Physiotherapists use of and perspectives on the importance of patient-reported outcome measures for shoulder dysfunction

Examining perspectives on the adoption and use of computer-based patient-reported outcomes among clinicians and health professionals: a Q methodology study

OBJECTIVE

To determine factors that influence the adoption and use of patient-reported outcomes (PROs) in the electronic health record (EHR) among users.

MATERIALS AND METHODS

Q methodology, supported by focus groups, semistructured interviews, and a review of the literature was used for data collection about opinions on PROs in the EHR. An iterative thematic analysis resulted in 49 statements that study participants sorted, from most unimportant to most important, under the following condition of instruction: "What issues are most important or most unimportant to you when you think about the adoption and use of patient-reported outcomes within the electronic health record in routine clinical care?" Using purposive sampling, 50 participants were recruited to rank and sort the 49 statements online, using HTMLQ software. Principal component analysis and Varimax rotation were used for data analysis using the PQMethod software.

RESULTS

Participants were mostly physicians (24%) or physician/researchers (20%). Eight factors were identified. Factors included the ability of PROs in the EHR to enable: efficient and reliable use; care process improvement and accountability; effective and better symptom assessment; patient involvement for care quality; actionable and practical clinical decisions; graphical review and interpretation of results; use for holistic care planning to reflect patients' needs; and seamless use for all users.

DISCUSSION

The success of PROs in the EHR in clinical settings is not dependent on a "one size fits all" strategy, demonstrated by the diversity of viewpoints identified in this study. A sociotechnical approach for implementing PROs in the EHR may help improve its success and sustainability.

CONCLUSIONS

PROs in the EHR are most important to users when the technology is used to improve patient outcomes. Future research must focus on the impact of embedding this EHR functionality on care processes.

The relationship of range of motion and muscle strength to patients' perspectives in pain, disability, and health-related quality of life in patients with rotator cuff disease

BACKGROUND

The literature emphasizes that a consideration of patients' perspectives is an important part of the assessment process; however, it is ignored by many clinicians because they believe physical impairment measures can reflect patients' perspectives about their symptoms. But the relevance of changes in physical impairments to changes in patient-reported outcome scores in rotator cuff disease is ambiguous.

AIMS

The purpose of this study is to determine the relationship between changes in glenohumeral range of motion (ROM) and shoulder muscle strength and changes in pain, disability, and health-related quality of life scores before and after physical therapy in patients with rotator cuff disease.

METHODS

This was a retrospective study of thirty-nine patients with unilateral rotator cuff disease. All patients received a 6-week physical therapy program. The outcome measures were glenohumeral ROM, shoulder muscle strength, pain and disability using the Shoulder Pain and Disability Index (SPADI), and health-related quality of life as measured by the Western Ontario Rotator Cuff Index. All outcomes were measured before and after the treatment period.

RESULTS

There were weak correlations between the changes in abduction ROM and the SPADI-total score (r = - 0.32, p < 0.05), and the changes in external rotation strength and the SPADI-disability score (r = - 0.32, p < 0.05). There was no correlation between the changes in the other parameters.

CONCLUSIONS

This study implies that the changes in glenohumeral ROM and shoulder muscle strength do not represent the changes in patients' perspectives in pain, disability, and health-related quality of life after the physical therapy program in patients with rotator cuff disease.

Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials

OBJECTIVE

The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched.

METHODS

Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4).

CONCLUSION

Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ Rapid Recommendation

OBJECTIVES

To identify credible anchor-based minimal important differences (MIDs) for patient-reported outcome measures (PROMs) relevant to a BMJ Rapid Recommendations addressing subacromial decompression surgery for shoulder pain.

DESIGN

Systematic review.

OUTCOME MEASURES

Estimates of anchor-based MIDs, and their credibility, for PROMs judged by the parallel BMJ Rapid Recommendations panel as important for informing their recommendation (pain, function and health-related quality of life (HRQoL)).

DATA SOURCES

MEDLINE, EMBASE and PsycINFO up to August 2018.

STUDY SELECTION AND REVIEW METHODS

We included original studies of any intervention for shoulder conditions reporting estimates of anchor-based MIDs for relevant PROMs. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria. Six reviewers, working in pairs, independently extracted data from eligible studies using a predesigned, standardised, pilot-tested extraction form and independently assessed the credibility of included studies using an MID credibility tool.

RESULTS

We identified 22 studies involving 5562 patients that reported 74 empirically estimated anchor-based MIDs for 10 candidate instruments to assess shoulder pain, function and HRQoL. We identified MIDs of high credibility for pain and function outcomes and of low credibility for HRQoL. We offered median estimates for the systematic review team who applied these MIDs in Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence summaries and in their interpretations of results in the linked systematic review addressing the effectiveness of surgery for shoulder pain.

CONCLUSIONS

Our review provides anchor-based MID estimates, as well as a rating of their credibility, for PROMs for patients with shoulder conditions. The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain, and could also prove useful for authors addressing other interventions for shoulder problems.

PROSPERO REGISTRATION NUMBER

CRD42018106531.