L. Ackermans, M. G. Hageman, A. H. Bos, V. A. B. Scholtes, R. W. Poolman, OLVG-Oost, Orthopaedic Surgery, Joint Research, Amsterdam, The Netherlands D. Haverkamp, Slotervaart Centre of Orthopedic Research and Education (SCORE), Amsterdam, The Netherlands.
Clin Orthop Relat Res. 2018 Apr;476(4):716-722. doi: 10.1007/s11999.0000000000000069.
Although patient-reported outcome measures (PROMs) are helpful to define whether an intervention has improved a patient's status in ways the patient feels are important, they may also serve an empowering educational role; specifically, sharing a patient's scores might help the patient understand his or her progress during treatment. However, whether sharing PROM scores in this way improves the sense of empowerment or satisfaction with the process of care has not been well explored. Also, less is known whether specific demographic factors or coping strategies are associated with empowerment.
QUESTIONS/PURPOSES: We asked the following: (1) Does giving patients feedback on their PROM scores improve a patient's sense of empowerment or satisfaction? (2) Do demographic factors, duration of disability, or self-efficacy correlate with patient empowerment?
In this prospective cohort study, we assigned patients with osteoarthritis of the knee or hip sequentially such that the first 70 patients did not receive the intervention and the next 72 did. Patients enrolled in the control cohort were managed according to standard care, whereas patients enrolled in the intervention cohort completed web-based questionnaires measuring their physical function and pain. After filling out the questionnaires, a printout with the scores was given to the patients providing feedback about their physical function and pain. The primary outcome measure was patient empowerment, as measured by the Patient Activation Measure. Secondary outcomes were patient satisfaction, as measured by an 11-point Likert scale and Patient Doctor Relation Questionnaire. Independent variables were demographic factors and coping, measured by the Pain Self-efficacy Questionnaire. Bivariate and multivariable analyses were performed to determine the influence of the feedback. Although no minimum clinically important differences have been defined for the patient empowerment or satisfaction scales, we believe that differences smaller than 10% are unlikely to be clinically important, even if they are statistically significant.
Although the group that received PROM feedback had higher scores for empowerment than the group that did not, the effect size was small and likely not to have been clinically important (2.8 ± 0.85 versus 3.1 ± 0.811; mean difference -0.31; 95% confidence interval, 2.8-3.1; p = 0.037). With the numbers available, there were no differences between the group given PROM feedback and the group that did not receive such feedback in terms of satisfaction scores (8.6 ± 1.4 versus 8.8 ± 1.2; mean difference -0.19; p = 0.39). After controlling for demographic factors such as level of education and duration of complaint, we found that the group that received PROM feedback and who had a higher level of self-efficacy had higher scores for empowerment than the group that did not, although the effect size was small.
PROM feedback did not have a clinically important impact on empowerment or satisfaction. This might indicate that counseling based on PROMs during a single visit may be ineffective. The most important positive finding is that more effective coping strategies are associated with greater patient empowerment.
Level II, therapeutic study.
尽管患者报告的结局测量（PROMs）有助于确定干预措施是否以患者认为重要的方式改善了患者的状况，但它们也可能发挥赋权教育作用；具体来说，分享患者的分数可能有助于患者了解他或她在治疗过程中的进展。然而，以这种方式分享 PROM 分数是否会提高患者对护理过程的赋权感或满意度，尚未得到很好的探索。此外，人们对特定的人口统计学因素或应对策略是否与赋权相关知之甚少。
问题/目的：我们提出了以下问题：（1）为患者提供 PROM 分数反馈是否会提高患者的赋权感或满意度？（2）人口统计学因素、残疾持续时间或自我效能与患者赋权相关吗？
在这项前瞻性队列研究中，我们按顺序为膝关节或髋关节骨关节炎患者分配，前 70 名患者未接受干预，接下来的 72 名患者接受干预。对照组患者接受标准护理管理，而干预组患者则完成测量其身体功能和疼痛的基于网络的问卷。填写完问卷后，将带有分数的打印件交给患者，为他们提供有关身体功能和疼痛的反馈。主要结局指标是患者赋权，用患者激活量表测量。次要结局指标是患者满意度，用 11 分李克特量表和患者医生关系问卷测量。独立变量是人口统计学因素和应对，用疼痛自我效能问卷测量。进行了双变量和多变量分析，以确定反馈的影响。尽管患者赋权和满意度量表尚未定义最小临床重要差异，但我们认为，即使在统计学上有意义，小于 10%的差异也不太可能具有临床重要性。
尽管接受 PROM 反馈的组比未接受反馈的组的赋权得分更高，但效果量较小，不太可能具有临床重要性（2.8 ± 0.85 与 3.1 ± 0.811；平均差异-0.31；95%置信区间，2.8-3.1；p = 0.037）。根据现有的数字，在满意度评分方面，接受 PROM 反馈的组与未接受此类反馈的组之间没有差异（8.6 ± 1.4 与 8.8 ± 1.2；平均差异-0.19；p = 0.39）。在控制教育程度和投诉持续时间等人口统计学因素后，我们发现，接受 PROM 反馈且自我效能水平较高的组比未接受反馈的组的赋权得分更高，尽管效果量较小。
PROM 反馈对赋权或满意度没有产生具有临床意义的影响。这可能表明单次就诊时基于 PROM 的咨询可能无效。最重要的积极发现是，更有效的应对策略与更大的患者赋权相关。
二级，治疗性研究。
