The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?

Greenhalgh, Joanne; Long, Andrew; Flynn, Rob

doi:10.1016/j.socscimed.2004.06.022

Cited by 370 publications

(368 citation statements)

References 48 publications

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“…A well-developed and responsive outcome measure provides beneficial information to determine real change and evidence of treatment effectiveness [57]. In clinical practice, outcome measures are increasingly used as screening instruments, but there is little evidence to suggest that their use substantially changes patient management [58].One possible reason is that clinicians are sceptical of the psychometric properties of measures and have a poor understanding about the meaning of score changes. This study presented score changes in five different questionnaires to define clinical improvement.…”

Section: Resultsmentioning

confidence: 99%

Outcome measures in chronic low back pain

2010

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The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a ''successful'' outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution-and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution.

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Section: Resultsmentioning

confidence: 99%

Outcome measures in chronic low back pain

2010

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“…The implementation of PROs is a dynamic and challenging process, in which several factors play a role at individual (professional, patients, relatives) and system level 36 . We focused here on clinician training, but wish to acknowledge the importance of other factors, namely:…”

Section: Discussionmentioning

confidence: 99%

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

et al. 2015

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Patient-reported outcome measures (PROs) were originally developed for comparing groups of people in clinical trials and population studies, and the results were used to support treatment recommendations or inform health policy, but there was not direct benefit for the participants providing PROs data. However, as the experience in using those measures increased, it became obvious the clinical value in using individual patient PROs profiles in daily practice to identify/monitor symptoms, evaluate treatment outcomes and support shared decision-making. A effectively utilize PROs data in their clinical encounters.The implementation of PROs in patient care represents a significant change to clinical practice of individual clinicians and health organisations. Using a change-management theoretical framework, this paper describes the development and implementation of three programs for training clinicians to effectively use PRO data in routine practice. The training programs are in three diverse clinical areas (adult oncology, lung transplant and paediatrics), in three countries with different health care systems, thus providing a rare opportunity to pull out common approaches whilst recognizing specific settings. For each program we describe the clinical and organisational setting, the program planning and development, the content of the training session with supporting material, subsequent monitoring of PROs use and evidence of adoption. The common successful components and practical steps are identified, leading to discussion and future recommendations. The common successful components are identified, leading to discussion and future recommendations.

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“…60,61 This lack of an effect has been explained by the lack of attention paid to the complex processes involved to ensure integration of PROMs data in the clinical encounter and for use in clinical decision-making. 64 Attention to the use of knowledge translation Accepted Article 22 theories and strategies in the implementation and uptake of PROMs in clinical practice has been advised. 65 PROMs play an important role in cancer care as part of a person-centered approach to care and in national surveillance to identify the burden of cancer.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and diagnostic accuracy of the Patient‐Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care

Leung

Brown

Cosio

et al. 2016

Cancer

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This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version record. Please cite this article as doi:10.1002/cncr.30134.This article is protected by copyright. All rights reserved. Accepted Article2 of the study, ethics application, recruitment, data management), Dobriyal A (conceptualization of the study, recruitment), Malik N (conceptualization of the study, recruitment, data collection), Pat V (recruitment, data collection, data analysis), Irwin M (recruitment, data management, data analysis), Tomasini P (conceptualization of the study, recruitment, data collection, data analysis), Liu G ( There is no conflict of interest declared. Page 2 of 44 CancerThis article is protected by copyright. All rights reserved. Accepted Article 3Abstract (word limit: 250; word count: 246)

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The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?

Cited by 370 publications

References 48 publications

Outcome measures in chronic low back pain

Outcome measures in chronic low back pain

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

Feasibility and diagnostic accuracy of the Patient‐Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care

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