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Briggs MS, Rethman KK, Crookes J, Cheek F, Pottkotter K, McGrath S, DeWitt J, Harmon-Matthews LE, Quatman-Yates CC. Implementing Patient-Reported Outcome Measures in Outpatient Rehabilitation Settings: A Systematic Review of Facilitators and Barriers Using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2020; 101:1796-1812. [PMID: 32416149 DOI: 10.1016/j.apmr.2020.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review examines the facilitators and barriers to the use of patient-reported outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies to improve care to maximize patient outcomes. DATA SOURCES Eleven databases were systematically searched from November 2018 to May 2019. STUDY SELECTION Two reviewers independently assessed articles based on the following inclusion criteria: English text, evaluate barriers and facilitators, include PROMs, and occur in an outpatient rehabilitation setting (physical therapy, occupational therapy, speech language pathology, or athletic training). Of the 10,164 articles initially screened, 15 articles were included in this study. DATA EXTRACTION Data were extracted from the selected articles by 2 independent reviewers and put into an extraction template and into the Consolidated Framework for Implementation Research (CFIR) model. The Appraisal Tool for Cross-Sectional Studies (AXIS) was conducted on each study to assess study design, risk of bias, and reporting quality of the eligible studies. DATA SYNTHESIS Ten studies were identified as high quality, according to the AXIS. Based on the CFIR model, the top barriers identified focused on clinician training and time in the implementation process, lack of recognized value and knowledge at the individual level, lack of access and support in the inner setting, and inability of patients to complete PROMs in the intervention process. Facilitators were identified as education in the implementation process, support and availability of PROMs in the inner setting, and recognized value at the individual level. CONCLUSIONS More barriers than facilitators have been identified, which is consistent with PROM underuse. Clinicians and administrators should find opportunities to overcome the barriers identified and leverage the facilitators to improve routine PROM use and maximize patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Katherine Kozak Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin Crookes
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Fern Cheek
- Health Sciences Library, The Ohio State University, Columbus, Ohio
| | - Kristy Pottkotter
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shana McGrath
- OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John DeWitt
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Lindsay E Harmon-Matthews
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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