Patient Reported Outcome Measures (PROMs)

Original Editor - Stefano Berrone

Top Contributors - Stefano Berrone  

Introduction

Patient Reported Outcome Measures (PROMs) are a fundamental tool in the today’s physiotherapy practice. In a guidance document by The United States Department of Health and Human Services about the use of PROMs, they are defined as reports of a patient’s health condition that come straight from the patient himself, and that do not consider any interpretation of the patient’s response by a health professional. PROMs are tipically in the form of questionnaires (in paper or electronic form) that include the instructions and can be carried out autonomously by the patient. As stated by the Chartered Society of Physiotherapy, outcomes are progressively turning into the currency of the modern healthcare concept, therefore PROMs are essential to demonstrate the value and the success of the practice of physiotherapy.

Categories of PROMs

There are two main categories: generic PROMs, that measure the wellbeing of all types of people, regardless of their disease and condition-specific PROMs, that focus on a particular disease and target the relevant concerns for a population. Two significative examples are the EQ-5D for generic PROMs, that evaluates a person’s sate of health, and the Shoulder Pain and Disability Index (SPADI) for condition-specific PROMs, that assesses shoulder stiffness and pain of unspecified origin.

Furthermore, there is a third category of PROMs, less used in practice, but that lately have been gaining attention both in research and practice. This category includes individualised instruments such as the Patient Generated Index (PGI), Patient Specific Function Scale (PSFS) or the Measure Yourself Medical Outcome Profile (MYMOP). These measures assess patient's definition of health related quality of life. Their aim is to overcome the general pre-definition of the outcomes usually being measured by health professionals. As the other PROMs, they are particularly useful for goal setting and progress monitoring.

How to use PROMs

PROMs are used in three different areas:

• in research
• in service evaluation for policy maker
• in clinical practice

The most of physiotherapists use them in routine clinical practice. They can be administered on paper, or on any electronic device such as smartphones or computers, and are completed by the patient indipendently following the instructions. The role of the physiotherapist is to choose the appropriate PROM, calculate the score and set follow-up assessements at the appropriate time. To choose the appropriate PROM it is useful to ask these two questions: ‘what do I want to measure?’ and ‘what is the rationale for assessment?'. Moreover, the physiotherapist should also verify the strenght of the outcome measure choosen by its psychometric properties (validity, inter-rater reliability, intra-rater reliability, responsiveness, minimal clinically important difference).

There are some useful resources that help to find an appropriate outcome measures (not only PROMs) for example the outcome measures list, the rehabilitation measures database and COSMIN.

Why using PROMs

Using PROMs in clinical practice can have many benefits. These are the most common ones:

• support of decision-making
• improvement of patient-centred care
• improvement of clinical reasoning process
• establishment of treatment objectives
• monitoring of treatment results
• stimulating patient awarness Patient Reported Outcome Measures (PROMs) are a fundamental tool in the today’s physiotherapy practice. In a guidance document by The United States Department of Health and Human Services about the use of PROMs, they are defined as reports of a patient’s health condition that come straight from the patient himself, and that do not consider any interpretation of the patient’s response by a health professional. PROMs are tipically in the form of questionnaires (in paper or electronic form) that include the instructions and can be carried out autonomously by the patient. As stated by the Chartered Society of Physiotherapy, outcomes are progressively turning into the currency of the modern healthcare concept, therefore PROMs are essential to demonstrate the value and the success of the practice of physiotherapy.

Projects

Widespread adoption of PROMs in physiotherapy clinical practice has been recently encouraged in some countries to gather data for quality of physiotherapy service evaluation and for improvement purposes. For example, in the Netherlands, the Royal Dutch Society for Physical Therapy (KNGF) carried out a programme to stimulate the use of PROMs in clinical practice, to test them for their added value in supporting physiotherapists and patients in decision-making.

Moreover, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), is an international initiative that operates in health care, that aims to improve the quality of studies on measurement properties and to standardize outcome measurement instruments by developing core outcome sets.