Reconceptualising patient-reported outcome measures as active components of specialist musculoskeletal care for back pain

Abstract

Patient-reported outcome measures (PROMs) are increasingly utilised in routine specialist musculoskeletal care. Using the Medical Research Council’s guidance on developing and evaluating complex interventions, this thesis examined how the use of PROMs in specialist musculoskeletal care affects patients with low back pain and the mechanisms that underlie this relationship.
The early development phase consisted of a systematic review examining prior research and a theoretical review exploring the underlying concepts of PROMs. The literature indicates PROMs may have an influence throughout the treatment encounter, affecting patients through multiple processes: increasing clinicians’ knowledge of patients, facilitating interactions, enabling patient-centred care, monitoring, enhancing therapeutic relationships, improving patient satisfaction, and encouraging self-management.
In the feasibility phase, a mixed-methods study explored future study procedures and estimated recruitment. Despite PROMs being routinely used in musculoskeletal care, no participants completed all PROMs. From qualitative interviews, recommendations were made to improve patient and clinician engagement with PROMs and trial processes in the future evaluation phase.
The final evaluation phase involved a randomised-controlled trial and a mixed-method process evaluation. The trial found no significant impact of PROMs on back pain-related disability. However, the process evaluation highlighted a series of processes by which PROMs may influence patient outcomes. PROMs were found to have a role within patient-clinician interactions, with patient-centred communication viewed as a key component of care.
This thesis has contributed to knowledge on implementing PROMs in specialist musculoskeletal care, including the selection and timing of PROMs, administrative processes, and training for clinicians. It provides a valuable theoretical foundation to guide future research on the use of PROMs. PROMs were found to be a useful tool for chiropractors to communicate with patients. Further research should explore how PROMs can be used to support patient-centred communication and how this might influence patients’ outcomes, self-management behaviours, and satisfaction with care.

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Identifiers

ORCID for Felicity Bishop: orcid.org/0000-0002-8737-6662

ORCID for Claire Hart: orcid.org/0000-0003-2175-2474

ORCID for David Newell: orcid.org/0000-0003-1462-3586

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