Abstract
Objective
This systematic review examines the facilitators and barriers to the use of patient-reported
outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies
to improve care to maximize patient outcomes.
Data Sources
Eleven databases were systematically searched from November 2018 to May 2019.
Study Selection
Two reviewers independently assessed articles based on the following inclusion criteria:
English text, evaluate barriers and facilitators, include PROMs, and occur in an outpatient
rehabilitation setting (physical therapy, occupational therapy, speech language pathology,
or athletic training). Of the 10,164 articles initially screened, 15 articles were
included in this study.
Data Extraction
Data were extracted from the selected articles by 2 independent reviewers and put
into an extraction template and into the Consolidated Framework for Implementation
Research (CFIR) model. The Appraisal Tool for Cross-Sectional Studies (AXIS) was conducted
on each study to assess study design, risk of bias, and reporting quality of the eligible
studies.
Data Synthesis
Ten studies were identified as high quality, according to the AXIS. Based on the CFIR
model, the top barriers identified focused on clinician training and time in the implementation
process, lack of recognized value and knowledge at the individual level, lack of access
and support in the inner setting, and inability of patients to complete PROMs in the
intervention process. Facilitators were identified as education in the implementation
process, support and availability of PROMs in the inner setting, and recognized value
at the individual level.
Conclusions
More barriers than facilitators have been identified, which is consistent with PROM
underuse. Clinicians and administrators should find opportunities to overcome the
barriers identified and leverage the facilitators to improve routine PROM use and
maximize patient outcomes.
Keywords
List of abbreviations:
AT (athletic training), AXIS (Appraisal Tool for Cross-Sectional Studies), CFIR (Consolidated Framework for Implementation Research), OT (occupational therapy), PROM (patient-reported outcome measure), PT (physical therapy), SLP (speech language pathology)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Office-based medical provider services-mean and median expenses per person with expense and distribution of expenses by source of payment: United States, 2014. Medical expenditure panel survey household component data.(Available at:)
- Developing outpatient therapy payment alternatives (DOTPA): 2010 utilization report.Research Triangle Park, NC: RTI International, 2013
- Developing Outpatient Therapy Payment Alternatives: Final report.Prepared for Centers for Medicare & Medicaid Services. RTI International. 2014; (Available at:) (Accessed July 22, 2019)
- Use of standardized outcome measures in physical therapist practice: perceptions and applications.Phys Ther. 2009; 89: 125-135
- Article commentary: patient-reported outcomes (pros) and patient-reported outcome measures (PROMs).Health Serv Insights. 2013; 6: 61-68
- The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review.BMC Health Serv Res. 2012; 12: 96
- Patient-reported outcomes in performance measurement.RTI Press, Research Triangle Park2015
- Patient-reported outcomes: a new era in clinical research.Perspect Clin Res. 2011; 2: 137
- Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions.Am J Sports Med. 2013; 41: 2577-2584
- Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study.BMC Musculoskelet Disord. 2013; 14: 232
- What influences patient-therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis.Phys Ther. 2016; 96: 609-622
- Integrating the use of patient-reported outcomes for both clinical practice and for performance measurement: experts’ views from three countries.Physiotherapy. 2015; 101e1571
- Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities.J Comp Eff Res. 2016; 5: 507-519
- How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study.BMC Health Serv Res. 2010; 10: 60
- Assessment of the therapeutic alliance in physical rehabilitation: a RASCH analysis.Disabil Rehabil. 2012; 34: 257-266
- Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations.Qual Life Res. 2012; 21: 1305-1314
- Impact of patient-reported outcome measures on routine practice: a structured review.J Eval Clin Pract. 2006; 12: 559-568
- Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review.Qual Life Res. 2013; 22: 2265-2278
- The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review.J Eval Clin Pract. 1999; 5: 401-416
- The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.Qual Life Res. 2008; 17: 179-193
- Patient reported outcome measures could help transform healthcare.BMJ. 2013; 346: f167
- The routine use of patient reported outcome measures in healthcare settings.BMJ. 2010; 340: c186
- Feature articles-systematic outcome measurement in clinical practice: challenges experienced by physiotherapists.Physiother Can. 2002; 54: 25-31
- Feasibility of the Canadian Occupational Performance Measure for routine use.Br J Occup Ther. 2010; 73: 48-54
- Uptake of standardised hand assessments in rheumatology: why is it so low?.Br J Occup Ther. 2005; 68: 148-157
- Evidence-based practice depends on the routine use of outcome measures.Sage Publications, London2011
- Assessment of patient-reported outcome instruments to assess chronic low back pain.Pain Med. 2017; 18: 1098-1110
- A comparison of five low back disability questionnaires: reliability and responsiveness.Phys Ther. 2002; 82: 8-24
- Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review.Aust J Physiother. 2008; 54: 233-241
- Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory.Am J Phys Med Rehabil. 2016; 95: 372-389
- Designing a quality improvement intervention: a systematic approach.Qual Saf Health Care. 2003; 12: 215-220
- Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience.Int J Qual Health Care. 2011; 23: 510-515
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- Monitoring the change: current trends in outcome measure usage in physiotherapy.Man Ther. 2006; 11: 46-53
- Implementation and use of standardized outcome measures by physical therapists in Saudi Arabia: barriers, facilitators and perceptions.BMC Health Serv Res. 2017; 17: 748
- Factors influencing the use of outcome measures for patients with low back pain: a survey of New Zealand physical therapists.Phys Ther. 2008; 88: 1492-1505
- The use of patient-reported outcomes measures: secondary school athletic trainers' perceptions, practices, and barriers.J Athl Train. 2019; 54: 142-151
- Systematic outcome measurement in clinical practice: challenges experienced by physiotherapists.Physiother Can. 2002; 54: 25-31
- Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study.J Eval Clin Pract. 2016; 22: 668-676
- How far have we come since 1992? A comparative survey of physiotherapists' use of outcome measures.Physiother Can. 2001; 53: 268-275
- Use of patient-reported outcome measures in athletic training: common measures, selection considerations, and practical barriers.J Athl Train. 2019; 54: 449-458
- A survey of physiotherapists' experience using outcome measures in total hip and knee arthroplasty.Physiother Can. 2014; 66: 274-285
- Development and evaluation of an implementation strategy for collecting data in a National Registry and the use of patient-reported outcome measures in physical therapist practices: quality improvement study.Phys Ther. 2017; 97: 837-851
- Implementation of measurement instruments in physical therapist practice: development of a tailored strategy.Phys Ther. 2010; 90: 953-961
- Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands.BMC Musculoskelet Disord. 2011; 12: 106
- Hand therapist use of patient report outcome (PRO) in practice: a survey study.J Hand Ther. 2014; 27: 299-308
- Benefits of and barriers to using patient-rated outcome measures in athletic training.J Athl Train. 2014; 49: 674-683
- Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS).BMJ Open. 2016; 6e011458
- Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.Implement Sci. 2009; 4: 50
- A systematic review of the use of the consolidated framework for implementation research.Implement Sci. 2015; 11: 72
- Measurement properties of multidimensional patient-reported outcome measures in neurodisability: a systematic review of evaluation studies.Dev Med Child Neurol. 2016; 58: 437-451
Article info
Publication history
Published online: May 13, 2020
Footnotes
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
