Reconceptualising Patient-

Reported Outcome Measures:

why use them and what do

they mean to your patients?

Michelle M Holmes

Patient Reported Outcome Measures

“PROMs are designed to measure either patients'

perceptions of their general health or their

perceptions of their health in relation to specific

diseases or conditions”

Using PROMs in Clinical Practice

Increase knowledge on

disease trajectories

Evaluate the

effectiveness of

treatment

Assess the quality of

care

Influence the

detection of

psychological

problems

Facilitate

communication

Use as a screening tool

Stage One

• Systematic literature review examining the effects of PROMs in clinical practice

Stage Two

• Theoretical review examining the potential mechanisms behind the effects of PROMs

Stage Three

• Feasibility study examining implementing PROMs and a trial into clinical practice

Stage Four

• A mixed-method pilot cluster RCT exploring the effects of using PROMS in clinical practice

What is the potential impact

on the process and outcome

of healthcare after

implementing PROMs in

routine clinical practice for

non-malignant pain?

Methods

Stage 1 • Searching the literature

Stage 2 • Selecting the studies

Stage 3

• Extracting data from the studies

Stage 4

• Synthesising the results together

Stage 5 • Assessing the confidence

Construct: Positive effect

Adverse or no effect

Quantitative

Qualitative

Results

During treatment

Therapeutic

relationship

Tracking progress,

evaluating and

changing treatment

Initial

consultation

Assessment of

patient

Decision-making

Post-treatment

Influencing

outcomes

“

”

“It is important to assess and take

into account the thresholds of

physical pain for each different

individual on different occasions

and how it is impacted by cultural

and physiological factors”

Assessment of Patient

“

”

Getting patients to fill out forms

is grossly inaccurate in my book…

the patient 9 time out of 10

wouldn’t understand what hip

pain is

Assessment of Patient

“

”

This method is of great value in

the performance/assistant of

planning so we can assign a more

expressive care in relation to the

pathology and the patient as a

whole. Thus, seeking to minimise

the patient’s suffering and pain

Decision-Making

“

”

I see the implementation of the

pain scale as a way to humanize

care, where we can stop relying

on machines and turn to the

patient; to what he is saying and

feeling. Giving them an active

voice and a right to express

themselves

Therapeutic Relationship

“

”

This scale is important in the

sense of monitoring the evolution

of the intensification of pain and

even to what point the treatment

is being beneficial to the patient

Tracking progress and evaluating and

changing treatment

“

”

I just think there is a lot of

effort being put in there for

not a lot of surgical gain from

my perspective

Tracking progress and evaluating and

changing treatment

Pain levels Patient

satisfaction

Influencing outcomes

Assessment of Confidence

Review finding Confidence

Assessment of patient Moderate confidence

Decision-making High confidence

Therapeutic relationship Moderate confidence

Tracking progress, evaluating

and changing treatment

Low confidence

Influencing outcomes Very low confidence

Conclusions

More research is needed

During treatment

Therapeutic

relationship

Tracking progress,

evaluating and

changing treatment

Initial

consultation

Assessment of

patient

Decision-making

Post-treatment

Influencing

outcomes

Through what processes might

PROMs influence health

outcomes in routine clinical

practice for non-malignant

pain?

Methods

Stage 1

• Searching the literature

Stage 2

• Selecting the studies

Stage 3

• Extracting data from the studies

Stage 4

• Synthesising the results together

Stage 5

• Apply to psychological theories

Results

Increasing clinician knowledge

Facilitating patient-clinician interaction

Provision of patient-centered care

Monitoring

Informing strategies to improve care

Enhancing the therapeutic relationship

Influencing patient satisfaction

Influencing patient behaviour

Factors influencing clinician behaviour

Psychological Theories

Common-sense model of self-regulation

The extended common-sense model

Fear-avoidance model

Self-efficacy

Protection-motivation theory

Self-regulation control theory

Integrated behavioural model

Concepts

Patient satisfaction

Communication

Shared-decision making

Patient-centered care

Therapeutic relationship

Acknowledgements

Dr. Felicity Bishop, University of Southampton); Professor George Lewith, University of Southampton; Dr David Newell, Anglo-European College of Chiropractic; Jonathan Field, Back2Health;

Funders: University of Southampton, the Anglo-European College of Chiropractic, the Royal College of Chiropractors and Southampton Complementary Medicine Research Trust.

Miss Stephanie Barker, University of Southampton; Mrs. Polly Langdon, University of Southampton

Thank you for listening!

Questions?

m.m.holmes@soton.ac.uk

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