Patient-Reported Outcome Measures (PROMs)

Patient Reported Outcome Measures (PROMs) are reports completed by patients about how they feel or function in relation to a health condition/therapeutic intervention. They can assess whether an intervention is improving a patient’s symptoms, health, or functionality with limited risk of professional bias or interpretation. PROMs also provide uniform assessment of patients over time and allow for quantitative assessment and evaluation of changes in patient status. 

The use of PROMs in practice is encouraged as they can provide strong evidenced based practice which will help advocate and validate the Australian osteopathic profession, provide a strong basis for any improvement in patient care/status from osteopathic intervention, and help build the professional standard of osteopathic care alongside other allied health professions in Australia. The use of standardised outcome measures also benefits patients as they may improve safety, efficacy, and delivery of care which often result in better patient outcomes.

Found below is a list of commonly used and validated outcome measures that may be useful to you as an osteopath. The list provides detail about each measure as well as a downloadable PDF. The list is not exhaustive and new measures may be added over time.

Feedback or comments are welcome - please provide them via email to seaves@osteopathy.org.au

RESEARCH STUDY:

Osteopathy Australia is conducting research on practitioner perceptions and barriers to the use of Patient-Reported Outcome Measures (PROMs) in Osteopathic Practice.

The aim of this study is to understand osteopaths’ perceptions and barriers to the use of PROMs in practice. Your participation can help inform us about the use of PROMs in osteopathic practice and will help us determine the potential for implementing measures in practice, in turn, supporting patient progress and building evidence-based practice for osteopathy in Australia.

PARTICIPANTS NEEDED – HAVE YOUR SAY!

We want to know your views on PROMs in practice.

Osteopathy Australia is looking for practising osteopaths to take part in focus groups to tell us their views on the use of PROMs in osteopathic practice.

Focus groups will be run online and will take approximately 1.5 to 2 hours of your time. All results obtained will remain entirely confidential and secure.

The focus groups will take place on:

  • 7th April 10am, 2pm, 6pm (times are in AEST)
  • 8th April 10am, 2pm, 6pm (times are in AEST)

Alternative days/times may be arranged depending on interest.

Participant Information Sheet

Please note: In order to participate in the study, participants must be practicing in Australia but do not need to be members of Osteopathy Australia.

For more information or to register your interest, please contact:

Dr Shamona Eaves
Phone: (02) 9410 0099
Email: seaves@osteopathy.org.au

NOTE: This study has been approved in line with the University of Technology Sydney Human Research Ethics Committee [UTS HREC] guidelines. If you have any concerns or complaints about any aspect of the conduct of this research that you wish to raise independently of the research team, please contact the Ethics Secretariat on ph.: +61 2 9514 2478 or email: Research.Ethics@uts.edu.au and quote the UTS HREC reference number: ETH21-6445. Any matter raised will be treated confidentially, investigated and you will be informed of the outcome.

OUTCOME MEASURE LIST:

Note: Cronbach’s alpha is a measure of reliability, specifically the internal consistency of a scale. Generally, alpha values over .70 are good with higher values reflecting better internal consistency.

Self-Report       Population: Adult          Difficulty: Easy (5min)   Cost: Free         Use: Functionality

DESCRIPTION: Used to assess functional ability for up to five activities that that a patient deems important e.g., getting dressed, or more specifically, putting socks on. Patients rate the current level of difficulty for each task and are asked to rate them again following treatment/intervention.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.81 - 0.91) 1, 2, 3, 4, 5

INSTRUCTIONS AND NOTES (for clinicians): Measure is given at initial assessment and then at follow up assessments over time. There is no total score calculated and the measure is not used to compare clients (though possible to do so in research settings6), but rather individual items are followed over time to assess change. The minimal detectable change for an average score is 2, and 3 points for an individual activity score.

INSTRUCTIONS FOR USE (for patients): Please list up to 5 important everyday tasks/activities that you are unable to perform or have difficulty with as a result of your condition. Next to each task, please rate how difficult you find it (between 0 to 10 – 0 being unable to perform the task and 10 being able to perform the activity at the same level as you could prior to injury/condition.

Advantages

  • No scoring required
  • Quick and easy to use for patients and clinicians
  • Not condition specific so can be used for a variety of patients
  • May provide positive reinforcement when an intervention is effective
  • Can be used for chronic conditions

Disadvantages or Limitations

  • Measure is recommended to be used alongside other standardised outcome measures

Download PDF

Self-Report       Population: Adult          Difficulty: Easy (5min)   Cost: Free         Use: Functionality

DESCRIPTION: Assesses impairments on productivity and regular activities in paid and unpaid work (over the last seven days). It explores items such as absenteeism, presenteeism, and work performance.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.74) 1, 2, 3, 4

INSTRUCTIONS AND NOTES (for clinicians): The WPAI produces four scores:  Absenteeism, presenteeism, work productivity loss and activity Impairment. WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity. Scores are multiplied by 100 so to express them as percentages.
Percent work time missed due to problem: Q2a/(Q2a+Q2b+Q3)
Percent impairment while working due to problem: Q4a/10
Percent overall work impairment due to problem: 
Q2a/(Q2a+Q2b+Q3) + {(1-(Q2a+Q2b)/(Q2a+Q2b+Q3)) x Q4a/10
Percent activity impairment due to problem: Q5a/10
Percent work time missed due to all health: (Q2a+Q2b)/(Q2a+Q2b+Q3)
Percent impairment while working due to all health: (Q4a+Q4b)/10
Percent overall work impairment due to all health: 
(Q2a+Q2b)/(Q2a+Q2b+Q3) + {(1-(Q2a+Q2b)/(Q2a+Q2b+Q3)) x (Q4a+Q4b)/10
Percent activity impairment due to all health: (Q5a+Q5b)/10

INSTRUCTIONS FOR USE (for patients): The following questions ask about the effect of your health problems (physical and/or emotional) on your ability to work and perform regular activities. Please fill in the blanks or circle a number, as indicated by each question.

Advantages

  • Quick and easy to use for patients

Disadvantages or Limitations

  • Multiple versions of WPAI exist
  • Scoring is quite detailed and may be difficult

Download PDF

Self-Report         Population: Adult             Difficulty: Easy (5min)    Cost: Free            Use: Pain

DESCRIPTION: Assesses an individual’s confidence to perform a task while suffering from persistent pain and in turn, assesses the impact that pain Is having on their daily life. The measure covers a range of activities such as household chores, work, leisure, and general lifestyle.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.76 - 0.95) 1, 2, 3, 4

INSTRUCTIONS AND NOTES (for clinicians): By tallying the number selected for each of the 10 items/activities, the measure provides a total score between 0-60. Higher scores are indicative of higher levels of confidence. Scores <20 = severe, 20 to 30 = moderate, 31 to 40 = mild, >40 = minimal impairment

INSTRUCTIONS FOR USE (for patients): Please rate how confident you are that you can do the following things at present, despite the pain. To indicate your answer, circle one of the options between 0 and 6 - 0 being “not at all confident" and 6 being "completely confident". Remember, this questionnaire is not asking whether or not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain.

Advantages

  • Quick and easy to use for patients and clinicians
  • Minimal scoring required

Disadvantages or Limitations

  • Scale is in the opposite direction (i.e., larger scores refer to higher levels of confidence, not higher levels of impairment)

Download PDF

Self-Report         Population: Adult             Difficulty: Easy (5min)    Cost: Free            Use: Pain

DESCRIPTION: Used to assess catastrophising (catastrophic thinking) related to pain. The item can be used for individuals with and without chronic pain.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.90 - 0.94) 1, 2, 3, 4 5

INSTRUCTIONS AND NOTES (for clinicians): Scoring consists of a total score and three subscales being: Rumination (items 8, 9, 10, 11), Magnification (items 6, 7, 13), Helplessness (items 1, 2, 3, 4, 5, 12). Score ranges: Total: 0-52, Rumination 0-16, Magnification 0-12, Helplessness 0-24 with higher scores indicating higher levels of catastrophising. Total score <20 = mild, 20-30 = high, >30 indicates severe/clinically relevant catastrophising.

INSTRUCTIONS FOR USE (for patients): We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the following scale, please read each statement and indicate the degree to which you have these thoughts and feelings when you are experiencing pain. The Scale is between 0 to 4 – 0 being not at all, and 4 being all the time.

Advantages

  • Quick and easy to use for patients
  • Can be used for patents with and without chronic pain
  • Children and parents’ version available

Disadvantages or Limitations

  • Additional scoring required if using more than the total score
  • Care should be taken when discussing catastrophising with patients

Download PDF

Self-Report         Population: Adult             Difficulty: Easy (5min)    Cost: Free            Use: Pain

DESCRIPTION: Assesses neuropathic pain in adults with lower back pain via a 9-item questionnaire.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.76 – 0.78 ) 1, 2, 3, 4

INSTRUCTIONS AND NOTES (for clinicians): The measure consists of 9 items. Seven sensory items graded from 0 (= never) to 5 (= strongly), one temporal item course pattern graded from −1 to +1, and one spatial item graded 0 (for no radiation) or +2 (for radiating pain). From the nine items, a total score between −1 to 38 can be calculated. Higher scores indicating higher levels of neuropathic pain. Suggested cut offs: Scores ≥19 indicate neuropathic pain is likely, while scores ≤12 indicate neuropathic pain is unlikely.

INSTRUCTIONS FOR USE (for patients):

Advantages

  • Quick and easy to use for patients and clinicians
  • Can be done online with results given at the end
  • If completed online, it is scored automatically (no scoring required)

Disadvantages or Limitations

  • Mixed findings suggest that the measure may not be useful for conditions outside of lower back pain
  • Scores between 13-18 suggest that the results are uncertain and may require further examination

Complete Online

Self-Report         Population: Adult             Difficulty: Easy (5min)    Cost: Free            Use: Pain

DESCRIPTION: Used to measure the impact that pain has on an individual’s ability to participate in everyday activities. The measure can be used for an initial evaluation and then over time and to judge the effectiveness of an intervention.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.86) 1, 2, 3

INSTRUCTIONS AND NOTES (for clinicians): The measure is a seven-item scale and individual items are measured on a scale of 0 – 10. A total score is then calculated out of 70 where higher scores are indicative of a higher impact of pain on daily activities.

INSTRUCTIONS FOR USE (for patients): The rating scales below are designed to measure the degree to which aspects of your life are disrupted by chronic pain. In other words, we would like to know how much pain is preventing you from doing what you would normally do or from doing it as well as you normally would. Respond to each category indicating the overall impact of pain in your life, not just when pain is at its worst. For each of the 7 categories of life activity listed, please circle the number on the scale that describes the level of disability you typically experience. A score of 0 means no disability at all, and a score of 10 signifies that all the activities in which you would normally be involved have been totally disrupted or prevented by your pain.

Advantages

  • Quick and easy to use for patients and clinicians

Disadvantages or Limitations

  • na

Download PDF

Self-Report         Population: Adult             Difficulty: Easy (10min)  Cost: Free            Use: Quality of Life

DESCRIPTION: Assesses an individual’s quality of life. The measure covers eight key concepts of health: physical functioning, body pain, role limitations due to physical/emotional/personal health problems, emotional well-being, social functioning, energy/fatigue, general health perceptions and perceived change in health.

VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.70 – 0.95) 1, 2, 3, 4

INSTRUCTIONS AND NOTES (for clinicians): The scoring process requires 2 main steps as outlined in the link below. Unlike other measures, higher SF-36 scores reflect better quality of life. Each item is also scored on a 0 to 100 range. Scoring details: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html

INSTRUCTIONS FOR USE (for patients):

Advantages

  • Covers several key aspects associated with quality of life

Disadvantages or Limitations

  • More items than other outcome measures
  • Detailed scoring required
  • Interpretation of the scores may be difficult

Download PDF

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