Tag Archives: treatment outcomes

Clinical Practice, Outcome Measures

Patient-Reported Outcome Measures (PROMs): what to select clinically and how to reduce human scoring errors

Self-reported outcome instruments or patient-reported outcome measures (PROMs) are gaining popularity.(1) Recently, there has been interest in using PROMs to aid management of individual patients – this is mainly due to the importance of monitoring the subjective effectiveness of received treatments, required in the current healthcare system to assess treatment quality.(1,2)

In Australia, WorkSafe (3) expects that all healthcare professionals who provide services to injured workers for longer than 4-6 weeks will use standardised or customised outcome measures to assist in the clinical justification of their services. (read more here)

The outcome of objective tests (e.g. orthopaedic tests performed by a clinician) does not necessarily correspond with subjective feelings of patients, whereas PROMs provide feedback on patients’ view of their complaints.(1)

PROMs can be used in clinical practice in various ways: they can be used as one-time screening questionnaires; alternatively, they can be administered serially to monitor patients’ progress and facilitate identification of problems.(2)

Worksafe and The Transport Accident Commission (TAC) note the need to evaluate the appropriateness of PROMs based on the individual patient’s needs and the clinician’s own professional expertise.(3,4) Furthermore, the TAC (4) state “It is often best to use more than one measure.” As such, clinicians need to select multiple PROMs in an attempt to cover the various domains of a patients’ presenting complaint(s).

Listed below are PROMs  grouped according to their primary focus (3,4). As a  general guideline, clinicians should select one PROM from each primary focus group, for each region (e.g. a patient presents with neck pain – the clinician would select one PROM for pain, another PROM for neck disability / function etc)

  1. Pain
    • e.g. Quadruple Numerical Rating Scale (QNRS)
  2. Disability / Function
    • e.g. Upper Extremity Functional Index (UEFI), Shoulder Pain and Disability Index (SPADI), Lower Extremity Functional Scale (LEFS)
, Neck Disability Index (NDI)
, Whiplash Disability Questionnaire (WDI), Quebec Back Pain Disability Scale (QBPDS)
  3. Risk Identification / Predicting response to treatment (‘Yellow Flags’)
  4. General Health Status (Quality of Life)
    • Short-Form 12 Health Survey (SF-12), RAND 36-Item Health Survey (SF-36)

Importantly, it has been shown that clinicians have incorrectly scored PROMs at a level that is of concern, and problematic!(5) A study by Matthey et al (5) suggest that clinicians adopt using scoring templates and a double adding-up procedure to reduce scoring errors… one of the great things about Erepsonline, is that you can save time and remove the human error when scoring outcome measures.

Easily administer, score and interpret outcome measures through Erepsonline – which may be used to assist your clinical practice. You must evaluate the appropriateness of the outcome measures based on the individual’s needs and your own professional expertise.

 

References

  1. Vuurberg G, Kluit L, van Dijk CN. The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability. Knee Surgery Sports Traumatol Arthrosc. 2018;26:882-891
  2. Snyder CF, Aaronson NK. Use of patient-reported outcomes in clinical practice. The Lancet. 2009;374(9687):369–70.
  3. WorkSafe. (n.d.). Outcome Measures. Retrieved from: http://www.worksafe.vic.gov.au/health-professionals/treating-injured-workers/outcome-measures
  4. TAC (Transport Accident Commission). Standard Outcome Measures. Retrieved from: http://www.tac.vic.gov.au/providers/working-with-tac-clients/clinical-resources/outcome-measures
  5. Matthey S, Lee C, Črnčec R, Trapolini T. Errors in scoring the Edinburgh Postnatal Depression scale. Arch Womens Ment Health. 2013 Apr;16(2):117-22.
Clinical Practice, Patient Adherence

Patient Adherence and Treatment Outcomes

Adherence has been defined as: “the extent to which a person’s behaviour… corresponds with agreed recommendations from a healthcare provider” (1)

Adherence with treatment is an important factor which can influence the outcome of that treatment (2). It has been suggested that adherent patients are likely to have better treatment outcomes than non-adherent patients (3).

For practitioners of manual therapy, rehabilitation and exercise therapy prescription is part of a multimodal management strategy utilised to improve clinical outcomes. It has been shown that patients who are more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.(4) Conversely, it has been suggested that non-adherence with treatment could be as high as 70% (5).

Martin et al (6)  have stated: “Patient non-adherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice.”

While no single intervention strategy can improve the adherence of all patients, home exercise programs – such as the ones you can create on Erepsonline – have been shown to increase patient adherence.(4, 7-9)

Visit the Help & Support page to watch short video clips of the various features of Erepsonline.

 

References:

  1. WHO . World Health Organisation; Geneva: 2003. Adherence to Long Term Therapies – Evidence for Action.
  2. Hayden J.A., van Tulder M.W., Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine. 2005;142(9):776–785.
  3. Vermeire E., Hearnshaw H., Van Royen P., Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics. 2001;26(5):331–342.
  4. Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA. Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty? Journal of Orthopaedic Surgery and Research 2010, 5:20
  5. Vasey L. DNAs and DNCTs – why do patients fail to begin or complete a course of physiotherapy treatment? Physiotherapy. 1990:76575–76578.
  6. Martin LR, Wiliams SL, HAskars KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005 Sep; 1(3): 189–199.
  7. Coulter CL, Scarvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. J Physio. 2013;59(4):219-26
  8. Latham NK, Harris BA, Bean JF, Heeren T, Goodyear C, Zawack S, Heislein DM, Mustafa J, Pardasaney P, Giorgetti M, Holt N, Lori Goehring L, Jette AM. Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture: A Randomized Clinical Trial. JAMA. 2014;311(7):700-708.
  9. Jan MH, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF. Effects of a home program on strength, walking speed, and function after total hip replacement. Arch Phys Med Rehabil. 2004 Dec;85(12):1943-51.
Clinical Practice, Outcome Measures

The Fear Avoidance Beliefs Questionnaire (FABQ): The importance of its utilisation in clinical practice

The Fear Avoidance Belief Questionnaire (FABQ) was developed by Waddell to investigate the fear-avoidance beliefs of patients with chronic low back pain.(1) The Rehabilitation Measures Database states that the FABQ “focuses specifically on how a patient’s fear-avoidance beliefs about physical activity and work may affect and contribute to their low back pain (i.e. the cognitive/affective components of pain that are differentiated from specific tissue damage, injury, and nociception) and resulting disability.”(2)

The FABQ has been demonstrated to be valid and reliable in a chronic LBP population and appears to be a useful screening tool for identifying acute low back pain patients who will not return to work by 4 weeks. (1,3)

The FABQ consists of 2 subscales:

  • The Physical Activity subscale (FABQPA)
    • FABQPA of 15 or greater is considered a high score.
  • The Work subscale (FABQW).
    • FABQW of 34 or greater is considered a high score.

A patient with work related low back pain and a “positive” FABQ-W test result (score >34) has a higher probability of not returning to work in four-weeks.

Not only can the FABQ help determine the probability of current and future work loss and disability, the FABQ can also help healthcare professionals choose clinical interventions that have an increased probability of a successful outcome (i.e. the FABQ can predict successful outcomes from clinical interventions or predict decreased probability of successful outcomes).

For example, the FABQ can be used for the following clinical prediction rules:

  • Sacroiliac Joint Manipulation
    • A low FABQW score (less than 19) is one of 5 variables in a clinical prediction rule that increased the probability of success from sacroiliac region manipulation in individuals with low back pain.(4)
  • Stabilization Exercise
    • A low FABQPA score (less than 9) would decrease the probability of success of a stabilisation exercise program in individuals with low back pain.(5)
  • A predictor of 6-month outcomes following 4-weeks of physical therapy.
    • FABQW scores greater than 20 indicated an increased risk of reporting no improvement in 6-month ODQ scores.(6)

*The Oswestry Disability Questionnaire (ODQ) is considered the ‘gold  standard’ of low back functional outcome tools.

In conclusion, healthcare professionals should be administering the FABQ within clinical practice. The FABQ can help determine the probability of current and future work loss and disability, as well as indicate increased risk of poor treatment outcomes. Practitioners utilising manipulation and exercise therapy in the management of low back pain, can derive information from the FABQ to determine the probability of success – or lack thereof – when deciding to implement these two clinical interventions.

 

Easily administer, score and interpret outcome measures – including the FABQ – through Erepsonline. For more information on selecting and viewing outcome measures, see the Erepsonline Video Tutorials, or check out the Quick Start Quide

 

 

References:

  1. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52:157-168
  2. Mordini N. (2014, June). Rehab Measures: Fear-Avoidance Beliefs Questionnaire. Retrieved from: http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=1200
  3. Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 2001; 94:7-15. 3.
  4. Flynn T, Fritz J, Whitman J, Wainner R, et al. Clinical Prediction Rule for Classifying Patients with Low Back Pain Likely to Respond to a Manipulation Technique. Spine (Phila Pa 1976). 2002;27(24):2835-43.
  5. Hicks G et al.  Prelimary Development of a Clinical Prediction Rule for Determining Which Patients with Low Back Pain Will Respond to Stabilization Exercise Program. Arch Phys Med Rehabil. 2005;86:1753-1762.