Which factors are associated with the use of measurement instruments in patients with non specific low back pain?
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Aim: To determine patient-related, therapist-related, and practice-related factors associated with the use of measurement instruments in patients with non-specific low back pain (LBP) visiting a primary care physical therapist. Methods: An observational study on continuously, routinely reported data in NIVEL Primary Care Database in the Netherlands. Patients were eligible to participate if they met the inclusion criteria: 1) diagnosis of non-specific LBP, 2) treated within the timeframe January 2014–July 2016 and 3)> 18 years or older. The dependent variable was whether measurement instruments were used or not. The factors tested for association are divided in three levels: patient-level, therapist-level and organization-level. The patient factors were: age, gender, health insurance, duration of the complaint prior to treatment, recurrence of the complaint, number of treatment sessions, duration of the treatment episode and treatment result. The therapist factors were: age, gender and specialization. The organization factors were: number of locations and practice site. A 3-level logistic multilevel analysis was performed to determine which factors are associated with the use of measurement instruments in patients with non-specific LBP. Results: None of the predictor variables are associated with the use of measurement instruments. Eighty-two per cent of the variation, in the use of measurement instruments, is located at patient-level, fifteen per cent is located at practice-level and four per cent is located at therapist-level. It was possible to explain one per cent of all variance. Conclusion: Despite the fact that PROMs have the potential to improve quality of healthcare, other quality indicators, for example the number of treatment sessions or the therapist’s specialization are not associated with the use of measurement instruments, and in some extent with the quality of care, in patients with LBP. Clinical Relevance: Patient Related Outcome Measures (PROMs) guide clinicians in providing evidence-based treatment and have the potential to empower patients, support clinical decision making and drive forward quality improvement. The current quality indicators are not associated with quality of care. Therefore more insight in factors, on the therapist-, patient- and organization-level, associated with the use of PROM’s is needed, to improve and enhance quality of care.