Patient Reported Outcomes (PROs) – a Tool for Strengthening Patient Involvement and Measuring Outcome in Orthopaedic Outpatient Rehabilitation

Patient Involvement ◽

Pain Treatment ◽

Cervical Disc ◽

Outpatient Rehabilitation ◽

Positive Effects ◽

Disc Surgery ◽

Patient Reported ◽

Quick Dash

AbstractThe present study serves to establish Patient Reported Outcomes (PROs) as a tool for strengthening patient involvement and measuring outcomes in orthopaedic outpatient rehabilitation. Assessments by FFbH-R (Hannover Back Function Questionnaire for patients with back problems), Quick-DASH (Disabilities of Arm, Shoulder, and Hand Score for patients with upper extremity lesions), and LEFS (Lower Extremity Function Scale for patients with lower extremity lesions) were employed in 20 outpatient rehabilitation centres over a period of 12 months to evaluate changes in performance and participation from the subjective patient perspective. The following questionnaires were used: FFbH-R status post: lumbar disc surgery; cervical disc surgery; spinal canal decompression; conservative back pain treatment; other; Quick-DASH status post: rotator cuff reconstruction; shoulder arthroplasty; fracture (conservative or osteosynthesis); other; LEFS status post: hip arthroplasty; knee arthroplasty; anterior cruciate ligament repair; osteotomy; fracture (conservative treatment or osteosynthesis); other. Analysis of the 6,751 usable data sets demonstrated significant positive changes in all scores and diagnostic subgroups. The mean difference in score was 14.2 points in the FFbH-R, − 22 points in the Quick-DASH and 18 points in the LEFS. Thus, this study proves the positive effects of orthopaedic rehabilitation in an outpatient setting. PROs were instituted on a permanent basis in seven of the participating institutions.

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

10.1177/1363459321996741 ◽

2021 ◽

pp. 136345932199674

Author(s):

Rikke Torenholt ◽

Henriette Langstrup

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Patient Involvement ◽

Clinical Decision Making ◽

Diagnostic Procedures ◽

Clinical Decision ◽

Patient Reported ◽

Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

Systematic Review of Quality of Life and Patient Reported Outcomes in Patients with Oncologic Related Lower Extremity Lymphedema

Lymphatic Research and Biology ◽

10.1089/lrb.2012.0015 ◽

2013 ◽

Vol 11 (1) ◽

pp. 14-19 ◽

Cited By ~ 39

Author(s):

Yeliz Cemal ◽

Sarah Jewell ◽

Claudia R. Albornoz ◽

Andrea Pusic ◽

Babak J. Mehrara

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Lower Extremity ◽

Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.10.026 ◽

2020 ◽

Author(s):

Sandra Russo ◽

Joan L. Walker ◽

Jay W. Carlson ◽

Jeanne Carter ◽

Leigh C. Ward ◽

...

Keyword(s):

Lower Extremity ◽

Gynecologic Cancers ◽

Clinical and Patient-Reported Outcomes of Patients With Four Major Lower Extremity Arthroplasties

The Journal of Arthroplasty ◽

10.1016/j.arth.2011.06.014 ◽

2012 ◽

Vol 27 (4) ◽

pp. 507-513 ◽

Cited By ~ 3

Author(s):

Catherine Hui ◽

Oren Ben-Lulu ◽

Juan Sebastian Rendon ◽

Leslie Soever ◽

Allan E. Gross ◽

...

Keyword(s):

Lower Extremity ◽

Pneumatic Compression Device Treatment of Lower Extremity Lymphedema Elicits Improved Limb Volume and Patient-reported Outcomes

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2013.07.012 ◽

2013 ◽

Vol 46 (4) ◽

pp. 480-487 ◽

Cited By ~ 27

Author(s):

S.C. Muluk ◽

A.T. Hirsch ◽

E.C. Taffe

Keyword(s):

Lower Extremity ◽

Limb Volume ◽

Compression Device ◽

Patient Reported ◽

Pneumatic Compression Device

Patient-reported outcomes in women after myocardial infarction a longitudinal study of quality of life, sense of coherence and perceived positive effects

Sykepleien Forskning ◽

10.4220/sykepleienf.2011.0030 ◽

2010 ◽

Vol 5 (4) ◽

pp. 326-326

Author(s):

Tone Merete Norekval

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Longitudinal Study ◽

Sense Of Coherence ◽

Positive Effects ◽

Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support – a qualitative study of the patient perspective

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v4i2.1125 ◽

2016 ◽

Vol 4 (2) ◽

pp. 359 ◽

Cited By ~ 7

Author(s):

Caroline Trillingsgaard ◽

Berit Kjærside Nielsen ◽

Niels Henrik Hjøllund ◽

Kirsten Lomborg

Keyword(s):

Clinical Practice ◽

Outpatient Clinic ◽

Patient Involvement ◽

Disease Patient ◽

Psychosocial Problems ◽

Well Being ◽

University Hospital ◽

Self Management ◽

Rationale, aims and objectives Patient-reported outcomes (PRO) is being implemented in clinical practice across different healthcare settings with various purposes. Involving the patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients fill in a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PRO influenced the interaction between patients and clinicians during the consultation.Methods Through participant observations of nine consultations and 12 semi-structured interviews with patients after the consultation this interpretive description study explored patients’ experiences with the PRO system. The PRO included self-assessment on health-related quality of life, symptoms, and well-being. Patients who visited the outpatient clinic at Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach to recruit patients who had completed at least two PRO questionnaires.Results The analysis revealed rudiments of PRO in clinical practice leading to an increased understanding of their chronic disease, patient-centred communication and an additional focus on psychosocial problems. However, the very application of PRO in the outpatient clinic and the patient attitudes were substantial and crucial barriers for PRO as a method to achieve patient involvement and self-management.Conclusion The use of PRO in outpatient consultations may support patients' self-management by a) impelling patient-centred communication in the consultation, b) legitimising talk about psychosocial problems, and c) increasing the patients' understanding of their disease. Yet, applying PRO into clinical practice does not automatically involve the patients and support their self-management. We suggest supplementary clinical initiatives to strengthen the patient involving benefits of PRO.

Developing a pediatric pain data repository

JAMIA Open ◽

10.1093/jamiaopen/ooz062 ◽

2019 ◽

Vol 3 (1) ◽

pp. 31-36

Author(s):

Carolina Donado ◽

Kimberly Lobo ◽

Charles B Berde ◽

Florence T Bourgeois

Keyword(s):

Pain Treatment ◽

Clinical Information ◽

Medical Decision ◽

Data Repository ◽

Pediatric Pain ◽

Patient Centered ◽

Patient Reported ◽

Treatment Plans ◽

Web Platform

Abstract The management of pediatric pain typically consists of individualized treatment plans and interventions that have not been systematically evaluated. There is an emerging need to create systems that can support the translation of clinical discoveries, facilitate the assessment of current interventions, and improve the collection of patient-centered data beyond routine clinical information. We present the development of the pediatric pain data repository, a custom-built system developed at Boston Children’s Hospital by a multidisciplinary pain treatment service. The Repository employs a web platform to collect standardized patient-reported outcomes and integrates this with electronic medical record data. To date, we have collected information on 2577 patients and anticipate adding approximately 500 new patients per year. Major strengths of the Repository include collection of extensive longitudinal patient-reported outcomes, automated clinical data abstraction, and integration of the system into clinical workflows to support medical decision making.