Posted January 17, 2017
By Beth Druvenga, M.S. Ed, LAT, ATC
As athletic training pushes to the forefront of healthcare professions, it is necessary for us to also change with the times. The Institute of Medicine urges healthcare educational programs to incorporate outcomes that are reported by the patient into their curriculum as to enhance clinicians’ decision making processes and drive forward patient centered care.1 Patient reported outcomes (PROs) are a valuable tool for Athletic Trainers (ATs) to add to their arsenal of evaluating their patient as a whole. With the addition of PROs into educational programs,1 this gives the student a chance to learn how and when to utilize these outcomes. It also makes it easier to analyze and interpret the results.
Many clinicians are hesitant to use PROs, especially in the fast-paced world of athletic training. Some of the greatest barriers to using PROs are time, comprehension and independence. Most clinicians and patients, report that it takes too much time to complete the surveys, and therefore, do not want to include them in their plan of care. Others report that patients don’t understand the questions and cannot properly fill out the survey without dependence on the clinician.1 How can we break through these barriers?
Initially, it may take time to walk the patient through the survey, but after they understand it, they can independently complete it at subsequent times. On the patient’s side, they can complete the survey while they are hooked up to electrical stimulation, icing or heating. This breaks down the time, comprehension and dependency barriers. It could be easily argued that recording PROs is as important to the patient’s rehab as recording objective measures of range of motion, strength and flexibility.
Once you’ve decided to use PROs, there are some things to consider for picking the correct outcome measure to use. First is to select the type of PRO. There are PROs to record the overall health related quality of life, the patient’s whole body health or information that focuses directly to one area of the body. The PRO that focused directly to one area of the body will be best suited for the outcomes most ATs will want to measure.
Once the type is determined, it’s time to decide on the quality of the PRO. In determining the quality, a clinician should look at the reliability and validity of the measure. This is to make sure that the outcome measure accurately shows change over time for the intended population and evaluates items which are important to the clinician and the patient. 2 Other elements to look at are the stability of the measure to reproduce a same score when a patient’s health status has not changed and responsiveness to detect how true the change in the score is over time.2
Along with the internal elements of the outcome measure, the measure also should be patient and clinician friendly, easy to use and score and support the goals that have been made for the patient. If you are interested in adding PROs into your practice but are still not sure where to go, http://www.orthopaedicscores.com/ is a valuable website. This resource has PROs grouped into specific categories as well as offers printable excel files.
One of the best reasons to use patient reported outcomes is to increase communication with the patient and to direct the patient’s care plan.1 Utilizing PROs in conjunction with clinician reported outcomes can enhance the rehabilitation process. Imagine the scenario of a patient returning from ACL surgery. By utilizing PROs, they will be able to see their progress from day 1 to present. As ATs, we watch our patients go through the highs and the lows of their rehabilitation process, including days where they feel like they haven’t made any progress. PROs, in conjunction with clinician reported outcomes, are valuable tools to utilize in helping patients reach their goals.
1. Snyder Valier, A. R., Jennings, A. L., Parsons, J. T., & Vela, L. I. (2014). Benefits of and Barriers to Using Patient-Rated Outcome Measures in Athletic Training. Journal of Athletic Training, 674-683.
2. Valier, A. R., & Lam, K. C. (2015). Beyond the Basics of Clinical Outcomes Assessment: Selecting Appropriate Patient-Reported Outcomes Instruments for Patient Care. Athletic Training Education Journal, 91-100.
About the Author
Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.