Elsevier

Manual Therapy

Volume 11, Issue 1, February 2006, Pages 46-53
Manual Therapy

Original article
Monitoring the change: Current trends in outcome measure usage in physiotherapy

https://doi.org/10.1016/j.math.2005.02.003Get rights and content

Abstract

Physiotherapists have traditionally relied on impairment measures such as range of motion and muscle strength to monitor patient progress. The impact of treatment on patients’ daily activities can be assessed with valid and reliable questionnaires, but the use of standardized questionnaires by physiotherapists appeared to be limited. A range of strategies were implemented that aimed to increase physiotherapists’ use of standardized measures of functional activities. A simple random sample of 300 was drawn from a database of physiotherapy providers to a transport accident scheme, and was surveyed in March and September 2003, with response rates of 51% and 55%, respectively. There was a statistically significant (P<.05) increase in reported use of seven questionnaires and a significant reduction in the perception of barriers that were targeted by the interventions The most frequently utilized tests were a pain rating scale and questionnaires for lumbar and cervical problems. Physiotherapists’ attitudes to outcome measurement were generally positive although there was a small but statistically significant (P=.02) reduction in mean attitude score over the re-test period. Physiotherapists in the population sampled significantly increased their reported use of a range of standardized outcome measures over the re-test period. The trend towards greater objectivity in measuring the progress of rehabilitation can enable physiotherapists to develop improved treatment plans with the patients’ needs at the centre of the equation.

Introduction

As the emphasis on evidence-based medicine in health services delivery grows (Jette et al., 2003) health professionals are increasingly expected to demonstrate improved treatment outcomes. The World Health Organisation International Classification of Functioning (ICF) conceptualizes dysfunction as impairments, activity limitations and participation restrictions (WHO, 2001). It is now widely accepted that measurement of outcomes should occur across those domains and over the past 10–20 years, patient-report health outcome measures have been developed and increasingly used for measuring a wide range of health and rehabilitation outcomes (Garratt et al., 2002).

Entry-level professional competencies for physiotherapists include the ability to select relevant, achievable and measurable treatment goals and the use of valid and reliable tests and measures to evaluate the results of treatment (ACOPRA, 2002). Physiotherapists, particularly in orthopaedic practice, have traditionally focused on the measurement of impairments such as pain, range of motion and muscle strength, but have not utilized standardized measures of activity and participation (Jette et al., 1994; Kay et al., 2001; Vanderkooy et al., 1999; van der Valk et al., 1995). Two European surveys of rehabilitation health professionals, including physiotherapists, suggest a pattern across professions, countries and health care settings that the use of standardized measures of function in low back pain rehabilitation is not routine and most assessments are at the impairment level (Haigh et al., 2001; Torenbeek et al., 2001).

In 2003, a number of initiatives occurred in Victoria to encourage physiotherapists to use standardized measures of activity and participation. The Australian Physiotherapy Association (APA) adopted a national position statement on treatment justification that re-stated the professional requirement to measure outcomes using valid and reliable instruments. The Transport Accident Commission (TAC)1 produced a “Clinical Justification Model”, a decision algorithm that included a requirement to use standardized outcome measures to assess activities/participation and monitor outcomes for individual patients. A new treatment notification plan was adopted by the TAC that required practitioners to submit standardized or customized outcome measures with all new treatment plans proposed. Flanagan et al. (2003) discussed the use of outcome measures to assess the management of long term patients on a case by case basis. The implementation of the clinical justification model was supported by a series of lectures and education seminars offered by the APA and TAC, educational material (including copies of a range of standardized questionnaires) was made available in hard copy and on the TAC and APA websites, and peer contact was made with physiotherapy treatment providers to assist them implement the clinical justification model. Peer contact was performed by Physiotherapy consultants employed by the TAC, and the results over the corresponding period to this study were internally audited.

These strategies aimed to increase the use of standardized measures of activity/participation by physiotherapy providers of services to TAC clients. The primary aim of this study was to survey the use of outcome measures over the 6 month period during which these strategies were implemented. Secondary aims were to determine physiotherapists’ attitudes toward outcomes measurement, and the perceived barriers to their use.

Section snippets

Method

A longitudinal mailed survey was conducted in March and September 2003. Simple random samples of 300 private practitioners were drawn from the register of 1092 physiotherapists who had treated Transport Accident Commission clients in Victoria in the preceding year. Ethical approval for the study was provided by the Faculty Human Ethics Committee, Faculty of Health Sciences, La Trobe University. A simultaneous internal audit on the use of outcome measures by physiotherapists was conducted by the

Analysis

A test of the difference between the proportion of respondents using each test in March and September was calculated (Bland, 1995), and two types of analyses were done. The response categories of Sometimes, Frequently and Always were collapsed for comparison of change in reported use. The second analysis grouped the categories Frequently and Always to examine change in common practice. Differences were not tested where any proportion was less than 10%.

For the five items relating to barriers the

Results

There were 154 and 164 completed forms received in the March and September surveys, a return rate of 51% and 55%, respectively. The average age was 40.6 years (SD 8.3) and the average time since graduation 17.1 years (SD 8.6). The sample was similar in age to the average age of 38.7 years for Victorian Physiotherapists in 1998. However, there were significantly more rural practitioners (27.4% compared to 17%) and more males (58.5% compared to 27%) (AIHW, 2001).2

Discussion

The results showed that the use of outcome measures amongst TAC physiotherapy providers had increased significantly over the period. This was confirmed by findings of the TACs internal audit over the same period. During this audit, physiotherapy consultants contacted physiotherapy treatment providers to discuss the use of outcome measures in assisting with treatment plans. An increase in the usage of outcome measures was found, rising from 30% in March to 66% in September.

Significant increases

Conclusion

This study found a significant increase in the use of a number of standardized outcome measures by physiotherapists over a 6 month period. The changes observed were likely influenced by active education initiatives, professional support, and peak body position statements. Mandatory reporting of outcome measures, implemented by TAC during the period and monitored by peer review, also played a key role. Most of the physiotherapists surveyed supported the use of valid and reliable instruments,

References (21)

There are more references available in the full text version of this article.

Cited by (94)

  • Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review

    2022, Archives of Physical Medicine and Rehabilitation
    Citation Excerpt :

    There were 56 unique KT studies (68 articles) included in this scoping review ( see fig 1). Thirty-eight of the 56 (68%) were pre-post design,30,32-37,40-42,45-54,56,59,60,64,67,69-72,78,81,83,84,87-89,91,92 15 (27%) were randomized controlled trials65,66,76,77,86 or cluster randomized controlled trials,38,39,43,55,57,61-63,68,75 and 3 (5%) were controlled trials73,74,85 (see table 1). Seven (13%) had a mixed methods design.30,38,48,51,53,54,83

  • Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden

    2021, Musculoskeletal Science and Practice
    Citation Excerpt :

    However, there have been reports of sub-optimal use of PROMs among physiotherapists, and lack of routines or guidelines for how to understand PROMs in general, and especially for patients with LBP (Swinkels et al., 2011; van Dulmen et al., 2017; Copeland et al., 2008; Osthols et al., 2019). The use of PROMs among physiotherapists has been studied globally and these studies identify advantages of using PROMs as well as barriers (Swinkels et al., 2011; Copeland et al., 2008; Wedge et al., 2012; Abrams et al., 2006; Stokes and O'Neill, 2008; Braun et al., 2018; Mehta and Grafton, 2014; Knoop et al., 2020; Al-Muqiren et al., 2017; Inglis et al., 2008; Skinner and Turner-Stokes, 2006). Advantages of PROMs include factors such as improved patient-therapist interaction, better communication, and clearer goal setting, which enhances quality of care.

  • Utilisation of outcome measures in the management of non-specific neck pain: A national survey of current physiotherapy practice in the UK

    2021, Musculoskeletal Science and Practice
    Citation Excerpt :

    Fig. 1 shows the processes used during the development of the survey instrument. Survey structure and content were informed by a review of current evidence, including systematic reviews (Pietrobon et al., 2002; Schellingerhout et al., 2012; Alreni et al., 2017) and comparable surveys of OMs utilisation (Torenbeek et al., 2001; Haigh et al., 2001; Abrams et al., 2006; MacDermid et al., 2013). Identified OMs were collated, then grouped thematically to represent the spectrum of measures used to evaluate neck pain and its associated disabilities (i.e. 1.

View all citing articles on Scopus
View full text