Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 2: Linking Outcomes to the International Classification of Functioning, Disability and Health

Comparing the Primary Concerns of Injured Collegiate Athletes With the Content of Patient-Reported Outcome Measures

CONTEXT

Patient-reported outcome measures (PROMs) have been endorsed for providing patient-centered care. However, PROMs must represent their target populations.

OBJECTIVE

To identify the primary concerns of collegiate athletes experiencing injury and compare those with the content of established PROMs.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

Collegiate athletes experiencing injury (N = 149).

MAIN OUTCOME MEASURE(S)

Open-ended responses to the Measure Yourself Medical Outcome Profile were used to identify primary concerns, which were linked to International Classification of Functioning, Disability and Health taxonomy codes. Items of the Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; Lower Extremity Functional Scale; Knee injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee Subjective Knee Form (IKDC); Foot and Ankle Ability Measure; Disabilities of the Arm, Shoulder, and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire were linked to International Classification of Functioning, Disability and Health codes. We calculated χ2 single-sample goodness-of-fit tests to determine if 70% of the content was shared between PROMs and participant-generated codes.

RESULTS

Participant-generated concerns were primarily related to sport participation (16%) and pain (23%). Chi-square tests showed that the Lower Extremity Functional Scale and Foot and Ankle Ability Measure presented significant content differences, with common participant-generated lower extremity responses at all levels. The Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; KOOS; IKDC; Disabilities of the Arm, Shoulder and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire did not have significant content differences for level 2 codes; still, significant differences were present for level 3 analyses except for the KOOS and IKDC (P < .001). All measures except the IKDC contained significant superfluous content (P < .05).

CONCLUSIONS

The presence of significant content differences supports clinician-perceived barriers regarding the relevance of established PROMs. However, the IKDC was a relevant and efficient PROM for evaluating the primary concerns of collegiate athletes experiencing lower extremity injury. Clinicians should consider using patient-generated measures to support coverage of patient-specific concerns in care.

A THEORETICAL BASED PHYSIOTHERAPY GOAL SETTING MODEL FOR ANTERIOR CRUCIATE LIGAMENT REHABILITATION

BACKGROUND

Anterior Cruciate Ligament rehabilitation is a lengthy process and requires appropriate goal setting strategies to help optimize patient and athlete outcomes. From a global perspective, ACL injury incidences are continuing to rise, with Australia and the USA having one of the highest incidences of ACL injury rates in the athletic population. In addition, physiotherapists are expected by their professional regulatory body to effectively use goal setting practices.

DESIGN

Theoretical Goal Setting Model consisting of three phases: 1) Pre goal setting phase (empower); 2) goal implementation phase (strive); and 3) goal evaluation phase (attain).

DISCUSSION

This model provides physiotherapists with a useful process so that key aspects of setting goals are considered and incoporporated. This model showcases a necessary path a physiotherapist and patient must journey together in order to enhance rehabilitation outcomes. This model will also advance the  physiotherapists' awareness of the multi-stages of the patients goal desires, intentions and commitment to their rehabilitation.

CONCLUSION

This model is a preliminary attempt to guide both practice, teaching, and research to ensure that goal setting practices in ACL rehabilitation are given an appropriate rehabilitative platform. The next stage is to empirically validate the practical application of the model and how each phase manifests.