Facilitators and Barriers to the Use of Outcome Measures by Certified Lymphedema Therapists

Abstract

Background: Various outcome measures (OMs) have been used with individuals with breast cancer–related lymphedema (BCRL). There have not been studies investigating the facilitators and barriers to the use of OMs by certified lymphedema therapists (CLTs) on BCRL. The purposes of this study was to (1) identify facilitators and barriers for use of OMs reported by CLTs and (2) investigate the association of personal and professional characteristics of CLTs and their knowledge or beliefs about OMs. Methods: Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists and 41 occupational therapists were analyzed. Point-biserial correlations examined associations and logistic regression examined predictors to OMs facilitators and barriers. Results: Certified lymphedema therapists agreed that OMs help direct a plan of care (90.1%), improve quality of care (76.6%), and determine the efficacy of their intervention on BCRL (72.7%). Certified lymphedema therapists reported difficulty knowing the best OM to choose due to numerous options (67.3%). Barriers for OMs included lack of knowledge and time, availability in workplace, and personal preferences. Characteristics associated with barriers and facilitators were few and poorly correlated. Conclusion: Certified lymphedema therapists agree on the benefits of and to the use of OMs, however, physical therapist CLTs may value the use of OMs less than occupational therapists. Certified lymphedema therapists experience barriers to use of OMs related to lack of knowledge and implementation skills. Further guidance is needed in selecting OMs for breast cancer survivors with BCRL to reduce barriers to their use.

Development of a core outcome set for breast cancer-related lymphedema: a Delphi study

“…Lack of time and resources are frequently reported as barriers to the use of ODs especially when using OMs that measure activities and participation [ 25 ]. The SMG took these barriers into consideration during survey development for the first and second surveys to identify (1) ODs recommended in a time-constrained research or clinic environment, and (2) ODs recommended in a research or clinic environment not constrained by time or resources, respectively.…”

Development of a core set of outcome measures to be applied toward breast cancer-related lymphedema core outcome domains

“…However, these measures alone limit a specialist’s comprehensive understanding of the burden of this chronic condition and the identification of related co-morbidities that require specific interventions. CLTs have reported difficulty knowing the best OM to use due to numerous options [ 14 ]. Extensive choices of OMs that have acceptable psychometrics should be narrowed to guide healthcare professionals and researchers alike to gather best measures on ODs.…”

“…CLTs have reported difficulty knowing the best OM to use due to numerous options [14]. Extensive choices of OMs that have acceptable psychometrics should be narrowed to guide healthcare professionals and researchers alike to gather best measures on ODs.…”

Narrowing the Evidence-to-Practice Gap

“…One piece in this current issue by Doubblestein et al2 addresses step 3—identifying barriers and facilitators among clinicians to adopt standardized outcome measures for use among women treated for lymphedema. Outcome measures, critical to evaluate the effectiveness of treatment, play a role in ensuring that treatment is effective.…”

“…Reducing the number of available measures in order to create a standardized list is also important to be able to evaluate the findings of clinical studies, to identify acceptable metrics to measure effectiveness of treatment, and to avoid redundancy among tests and measures 4. Indeed, one of the key barriers identified by Doubblestein et al2 is that there are multiple outcome measures for lymphedema that evaluate similar domains, resulting in inconsistency in clinical use. Work to reduce this variability will be key as the clinician community will have difficulty moving evidence into practice if the variability among research studies creates confusion regarding best practice.…”