Which Factors Influence the Use of Patient-Reported Outcome Measures in Dutch Physiotherapy Practice? A Cross-Sectional Study

Feasibility of a quality-improvement program based on routinely collected health outcomes in Dutch primary care physical therapist practice: a mixed-methods study

BACKGROUND

This study evaluates the feasibility of a nine-month advanced quality-improvement program aimed at enhancing the quality of care provided by primary care physical therapists in the Netherlands. The evaluation is based on routinely collected health outcomes of patients with nonspecific low back pain, assessing three feasibility domains: (1) appropriateness, feasibility, and acceptability for quality-improvement purposes; (2) impact on clinical performance; and (3) impact on learning and behavioral change.

METHODS

A mixed-methods quality-improvement study using a concurrent triangulation design was conducted in primary care physical therapist practice. Feedback reports on the processes and outcomes of care, peer assessment, and self-assessment were used in a Plan-Do-Study-Act cycle based on self-selected goals. The program's appropriateness, feasibility, and acceptability, as well as the impact on clinical performance, were evaluated using the Intervention Appropriate Measure, Feasibility Intervention Measure, Acceptability Intervention Measure (for these three measure, possible scores range from 4 to 20), and with a self-assessment of clinical performance (scored 0-10), respectively. The impact on learning and behavioral change was evaluated qualitatively with a directed content analysis.

RESULTS

Ten physical therapists from two practices participated in this study. They rated the program with a mean of 16.5 (SD 1.9) for appropriateness, 17.1 (SD 2.2) for feasibility, and 16.4 (SD 1.5) for acceptability. Participants gave their development in clinical performance a mean score of 6.7 (SD 1.8). Participants became aware of the potential value of using outcome data and gained insight into their own routines and motivations. They changed their data collection routines, implemented data in their routine practice, and explored the impact on their clinical behavior.

CONCLUSIONS

This explorative study demonstrated that a quality-improvement program, using health outcomes from a national registry, is judged to be feasible.

IMPACT STATEMENT

This study provides preliminary evidence on how physical therapists may use health outcomes to improve their quality, which can be further used in initiatives to improve outcome-based care in primary physical therapy.

Patient-reported outcome measurements (PROMs): Use during the physical therapy practice and associated factors

OBJECTIVE

To assess the current level of routine use of psychosocial-related patient-reported outcome measurements (PROMs) in physical therapy practice and which physical therapist-level factors are associated with the use of these measurement instruments.

METHODS

We conducted an online survey study among Spanish physical therapists involved in the treatment of LBP patients in Public Health Service, Mutual Insurance Companies, and private practice during 2020. Descriptive analyses were conducted for reporting the number and instruments utilized. Thus, sociodemographic and professional features differences between PTs using and not using PROM were analyzed.

RESULTS

From 485 physiotherapists completing the questionnaire nationwide, 484 were included. A minority of therapists routinely used psychosocial-related PROMs (13.8%) in LBP patients and only 6.8% did so through standardized measurements instruments. The Tampa Scale for Kinesiophobia (28.8%) and the Pain Catastrophizing Scale (15.1%) were used most frequently. Physiotherapists working in Andalucía and País Vasco regions, in private practice environments, educated in psychosocial factors evaluation and management, considering psychosocial factors during the clinical practice and expecting patients' collaborative attitudes demonstrated significantly greater use of PROMS (p < 0.05).

CONCLUSIONS

This study showed that the majority of physiotherapists in Spain do not use PROMs for evaluating LBP (86.2%). From those physiotherapists using PROMs, approximately the half use validated instruments such as the Tampa Scale for Kinesiophobia or the Pain Catastrophizing Scale while the other half limit their evaluation to anamnesis and non-validated questionnaires. Therefore, developing effective strategies to implement and facilitate the use of psychosocial-related PROMs would enhance the evaluation during the clinical practice.

Clinicians' perceived value and demographic factors that predict the utilisation of patient reported outcome measures for low back pain amongst chiropractors in Australia

Background

Factors that influence utilisation rates of patient reported outcome measures (PROMs) for low back pain (LBP) within the chiropractic profession of Australia are currently unknown. This study aimed to examine whether factors, including age, sex, experience level, clinical title (principal vs associate), or a clinicians’ perceived value of PROMs, are predictive of the frequency and/or type of PROMs used by chiropractors in the management of LBP.

Methods

A cross sectional online survey was distributed to members of the Chiropractic Association of Australia (CAA now known as Australian Chiropractors Association-ACA) and Chiropractic Australia (CA). 3,014 CAA members and 930 CA members were invited to participate totaling 3,944, only respondents that were using PROMs were included in the analysis (n = 370). Ordinal logistic regression was used to examine associations between clinician demographics and perceived value of PROMs, and the frequency of pain, health, and functional patient reported outcome measure (PROM) usage by chiropractors.

Results

Principal chiropractors were more likely (Wald = 4.101, p = 0.04, OR = 1.4 (1.0–2.1)) than associate chiropractors to frequently use pain-related PROMs for the management of patients with LBP. The remaining demographic factors (age, sex, and experience level) were not associated with the frequency of PROM usage; nor were the perceived value clinicians place on PROMs in clinical practice.

Conclusion

Principal chiropractors were more likely to frequently use pain-related PROMs for the management of patients with LBP when compared to associate chiropractors. Demographic factors, appear to have little influence on PROM usage. While chiropractors place high value on PROMs, these beliefs are not associated with increased frequency of PROM usage for the management of LBP.

Exploring the perspective of patients with musculoskeletal health problems in primary care on the use of patient-reported outcome measures to stimulate quality improvement in physiotherapist practice; a qualitative study

Background: Patient-reported outcome measures (PROMs) in clinical practice might enhance patient- centeredness and effectiveness of physiotherapy practice. Although patients have a crucial role in using PROMs, little is known about their perspective on its usefulness.Purpose: Explore the perspective of patients with musculoskeletal health problems on using PROMs for quality improvement in primary care physiotherapy practice, and determine what barriers and facilitators patients perceive.Methods: Semi-structured interviews were performed in 21 patients recruited from primary care physiotherapy practice and analyzed using theoretical thematic analysis. Barriers and facilitators on PROMs implementation were categorized into four predefined domains conform.Results: Across all domains, three major themes were identified: 1) Practicality; 2) Interaction with the physiotherapist for decision-making; and 3) Sharing information outside the clinical context. Generally, PROMs were perceived practically applicable instruments with added value to the interaction with the physiotherapist for shared decision-making and for stimulating quality improvement. The perceived barriers were: difficulties in administering PROMs for patients with poor computer skills, suboptimal efficiency when PROMs were administered at the expense of the consultation, the insufficient added value of PROMs for patients with recurrent health problems, and reluctance about sharing aggregated data for accountability purposes.Limitations: The dependence on the participating physiotherapists in patient recruitment might have resulted in selection bias.Conclusion: Patients perceive that using PROMs has an added value in primary care physiotherapy practice. Optimizing implementation using tailored implementation strategies related to the identified barriers in all four domains might further improve the use of PROMs in clinical practice.