or ‘always’, but there was less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%). Australian osteopaths reported using PROMs most frequently for patients with neck pain (31%) and low back pain (29%). The majority agreed PROMs were important for tracking improvement in patients (61%). The greatest barrier identified by osteopaths was the burden on consultation time.
This study highlighted only the minority of Australian osteopaths use PROMs frequently and consider them important. Professional organisations should consider professional development aimed to upskill and support practitioners in the efficient use of PROMs in practice.
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  Nearly half (47.6%) of 166 osteopaths reported using pain scales ‘frequently’ or ‘always’, but there was a less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%).
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  The majority of osteopaths agreed that PROMs were important for tracking clinical improvement in patients (61%), although only 48% agreed that PROMs were important in osteopathic practice.
- •
  The greatest barrier identified by osteopaths to using PROMs was the burden on consultation time and most common enabler was the requirement of PROMs by third party payers.
Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden
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It is however reported that PROMs better identify for example psychosocial factors compared to physiotherapists' own ratings (Miki et al., 2020; Calley et al., 2010). Using PROMs has been suggested to improve the patent-therapist interaction and to get the patient to be more actively involved in the rehabilitation process (Kyte et al., 2015; van Dulmen et al., 2017). In keeping with this, a recent study reported that patients perceive that PROMs add to the value of physiotherapy practice (Meerhoff et al., 2019).
Physiotherapists in primary health care are required to use patient reported outcome measures (PROMs) to manage patients with low back pain (LBP).
Our aim was to explore and describe how physiotherapists in primary care managing patients with LBP, experience the use of PROMs with a focus on facilitating and hindering factors.
We undertook a qualitative study with semi-structured interviews. Fifteen physiotherapists (9 female and 6 male) were included. The interviews were audio-recorded and transcribed verbatim and analysed by inductive manifest content analysis.
Our findings resulted in eight main categories: PROMs give structure and increase patient involvement; Patients' motivations to use PROMs; Time and the physiotherapist's clinical priorities; Physiotherapists' routines steer their use of PROMs; Physiotherapists' competences in using PROMs; Organizations and managers steer the use of PROMs; Prerequisites for future use of PROMs; Using PROMs develops the physiotherapy profession.
Our findings show that using PROMs gives structure and increases patient involvement, but the patient's motivation to use PROMs needs to be taken into consideration. Time and routines influence the use of PROMs and these factors depend on organizational and managerial levels. Using PROMs is believed to help develop the physiotherapy profession. Prerequisites for future use, such as digitalization and increased competence, need to be fulfilled. Future studies should focus on increasing physiotherapists' knowledge about relevant PROMs, and study implementation in clinical practice, thereby improving the physiotherapy profession's quality of care.
Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial
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Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review
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Feasibility of a quality improvement program based on routinely collected health outcomes in Dutch primary care physical therapist practice: a mixed-methods study
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View full text

Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study

Abstract

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Introduction

Section snippets

Setting and participants

Responses and characteristics of participants

Discussion

Acknowledgements

Spine J.

Pain

J Pain

Goal-oriented patient care – an alternative health outcomes paradigm

N Engl J Med

Integrating the use of patient-reported outcomes for both clinical practice and for performance measurement: experts’ views from three countries

Milbank Q

Supporting a person-centred approach in clinical guidelines

An introduction to patient-reported outcome measures (PROMs) in physiotherapy

Physiotherapy

Clinicians’ and patients’ views of metrics of change derived from patient reported outcome measures (PROMs) for comparing providers’ performance of surgery

BMC Health Serv. Res.

Reimagining quality measurement