The Use of Patient-Reported Outcome Measures: Secondary School Athletic Trainers’ Perceptions, Practices, and Barriers.
Coulombe BJ, Games KE, Eberman LE; J Athl Train. 2019 Feb;54(2):142-151. doi:10.4085/1062-6050-86-17. Epub 2018 Aug 10.
Take Home Message: Many secondary school athletic trainers viewed patient-reported outcomes as beneficial; however, skip using them because of time constraints (e.g., time to fill-out, score, or analyze).
A clinician can use patient-reported outcome (PRO) measures to assess how a patient perceives their symptoms, function, and rehabilitation progress. PROs are an essential way to inform how patient-centered care is provided after an injury. Unfortunately, clinicians, especially secondary school athletic trainers, may skip using PROs for many reasons. Understanding how and why a secondary school athletic trainer uses PROs may lead to strategies to promote the use of PROs. Hence, the authors used a web-based survey to evaluate the views that exist regarding the application, benefits, and problems associated with implementing PROs in the clinical practice of secondary school athletic trainers. Around 3,000 secondary school athletic trainers received an email invitation to complete a web-based survey regarding use of PROs in their clinical practice, and the benefits and barriers associated with implementation. Over 300 athletic trainers completed the survey, which consisted of 46 questions split into five sections: demographics, familiarity with patient outcome measures, uses of PROs in clinical practice, beneﬁts of PROs, and problems with using PROs. Participants who indicated they use PROs also provided the criteria for selecting PROs and the specific PROs used. Athletic trainers who indicated they did not use PROs provided the reason for not using PROs and whether they planned to start using PROs. Respondents were on average 43 years of age, and most were certified for at least 11 years. Most respondents (85%) reported they were not using PROs in their clinical practice, with the top reason for not using PROs being lack of a support structure. Almost all respondents reported improving communication with the patient (90%) and helping to direct the plan of care (86%) as benefits of using PROs. The most common reasons for potentially using PROs were to determine treatment effectiveness (73%), demonstrate effectiveness to administration (66%), or document patient outcomes by individual clinicians (66%). The top problems faced were time to score and analyze (53%), as well as time for patients to complete (47%).
The authors gathered pertinent information about how athletic trainers in the secondary school setting view using PROs and reasons why athletic trainers did, or did not use them. This information is useful to possibly figure out ways athletic trainers can be supported in using PROs in their setting. These findings complement a study we recently summarized where the authors showed similar challenges to using PROs. These 2 studies highlight that athletic trainers may need better support structures to make PRO usage common practice. Based on the perceived benefits of PROs, the benefits should outweigh the problems faced when implementing them into their practice; however, most athletic trainers of this setting reported that they were not using PROs. The authors included a section on familiarity with patient outcome measures, which showed that about one-third of respondents had not been exposed to clinician-rated outcomes or PROs. Another important thing to consider is most of the athletic trainers that responded had been practicing for at least 11 years, and CAATE standards including PROs were only implemented in 2012, which may account for the lack of exposure. The study also had a low response rate (10.8%). Hence, it is unclear if these results reflect most athletic trainers in the secondary school setting. For example, it is possible that people with more positive views of PROs were more willing to complete the survey than their peers. Despite these limitations, it might be helpful for an athletic trainer in a secondary school setting to consider using Single Assessment Numeric Evaluation, which can include numeric visual analog scores or a global rating of change score, which can help gauge a patient’s progress while mitigating time restraints.
Questions for Discussion: What would help increase the use of PROs? How do you use PROs in your clinical practice? What benefits do you and your patients get out of using PROs?