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Systematic review| Volume 101, ISSUE 10, P1796-1812, October 2020

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Implementing Patient-Reported Outcome Measures in Outpatient Rehabilitation Settings: A Systematic Review of Facilitators and Barriers Using the Consolidated Framework for Implementation Research

  • Matthew S. Briggs
    Correspondence
    Corresponding author Matthew S. Briggs, PhD, DPT, Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Dr, Columbus, OH 43202.
    Affiliations
    Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio

    OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio

    Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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  • Katherine Kozak Rethman
    Affiliations
    Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio

    OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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  • Justin Crookes
    Affiliations
    Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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  • Fern Cheek
    Affiliations
    Health Sciences Library, The Ohio State University, Columbus, Ohio
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  • Kristy Pottkotter
    Affiliations
    Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio

    OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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  • Shana McGrath
    Affiliations
    OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
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  • John DeWitt
    Affiliations
    OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio

    Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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  • Lindsay E. Harmon-Matthews
    Affiliations
    OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio

    OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
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  • Catherine C. Quatman-Yates
    Affiliations
    Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio

    Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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      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)
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