Fennelly Orna, Blake Catherine, Desmeules François, Stokes Diarmuid, Cunningham Caitriona
School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland.
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Musculoskeletal Care. 2018 Mar;16(1):188-208. doi: 10.1002/msc.1200. Epub 2017 Jun 29.
Advanced practice physiotherapists (APPs), also known as extended scope physiotherapists, provide a new model of service delivery for musculoskeletal (MSK) disorders. Research to date has largely focused on health service efficiencies, with less emphasis on patient outcomes. The present systematic review aimed to identify the patient-reported outcome measures (PROMs) being utilized by APPs.
A wide search strategy was employed, including the PubMed, Embase, CINAHL, CENTRAL and PEDro databases, to identify studies relating to PROMs utilized by APPs in MSK healthcare settings. PROMs identified were classified into predetermined outcome domains, with additional contextual data extracted.
Of the initial 12,302 studies, 38 met the inclusion criteria. These involved APPs across different settings, utilizing 72 different PROMs and most commonly capturing: Patient Satisfaction, Quality of Life (QoL), Functional Status, and Pain; and, less frequently: Global Status (i.e. overall improvement), Psychological Well-Being, Work ability, and Healthcare Consumption and Costs. The quality of the PROMs varied greatly, with Satisfaction most commonly measured utilizing non-standardized locally-devised tools; the EuroQol five-dimensions questionnaire (EuroQoL-5D) and 36-Item Short-Form (SF-36) cited most frequently to capture QoL; and the Visual Analogue Scale (VAS) to capture Pain. No key measure was identified to capture Functional Status, with 15 different tools utilized.
APPs utilized a multiplicity of PROMs across a range of MSK disorders. The present review will act as an important resource, informing the selection of outcomes for MSK disorders, with a view to greater standardization of outcome measurement in MSK clinical practice, service evaluation and research.
高级执业物理治疗师（APPs），也被称为扩展范围物理治疗师，为肌肉骨骼疾病（MSK）提供了一种新的服务模式。迄今为止的研究主要集中在卫生服务效率上，而对患者结局的关注较少。本系统评价旨在确定APPs所使用的患者报告结局指标（PROMs）。
采用广泛的检索策略，包括PubMed、Embase、CINAHL、CENTRAL和PEDro数据库，以识别与APPs在MSK医疗环境中使用的PROMs相关的研究。所识别的PROMs被分类到预先确定的结局领域，并提取额外的背景数据。
在最初的12302项研究中，38项符合纳入标准。这些研究涉及不同环境中的APPs，使用了72种不同的PROMs，最常测量的是：患者满意度、生活质量（QoL）、功能状态和疼痛；较少测量的是：总体状况（即整体改善情况）、心理健康、工作能力以及医疗消费和成本。PROMs的质量差异很大，满意度最常使用非标准化的本地设计工具进行测量；欧洲五维健康量表（EuroQoL-5D）和36项简短健康调查（SF-36）被最频繁地引用以测量QoL；视觉模拟量表（VAS）用于测量疼痛。没有确定用于测量功能状态的关键指标，共使用了15种不同的工具。
APPs在一系列MSK疾病中使用了多种PROMs。本综述将作为一项重要资源，为MSK疾病结局的选择提供参考，以期在MSK临床实践、服务评估和研究中实现结局测量的更大标准化。
