Tag Archives: yellow flags

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, Outcome Measures, Psychosocial Factors

Short Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-10)

Evidence suggests that clinicians are limited in their ability to identify psychosocial factors in patients presenting with musculoskeletal (MSK) pain.(1,2) As such, it is important to use screening tools to improve clinical recognition and the contribution of psychosocial factors in MSK pain disorders.(3-5)

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) has had several studies demonstrate its clinical utility in the identification of psychosocial factors.(6-8) However, calls were made to reduce the 21-item ÖMPSQ to a shorter form. A shorter version of the ÖMPSQ would improve practicality and reduce the burden on patients, clinicians and researchers.

The ÖMPSQ short version (ÖMPSQ-10) has recently been shown to be valid in identifying potential risk of pain-related disability and long-term work absence.(9) The ÖMPSQ-10 includes 10 items selected from the full version.(9)  These items are scored 0-10, where 0 refers to absence of impairment and 10 to severe impairment.

The total score will range between 1 and 100, with a score >50 correlating with greater long-term sick leave and poorer outcomes (high risk patient).(9)

In conclusion, the ÖMSPQ-10 is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version.(9) It can also be used to monitor patient progress (e.g. administer the ÖMSPQ-10 monthly or every 3-months to monitor changes over time).

Easily administer, score and interpret outcome measures – including the ÖMSPQ-10- 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. Bishop A, Foster NE. Do physical therapists in the United kingdom recognize psychosocial factors in patients with acute low back pain? Spine 2005;30:1316-22.[PMID: 15928559]
  2. Hill JC, Vohora K, Dunn KM, et al. Comparing the STarT back screening tool’s subgroup allocation of individual patients with that of independent clinical experts. Clin J Pain2010;26:783-7. [PMID: 20842014]
  3. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based mamagement of acute musculoskeletal pain. Brisbane: Australian Government: National Health and Medical Research Council, 2003. [pdf]
  4. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine 2007;147:478-91. [PMID: 17909209]
  5. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006;15 Suppl 2:S169-91. [PMID: 16550447]
  6. Gabel CP, Burkett B, Neller A, Yelland M. Can long term impairment in General Practitioner Whiplash patients be predicted using screening and Patient Report Outcomes? Int J Rehabil Res 2008; 31(1): 79-80.
  7. Gabel CP, Melloh M, Yelland M, Burkett B, Roiko A. Predictive Ability of a Modified Örebro Musculoskeletal Pain Questionnaire in an Acute Low Back Pain Working Population. Eur Spine J 2011; 20(3): 449-57.
  8. Gabel CP, Burkett B, Yelland M, Melloh M, Osborne J. The Örebro Musculoskeletal Screening Questionnaire: validation of a modified primary care musculoskeletal screening tool in an acute work injured population. Man Ther 2012;17(6):554-65
  9. Linton, S. J., Nicholas, M., & MacDonald, S. (2011). Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine, 36(22), 1891-1895.[PMID: 21192286]