Free Tools for Finding and Using the Perfect Outcome Measure
By: Nataliya Zlotnikov, MSc, HBSc
By: Nataliya Zlotnikov, MSc, HBSc
What Are Outcome Measures?
An outcome measure is a tool used to assess a patient’s current status.
Prior to any clinical intervention, outcomes measures provide baseline data about a clients' diagnosis and can be used to set up a treatment plan.
The same outcome measure can then be used to assess treatment efficacy over time and help clinicians adjust treatments if necessary, thereby leading to enhanced care.
In clinical practice, the following 4 types of outcome measures can be used:
- Self-reported measures
- Performance-based measures
- Observer-reported measures
- Clinician-reported measures
In this blog, we will only discuss self-reported measures, or patient-reported outcome measures (PROMs).
Today's Blog Aims To:
- Inform clinicians about patient-reported outcome measures (PROMs).
- Discuss the major issues surrounding PROM usage.
- Help clinicians effectively select and easily use PROMs in their practice.
This blog is the first in our series of 5 outcome measure blogs.
Subsequent blogs will delve into 4 individual PROMs in greater detail. These (and other) PROMs are preloaded into your Embodia account.
We hope to thoroughly discuss the following outcome measures used in physiotherapy:
- Lower Extremity Functional Scale (LEFS)
- Dizziness Handicap Inventory (DHI)
- Neck Disability Index (NDI)
- Edinburgh Postnatal Depression Scale (EPDS)
If you would like to know about other PROMs in greater detail, please reach out to us. We would love to write about your topic or PROM of interest!
Today's blog discusses the following sections:
- What Are Patient-Reported Outcome Measures (PROMs)
- Why You Should Use PROMs
- Major Issues with PROMs
- PROMs on Embodia
- Which Witch is Which? Tools & Tips for Choosing the Perfect PROM
- Things to Keep In Mind: Wording, Independence & Translation
I. What Are Patient-Reported Outcome Measures (PROMs)?
The difference between patient-reported outcome measures (PROMs) and other outcome measures is more than a little obvious.
Meaning that they are subjective.
They are meant to be independent of the clinicians' views.
Or more elegantly, PROMs are standardized, validated questionnaires that are completed by patients to measure their perceptions of their own functional status and wellbeing (Dawson et al., 2009).
II. Why You Should Use PROMs
"Evidence shows that the systematic use of information from PROMs leads to better communication and decision making between doctors (HCPS) and patients and improves patient satisfaction with care (Nelson et al., 2015)."
PROMs have numerous benefits that can help your clients and your practice including:
III. Major Issues with PROMs
Although most clinicians recognize the benefits of PROMs for improving and delivering client-centered care, they identify numerous barriers to their usage.
Commonly, the major issues identified include:
- Length of time to complete PROMs
- Length of time to analyze PROM results
Clinicians can therefore be reluctant to employ PROMs routinely because they fear it will add to their workload rather than make them more efficient and effective.
Part of the problem is that the majority of therapists using outcome measures are still using the traditional paper and pencil method, which is time-consuming for patients and practitioners and provides little opportunity for clinics to analyze their performance.
IV. PROMs on Embodia
"When technology is implemented effectively,
it has the potential to fundamentally change the delivery of healthcare." - Jones et al.
Integrating clinical practice with technology will improve the application of such measures and can shift our profession from one that knows the impact they have on patient outcomes, to the profession that shows their impact.
Here are the two major barriers to using PROMs mentioned above along with Embodia's solutions for them:
Problem 1: Length of time to complete PROMs.
Embodia's solution: Embodia provides you with pre-loaded questionnaires that you can easily share with your patients. Patients fill them out on Embodia and the clinician can then see the results.
Problem 2: Length of time to analyze PROM results.
Embodia's solution: Embodia calculates PROM scores for you so you don't need to spend time counting up the score/rating.
Take a look at this short video below to learn more about which pre-loaded PROMs we offer and how to easily use them!
Easy to Use PROMs on Embodia
Follow the yellow button below to view the outcome measures we have available to you on Embodia.
You can also easily make your own questionnaires!
*You will need to log in with your Embodia account to view the PROMs
V. Which Witch is Which? Tools & Tips for Choosing the Perfect PROM
Choosing the correct PROM for a particular purpose can often be challenging.
Many questionnaires may seem useful. Alternatively, none may seem entirely fitting and may include questions that are not appropriate for your patient.
When choosing a PROM to use, careful consideration should be given to the content of the questionnaire and its relevance to the intended form of usage and patient group.
An appropriate measure is one that is supported by published evidence demonstrating that it is:
- Acceptable to patients
- Responsive (sensitive to change) (Dawson et al., 2009)
Validity is illustrated nicely in the image below:
Image source: Dawson et al., 2009
Listings of available measures and systematic reviews of available instruments can assist in selecting an appropriate PROM (Dawson et al., 2009).
Below are a few free tools that you might find useful for selecting the correct PROM:
A. Listings of Available Measures - ProQolid
ProQolid allows you to search for specific PROMs alphabetically, using pathology, population, and more.
Upon selecting your PROM of interest, you are provided with information about it including its purpose (pathology, disease, objective, and population) and its characteristics as well as languages in which it is available.
Below is an example for the NDI:
B. Systematic Reviews - COSMIN
A second useful tool is COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).
COSMIN is an initiative of an international multidisciplinary team of researchers who have expertise in the development and evaluation of outcome measurement instruments.
COSMIN aims to improve the selection of outcome measurement instruments in research and clinical practice by developing methodology and practical tools for selecting the most suitable outcome measurement instrument.
Although COSMIN can help you locate and find the best PROMs, I actually find their database of systematic reviews on PROMs more useful. This tool allows you to be as broad or specific as you like. In the image below, you will see that I searched for "neck".
C. Guide to Selecting Outcome Measures
In addition to the above tools, Physiopedia offers an excellent Guide to Selecting Outcome Measures that you may also find useful.
The guide offers a list of questions across different categories that are intended to guide clinicians in selecting the correct outcome measures for their patients.
Stay tuned for our next PROM blog, in which we will discuss the Lower Extremity Functional Scale (LEFS).
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Thanks for reading!
Date written: 27 Sept 2021
Last updated: 22 Nov 2021