Objectives. Following the attendance of this presentation, athletic trainers will be able to: instruments based on their patient. clinical practice.

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2 Objectives Following the attendance of this presentation, athletic trainers will be able to: 1. Identify available Patient-reported Outcome instruments. 2. Understand the different types of patient-reported outcomes. 3. Select appropriate patient-reported outcome measurement instruments based on their patient. 4. Incorporate patient-reported outcome measurements into clinical practice. 5. Understand how to organize and utilize data from patientreported outcomes to enhance areas of athletic training operations.

3 The Goal Patient-centered, evidence-based healthcare for ALL student-athletes Goal Setting/Tracking Patient Motivation

4 The Problem 485 student-athletes (17 teams) 4 clinical athletic trainers 1 graduate assistant athletic trainer Approximately 6 athletic training students per preceptor/team

5 The Solution ok, maybe not exactly this!

6 First steps Before using PRO s its important to know what they are and what is available. Selecting the right PRO for your practice will make it more likely to be used consistently.

7 Your are already using PRO s

8 What are patient-reported outcome measures? Any report of the status of a patient s health condition that comes directly from the patient, without interpretation of the patient s response by a clinician or anyone else. ~ National Quality Forum

9 PRO Basics Generic vs. Specific Single-item vs. Multi-item Score vs. Category Score ADL Sport Subscales MCID represents the minimum amount of change on an outcome measure that represents a meaningful change for the patient

10 So, how do you get started?

11 Numeric Pain Rating Scale MCID = 2 points

12 Other Single-item PROs Global Rating of Change Overall since your first athletic training visit, has there been any change in your [body part] status? MCID = 2 points on 11-point scale

13 Other Single-item PROs Single Assessment Numeric Evaluation If I had to give my (body part) a grade from 1 to 100, with 100 being the best, I would give my (body part) a.

14 Patient Specific Functional Scale Ask the patient to list 3-5 activities they are either unable to perform or are having difficulty performing, due to their injury. Provide a score between 0 (unable to perform) to 10 (able to perform at same level as prior to injury). Repeat with patient approximately once per week

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16 Lower or Upper Extremity Functional Scales Contains 20 questions about a patient s ability to perform everyday tasks. Set on a 5 point scale (0-4) Total score is calculated by summing the 20 questions Total score ranges from 0-80 Lower scores indicate functional difficulty MCID = 9 points

17 Lower Extremity Functional Scale

18 Upper Extremity Functional Scale

19 Specific PROs Foot/Ankle Instrument American Foot & Ankle Score Foot & Ankle Disability Index Foot & Ankle Outcomes Questionnaire Foot & Ankle Ability Measure AAOS Foot & Ankle Module Sports Ankle Rating System

20 Specific PROs Knee Instrument Anterior Knee Pain Scale Kujala Knee Score International Knee Documentation Committee Scale Lysholm Knee Scoring Scale Cincinnati Knee Scale Knee Injury and Osteoarthritis Outcome Score

21 Specific PROs Hip/Back Instrument Hip Outcome Score (HOS) Hip Dysfunction and Osteoarthritis Outcome Score Hip & Groin Outcome Score Oswestry Disability Index Roland Morris Low Back Pain Questionnaire

22 Specific PROs Shoulder/Elbow Instrument Disability of the Arm, Shoulder, and Hand (DASH) Simple Shoulder Test Shoulder Pain & Disability Index Functional Arm Scale for Throwers Penn Shoulder Score UCLA Shoulder Rating Scale Western Ontario Rotator Cuff Index Patient-Rated Tennis Elbow Evaluation American Shoulder and Elbow Surgeons Score

23 PRO Resources

24 Implementing PROs into Practice Why? How? When? Who?

25 Why did we implement PRO s? Data to support the value of Athletic Training Services. Proof that we are beneficial to student-athletes. Proof that we provide a valuable serves to the university. Data to support our Strategic Plan. Supports additional clinicians. Supports funding of equipment. Added value to daily progress check. I m numbers driven.

26 How did we implement PRO s Pick one PRO and use it consistently (PSFS). Paper and pen.

27 When did we do PRO s Measurement Monday. Patients filled out PRO while doing modality, bike, or before starting therapy. Reviewed PRO s with patient prior to any exercises. Reviewed and used to make or modify treatment plans.

28 Who did PRO s? Started with one clinician. Athletic Training Students Other clinicians saw the value and joined the process.

29 What we learned Logistics of using PRO s Making PRO s part of EMR Athlete s values may not be what we assume. Treatment plans and return to play decisions became more of a team effort between athlete and AT. Athlete frustration was diminished. They could see progress. If progress was slow identifiable changes made to treatment plan. Made requests to administration easier.

30 What we learned cont d

31 Making PRO s Useful Have a conversation with the athlete about he PRO. They will value the process more. They see it as part of the treatment plan. Useable data Know your clinical services core values. Are those values being supported. Identify strengths and shortcomings.

32 PRO s in EMR Documented as a file. Included in EMR. Mobile Devices Directly into EMR Flexibility of timing.

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34 Results of using PRO s Patient Preferences Confidence in treatment plan Valued as part of treatment team Clinical Expertise 2 clinical positions added in two years. Over $100,000 in new modalities and equipment. Facility renovation (2). Funding for continuing education. Support from university administration. Evidence Measureable outcomes

35 Next Steps LEFS, UEFS Not used originally because of calculating scores PSFS was too general Available in our EMR system (Data minable) All 4 clinicians using PRO s More use in EMR

36 References Lam KC. Patient-rated outcomes measures in athletic training. NATA Webinar; Snyder AR, Parsons JT, Valovich McLeod TC, Curtis Bay R, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part I: disablement models. J Athl Train. 2008;43(4): Valovich McLeod TC, Snyder AR, Parsons JT, Curtis Bay R, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part II: clinical outcomes assessment. J Athl Train. 2008;43(4): Snyder AR, Valovich McLeod TC, Sauers EL. Defining, valuing, and teaching clinical outcomes assessment in professional and post-professional athletic training education programs. Athl Train Educ J. 2007;2(2): Valier AR, Lam KC. Beyond the basics of clinical outcomes assessment: selecting appropriate patient-rated outcomes instruments for patient care. Athl Train Educ J. 2015;10(1): Synder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012; 21(8): Rodriguez-Merchan EC. Knee instruments and rating scales designed to measure outcomes. J Orthop Traumatol. 2012;13(1):1-6. Synder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012; 21(8): Hoch JM, Druvenga B, Ferguson BA, Houston MN, Hoch MC. Patient-reported outcomes in male and female collegiate soccer players during an athletic season. J Athl Train. 2015;50(9): Snyder-Valier AR, Jennings AL, Parsons JT, Vela LI. Benefits of and barriers to using patient-rated outcome measures in athletic training. J Athl Train. 2014;49(5): Kyte DG, Calvert M, van der Wees PJ, ten Hove R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015;101(2): Deshpande PR, Rajan S, Sudeepthi BL, Abdul Nazir CP. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011; 2(4): Boyce MB, Browne JP. Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review. Qual Life Res. 2013;22(9): Lam KC, Valier AR, Bay RC, McLeod TC. A unique patient population? Health-related quality of life in adolescent athletes versus general, healthy adolescent individuals. J Athl Train. 2013; 48(2): O'Connor DP, Brinker MR. Challenges in outcome measurement. Clin Orthop Relat Res. 2013;471(11):

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