School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.
College of Applied Medical Sciences, Physical Therapy and Rehabilitation Department, Jouf University, Sakaka, Jouf, Saudi Arabia.
BMC Health Serv Res. 2020 Aug 25;20(1):789. doi: 10.1186/s12913-020-05616-5.
There is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings.
to 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice.
We invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention.
Eighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader.
The routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients' outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs' ability to integrate PROMs into clinical decision-making and to engage patients in their care.
医疗保健提供者（HCPs）越来越有兴趣在临床护理中使用患者报告的结果测量（PROMs）。PROMs 可以帮助改善医患沟通，并且可以用于告知是否需要为腰痛（LBP）提供跨学科护理。然而，实施 PROM 以支持临床决策是复杂的，需要知识转化（KT）干预措施，以克服在跨学科临床环境中使用 PROM 的障碍。
1）从医疗团队成员的角度确定在初级保健 LBP 临床实践中使用 PROM 的潜在障碍和促进因素，2）制定基于理论的定制 KT 干预措施，以促进 PROM 在跨学科临床实践中的使用。
我们邀请了 25 名在跨学科团队中工作的 HCP 完成一项自我管理的调查，该调查是基于理论领域框架（TDF）设计的，以确定在 LBP 临床实践中使用 PROM 评分的障碍和促进因素。问卷由 30 个问题组成，采用 5 点李克特量表（定量）进行评分，并包括开放式问题（定性）。对定量和定性数据进行分析，以估计障碍和促进因素的频率。然后由四位 KT 专家小组审查这些发现，他们将行为改变技术映射到识别出的障碍上，为 KT 干预措施的设计提供信息。
18 名 HCP 对调查做出了回应。被认为可能限制 PROM 评分使用的因素包括知识、技能、社会/专业角色和身份、目标、决策过程、对后果的信念、环境背景和资源、行为调节以及社会影响。专家组提出了一个多组件基于证据的 KT 干预措施来解决这些障碍：培训研讨会；教育材料；以及向 HCP 提供 PROM 评分报告，所有这些都由意见领袖提供。
在临床实践中常规使用 PROMs 可以优化 LBP 护理的质量并改善患者的结果。预期提出的多组件 KT 干预措施将是一种有效的策略，可以提高 HCP 将 PROM 纳入临床决策的能力，并使患者参与其护理。
