Use of Patient-Reported Outcome Measures in Athletic Training: Common Measures, Selection Considerations, and Practical Barriers.
Lam KC, Harrington KM, Cameron KL, Valier ARS. J Athl Train. 2019 [Epub ahead of print]
Take Home Message:The use of patient-reported outcome measures (PROMs) remains low among athletic trainers; however, athletic trainers who use PROMs commonly use injury- or joint-specific PROMs or single-item PROMs. Time to complete and score PROMs are important barriers to using PROMs.
The “Athletic Training Education Competencies” and the “Role Delineation/Practice Analysis” emphasizes the support for the implementation of patient-reported outcome measures (PROMs) into clinical practice to enhance patient care. However, athletic trainers appear reluctant to use them due to barriers such as time constraints. A better understanding of how athletic trainers perceive and use PROMs may help improve the adoption of PROMs into clinical practice. Therefore, the authors created a survey, which was distributed to ~18,000 athletic trainers to describe the commonly used PROMs, why those PROMS are selected, and barriers and reasons for not using PROMs. The survey was sent to NATA members and almost 1,800 (11%) athletic trainers completed the survey. The authors asked “Do you routinely use PRO instruments for clinical practice?” and then split the sample into 370 athletic trainers that use PROMs and 1,362 who did not use PROMs. The first section of the survey consisted of demographic questions (for example, sex, years certified, degree, job setting, district). The second portion of the survey depended on if the athletic trainer implemented PROMs or not. An athletic trainer that used PROMs answered questions regarding which PROMs they used and why. An athletic trainer that did not implement PROMs answered questions about why they did not use them. Answers about use or disuse were answered using a 6-point Likert scale. Among athletic trainers who used PROMs, 52% reported using PROMs for clinical practice only, 25% reported use for research only, and 24% for both clinical and research purposes. Athletic trainers that implemented PROMs most commonly used injury- or joint-specific PROMs (89%). The most common of these PROMs were the Lower Extremity Functional Scale, Disabilities of Arm, Shoulder and Hand, Oswestry Disability Index, and Foot and Ankle AbilityMeasure. Single-item measures were reported to be the second most used PROM, specifically, the Numeric Pain Rating Scale and Global Rate of Change. Generic PROMs were the least frequently endorsed PROMS, but athletic trainers that used them commonly reported using the Short Form-12 or 36 and the Disablement in the Physically Active Scale. Athletic trainers commonly reported using these instruments because they were easy for the patient to understand and were valid and reliable. Athletic trainers that do not implement PROMs said that they lack the support structure necessary (e.g., technology or staff), takes too long for patients to complete, or takes too long for clinicians to analyze.
The authors determined that many athletic trainers still do not use PROMs in their clinical setting. PROMs are important as they provide an athletic trainer with information on how a patient feels they are recovering from his/her perspective, which is a vital aspect of whole-person care that encourages the disablement modelpractice. It was not surprising to see injury specific PROMs were the most commonly used PROMs because they help assess function; however, they leave out information about a person’s overall quality of life, which is helpful for total-patient care. Therefore, the use of both generic and specific would be helpful but may only be used at key time points because of time constraints. Instead, athletic trainers could start adopting PROMs by using single-item measures (e.g., numeric pain rating scale, global rate of change) because these are fast to complete and analyze. For athletic trainers who report a lack of support structure, it may be helpful to identify mobile apps or websites that can be used to complete and score PROMs. Having even the simple PROMs can help clinicians track how a patient feels they are recovering, guide discussions and shared decision making with patients, and provide evidence to administrators that the care provided is beneficial.
Questions for Discussion: What PROMs do you commonly use? What barriers do you need to overcome to use PROMs, and how do overcome the barriers?