Developing a standard set of outcome domains and associated patient reported outcome measures for patients with neck pain in Dutch primary care exercise therapist practice

Abstract

Background Neck pain is, with a prevalence of 42 to 65%, one of the most common musculoskeletal disorders worldwide, and the second most treated condition in Dutch primary care exercise therapist practice. In order to evaluate the healthcare quality provided by exercise therapists in daily practice, there is a need for measures that could be used to compare treatment outcomes. Specifically, standardized outcome domains (i.e. ‘what’ to measure) with associated questionnaires can aid in the decision-making process for treatment of individual patients, and facilitate comparisons of quality of interventions for professionals. Aim To develop a clinical standard set of outcome domains and associated patient reported outcome measures (PROMs) for patients with neck pain in Dutch exercise therapy. Methods A four round consensus-driven modified RAND-UCLA Delphi procedure was performed including 1) literature/guideline search of recommended and currently used PROMs, 2) add of missing PROMs by an expert panel consisting of patients, exercise therapists and policy makers, 3) online survey where a group of Dutch exercise therapists scored the relevance and feasibility of PROMs, and 4) a consensus meeting by experts to determine the PROMs included in the standard set. Results Search of literature/guideline and currently used PROMs in five different patient reported outcomes resulted in twenty-six identified PROMs. After application of exclusion criteria, twenty PROMs were scored on a 9-point Likert scale by exercise therapists in a survey. Ten of the PROMs had a median score of 6 or higher for relevance and feasibility. These were discussed by experts in the consensus meeting, resulting in a standard set of three primary PROMs for four outcome domains and three optional PROMs for three outcome domains. Primary PROMs were the Numeric Pain Rating Scale to measure pain intensity, Patient Specific Complaints for physical functioning and Pain Disability Index for use in both pain behaviour and the social functioning domain. Conclusion and key findings This study presents a standard set of four outcome domains with three PROMs, including a measurement protocol with time points for moments of use in treatment, for Dutch exercise therapists treating patients with neck pain.