Determinants of patient reported outcomes in patients with musculoskeletal disorders. A prospective cohort study.

Abstract

Aim: Patient Reported Outcome Measures (PROMs) can contribute to patient centeredness and can be used to increase transparency of clinical outcomes. Applying PROMs in clinical practices is challenging. Several factors might influence the outcome in physical therapy, such as patient, therapist and organizational characteristics. The evidence regarding which characteristics can influence the outcome of PROMs is scarce. The aim of this study is twofold: firstly, to find out if the use of PROMs in clinical physical therapy practices can be stimulated by using an implementation program; and secondly to investigate which patient, therapist and organizational characteristics can influence the outcome of PROMs in physical therapy.

Methods: This study has a longitudinal prospective cohort design. The routine use of PROMs in physical therapist practices is investigated during the implementation program at the intake and evaluation of the treatment. The results of the implementation program were tested with a multilevel pairwise comparison analysis with Bonferroni correction. The characteristics are selected using univariate regression analysis and consequently modelled in a hierarchic linear multilevel regression analysis. This analysis estimates the influences of the characteristics on the outcome of the Neck Disability Scale (NDI), Quebec Back Pain Disability Scale (QBPDS) and the Numeric Pain Rating Scale (NPRS).

Results: The use of one single PROM in a therapy period increased significantly with 22,6% (p < 0.001) and repeated use of PROMs increased with 18,6% (p < 0.001). Two significant characteristics were identified: age of the patient and expected recovery. The characteristics explain none of the variance of the NDI, 49.1% of the QBPDS and 25.1% for the NPRS.

Conclusion: The implementation program showed significant improvements in the routine use of PROMs. The patient characteristics give little explanation of the outcomes. Further investigation is necessary to find out if the implementation program can ensure the routine use of PROMs and if different characteristics can explain more of the outcome.

Clinical Relevance: Applying PROMs can make healthcare transparent and contribute to patient centeredness. Knowing the influence of patient characteristics can result in a predictive outcome model in the future.