PATIENT REPORT OUTCOME MEASURE USE FOR CONCUSSION AMONG HIGH SCHOOL ATHLETIC TRAINERS

Background: Recent recommendations suggest incorporating patient-report outcome measures (PROMs) into concussion assessment batteries. Utilizing PROMs provides information on the patient’s perspective and how the concussion may influence the patient’s health status. Past studies evaluating PROM use among athletic trainers (ATs) found varying practices and barriers to implementation. However, there is limited data on use of PROMs in managing concussion among adolescent patients. Hypothesis/Purpose: To describe the use of PROMs as part of concussion assessment and treatment practices of ATs working in middle and high school settings. Methods: An online survey regarding concussion treatment perceptions and practices was distributed to a convenience sample of 5000 ATs through the NATA Survey Research Program. The survey included personal and institutional demographics, healthcare provider access and referral practices, perceptions of concussion treatment, clinical practice characteristics of concussion treatment and PROM use. The survey was pilot tested and validated in a sample of ATs prior to distribution. Analysis of the PROM section was conducted using descriptive statistics (percentages, frequencies) for this study. Results: The survey was accessed by 304 ATs (6.1% access rate) and completed by 153 ATs (58.3% completion rate). Of those, 27.2% (n=57) were employed in the middle school or high school setting and were analyzed for this study. Just over half of respondents had <10 years of experience (52.7%, n=30). Only 35.1% (n=20) of ATs reported they use PROMs as part of their clinical management of concussion. Of those who use PROMs, 75% (n=15) indicated that they use them always or almost always. The most commonly used generic PROMs were the Short Form 12 or 36 (25%, n=5) and Patient Reported Outcomes Measurement Information System (25%, n=5) and the most common specific PROMs were the Headache Impact Test (45%, n=9) and Dizziness Handicap Inventory (15%, n=3). Figure 1 shows the level of self-reported confidence of those utilizing PROMs. Barriers for PROM use included it being too time consuming (24.6%, n=14/57), lacking a support structure (15.8%, n=9/57), and not familiar with PROMs (14%, n=8/57). Close to one-fourth (22.8%, n=13/57) of respondents would be willing to use PROMs, but lacked time. Conclusion: While the use of PROMs is recommended in the evaluation and treatment of adolescent athletes, just over one-third of ATs providing care to these patients, use PROMs. Educational efforts for ATs should look to increase their familiarity and confidence when using PROMs for concussion while suggesting strategies to incorporate PROMs into practice. [Figure: see text]

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Methods of the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP), 2014/2015 through 2018/2019

Journal of Athletic Training ◽

10.4085/284-20 ◽

2020 ◽

Author(s):

Sarah N. Morris ◽

Avinash Chandran ◽

Erin B. Wasserman ◽

Sara L. Quetant ◽

Hannah J. Robison ◽

...

Keyword(s):

High School ◽

Athletic Trainers ◽

System Structure ◽

Athletic Injury ◽

Surveillance Program ◽

Common Data Elements ◽

Convenience Sample ◽

Patient Reported ◽

Network Surveillance ◽

Data Elements

Abstract Background: The National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) was established in 2011 to provide a comprehensive appraisal of injuries sustained by high school student-athletes receiving services from athletic trainers (ATs). The purpose of this manuscript is to update the surveillance methodology of NATION-SP for data reported during the 2014/15 through 2018/19 academic years. Surveillance system structure: NATION-SP used a convenience sample of US high schools with access to ATs via a rolling recruitment model. ATs at participating institutions volunteered to contribute data through electronic medical records systems; common data elements were then pushed to and maintained by the Datalys Center. ATs completed detailed reports on each injury, including condition and circumstances. The treatments component was used to comprehensively assess services provided to athletes by ATs. The outcomes companion component was developed to monitor patient-reported outcomes following athletic injury. Summary: NATION-SP continues to serve a critical purpose in informing injury prevention and treatment efforts among high school athletes.

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Athletic Trainers' Current Knowledge and Envisioned Use of Foundational Evidence-Based Practice Concepts

Athletic Training Education Journal ◽

10.4085/1202121 ◽

2017 ◽

Vol 12 (2) ◽

pp. 121-133 ◽

Cited By ~ 2

Author(s):

Sarah A. Manspeaker ◽

Dorice A. Hankemeier

Keyword(s):

Professional Education ◽

Evidence Based Practice ◽

Current Knowledge ◽

Athletic Trainers ◽

Knowledge Score ◽

Evidence Based ◽

Multiple Choice Questions ◽

Perceived Knowledge ◽

Convenience Sample ◽

Patient Reported

Context: The Board of Certification (BOC) requires 10 continuing education units (CEUs) in evidence-based practice (EBP) each reporting period. It is unknown whether participation in programming in the Foundations category for CEUs results in improved knowledge of and confidence in EBP. Objective: To examine a continuing professional education (CPE) program in relation to perceived knowledge of and confidence in EBP concepts among athletic trainers (ATs) and to determine ATs' perceptions regarding barriers to, use of, and resources for EBP. Design: Mixed-methods, within-subjects design; preintervention-postintervention evaluation of ATs' EBP knowledge and perceptions. Setting: A CPE workshop hosted at 2 Division I universities. Patients or Other Participants: Convenience sample of 123 AT workshop attendees. Intervention(s): Five-hour BOC-approved Foundations of EBP workshop. Main Outcome Measure(s): The Evidence-Based Concepts: Knowledge, Attitudes, and Use survey. The ATs' EBP knowledge was assessed via multiple-choice questions. Descriptive statistics, differences between scores, and correlations were ascertained. Open-ended questions were classified according to common themes and coded. Results: The 11-point knowledge score showed knowledge increased significantly (t = −12.42, P < .001, d = 1.31, 95% confidence interval = −2.41, −1.75) preworkshop (mean = 6.39 ± 1.63) to postworkshop (mean = 8.47 ± 1.55). Confidence in knowledge increased significantly (z = −9.51, P < .001) preworkshop (median = 26) to postworkshop (median = 38). The ATs identified barriers to EBP use as time, resources, environment, and experience in EBP; envisioned use of EBP included implementing patient-reported outcomes and internet resources. Conclusions: This workshop demonstrated improved immediate perceived knowledge and confidence in EBP concepts. Although a larger number of clinical EBP programs have been approved by the BOC, Foundations of EBP programming is valuable for CEU opportunities to narrow the gap regarding EBP knowledge. Future investigations may evaluate transference of EBP knowledge into professional practice.

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Post-concussion Driving Management Practices Among Certified Athletic Trainers

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.57 ◽

2019 ◽

Vol 34 (5) ◽

pp. 787-787

Author(s):

J D Schmidt ◽

R C Lynall ◽

L B Lempke ◽

H Devos

Keyword(s):

High School ◽

Management Practices ◽

Motor Vehicle ◽

Athletic Trainers ◽

Medical Professional ◽

Convenience Sample ◽

Novice Drivers ◽

Certified Athletic Trainers ◽

The Road ◽

On The Road

Abstract Purpose To describe post-concussion driving management practices and opinions among athletic trainers (ATs) and to compare practices across highest earned degree, setting, and years certified. Methods A survey weblink was emailed to a convenience sample of 8,723 ATs (10.8% response rate [945/8723]; years certified=14.5±10.7; years worked clinically=12.4±9.4). The validated survey captured AT driving management practices and opinions (agreement on a seven-point Likert scale). We compared the percentage of patients instructed to refrain from driving across highest earned degree, setting, and years certified using Kruskal-Wallis tests (alpha=0.05). Results When asked whether they recommended concussed patients refrain from driving, 58.5% of ATs responded “sometimes” (n=553/945), 37.9% responded “always” (n=358/945), and 3.6% responded “never” (n=34/945). ATs most commonly: recommended patients refrain from driving until symptom resolution (44.7%, n=399/892); utilized their clinical exam to determine readiness to return-to-drive (64.9%, n=579/892); and provided instructions verbally (94.2%, n=840/892). ATs agreed that “patients that are impaired by a concussion are a danger on the road”, but only somewhat agreed that “patients with suspected concussion should not drive a motor vehicle until cleared to do so by a medical professional” (median=5). High school (60.5±37.6%) and clinic-based ATs (66.5±31.2%) trended towards higher percentages of patients instructed to refrain from driving relative to college (52.3±38.2%; H(2)=5.92,p=0.052). No other differences observed. Conclusion ATs recommend driving restrictions to some, but not all, concussed patients. ATs recognize post-concussion driving dangers, but do not strongly endorse refraining from driving after concussion. High school and clinic-based ATs may manage more adolescent novice drivers and, therefore, act more conservatively.

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Motion Sickness Susceptibility and Baseline Vestibular and Ocular-Motor Performance in Adolescent Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-347-18 ◽

2019 ◽

Vol 54 (9) ◽

pp. 939-944 ◽

Cited By ~ 4

Author(s):

R. J. Elbin ◽

Anthony P. Kontos ◽

Alicia Sufrinko ◽

Mallory McElroy ◽

Katie Stephenson-Brown ◽

...

Keyword(s):

High School ◽

Motion Sickness ◽

Short Form ◽

Ocular Motor ◽

Neurocognitive Performance ◽

High School Athletes ◽

Symptom Scale ◽

Convenience Sample ◽

Symptom Scores ◽

History Of

Context High school athletes with a history of motion sickness susceptibility exhibit higher baseline vestibular and ocular-motor scores than those without a history of motion sickness susceptibility. Objective To examine the effects of motion sickness susceptibility on baseline vestibular and ocular-motor functioning, neurocognitive performance, and symptom scores. Design Cross-sectional study. Setting Preseason concussion testing. Patients or Other Participants A convenience sample of high school athletes (N = 308, age = 15.13 ± 1.21 years) involved in a variety of sports. Main Outcome Measure(s) Vestibular/Ocular Motor Screening, computerized neurocognitive assessment, symptom scale, and Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-S). Results Participants were categorized into 3 groups based on a median split of the scores (eg, NONE, LOW, and HIGH). The LOW (n = 95) and HIGH (n = 92) groups (ie, MSSQ-S score > 0) were 2.64 times more likely (χ21,257 = 7.94, P = .01, 95% confidence interval = 1.32, 5.26) to have baseline Vestibular/Ocular Motor Screening scores larger than the clinical cutoffs for the NONE group (n = 70). No between-groups main effects were present for the NONE (n = 52), LOW (n = 89), and HIGH (n = 90) MSSQ-S groups for verbal (F2,230 = .09, P = .91, η2 = .001) and visual (F2,230 = .15, P = .86, η2 = .001) memory, processing speed (F2,230 = .78, P = .46, η2 = .007), or reaction time (F2,230 = 2.21, P = .11, η2 = .002). The HIGH group exhibited higher total baseline symptom scores than the LOW (U = 3325.50, z = −1.99, P = .05, r = .15) and NONE (U = 1647.50, z = −2.83, P = .005, r = .24) groups. Conclusions Motion sickness should be considered a preexisting risk factor that might influence specific domains of the baseline concussion assessment and postinjury management.

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PROMIS Physical Function 10-Item Short Form for Older Adults in an Emergency Setting

The Journals of Gerontology Series A ◽

10.1093/gerona/glz163 ◽

2019 ◽

Vol 75 (7) ◽

pp. 1418-1423

Author(s):

G W Conner Fox ◽

Sandra Rodriguez ◽

Laura Rivera-Reyes ◽

George Loo ◽

Ariela Hazan ◽

...

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Functional Status ◽

Physical Function ◽

Daily Living ◽

Short Form ◽

Emergency Setting ◽

General Function ◽

Convenience Sample ◽

Patient Reported

Abstract Background Functional status in older adults predicts hospital use and mortality, and offers insight into independence and quality of life. The Patient-Reported Outcome Measurement Information System (PROMIS) was developed to improve and standardize patient-reported outcomes measurements. The PROMIS Physical Function (PROMIS PF) 10-Item Short Form was not created specifically for older adults. By comparing PROMIS with the Katz Index of Activities of Daily Living (Katz), we evaluated PROMIS for measurement of physical function versus general function in an older adult population seen in the ED. Methods A prospective, convenience sample of ED patients 65 years and older (from January 1, 2015 to June 30, 2015) completed Katz and PROMIS PF. Both were compared for scoring distributions and conventional scoring thresholds for severity of impairment (eg, minimal, moderate, severe). We assessed convergence through Spearman correlations, equivalents of conventional thresholds and ranges of physical function, and item-response frequencies. Results A total of 357 completed both function surveys. PROMIS PF and Katz have a modest positive correlation (r = .50, p < .01). Mean PROMIS PF scores within Katz scoring ranges for minimal (43, SD = 10), moderate (32, SD = 7), and severe (24, SD = 7) impairment fell within respective PROMIS PF scoring ranges (severe = 14–29, moderate = 30–39, mild = 40–45), indicating convergence. PROMIS identified impairment in 3× as many patients as did Katz, as PROMIS assesses vigorous physical function (eg, running, heavy lifting) not queried by Katz. However, PROMIS does not assess select activities of daily living (ADLs; eg, feeding, continence) important for assessment of function in older adults. Conclusions There is a modest correlation between PROMIS and Katz. PROMIS may better assess physical function than Katz, but is not an adequate replacement for assessment of general functional status in older adults.

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Patient-Report-Outcome-Measure and Incentives for Inpatient Chronic Care in Germany

Global Journal of Health Science ◽

10.5539/gjhs.v12n8p127 ◽

2020 ◽

Vol 12 (8) ◽

pp. 127

Author(s):

Tobias Romeyke ◽

Elisabeth Noehammer ◽

Harald Stummer

Keyword(s):

Rheumatic Diseases ◽

Well Being ◽

Treatment Quality ◽

Complex Treatment ◽

Incentive Structure ◽

Patient Report ◽

Patient Report Outcome ◽

Patient Report Outcome Measure ◽

Positive Effects ◽

Chronic Rheumatic Diseases

INTRODUCTION: In general, incentive tools like pay for performance (P4P) have positive effects regarding treatment quality and financial outcomes. As they are applicable to the clinical management of chronic conditions like asthma and diabetes, this article analyses their potential for multimodal complex treatment of chronic rheumatic diseases. METHODS: Cost data for chronic rheumatic diseases with and without specified complex treatments and their respective remuneration are compared to permit specific statements regarding incentive aspects in a DRG setting. Moreover, several standardized Patient-Report-Outcome-Measures (PROMs) are considered in the context of complex treatment to allow not only for efficiency, but also effectiveness evaluation. RESULTS: In total, 375 patients with complex treatment for rheumatic conditions were surveyed from 2013 to 2018. The incentive is slightly below (4,821.05 €) the costs incurred for complex treatments (4,972.44 €). The results of the used PROMs are positive as pain intensity decreased considerably (p <.001, r=0.75) and mental state complaints were reduced (p <.001). CONCLUSIONS: PROMs are valid instruments to capture changes in patient well-being. They also help to improve clinical operations and can be used for benchmarking. The P4P approach should cover the costs incurred to ensure the incentive structure.

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Retained Knowledge and Use of Evidence-Based Practice Concepts

Athletic Training Education Journal ◽

10.4085/1303239 ◽

2018 ◽

Vol 13 (3) ◽

pp. 239-247 ◽

Cited By ~ 1

Author(s):

Sarah A. Manspeaker ◽

Dorice A. Hankemeier

Keyword(s):

Clinical Practice ◽

Repeated Measures ◽

Evidence Based Practice ◽

Athletic Trainers ◽

Evidence Based ◽

Perceived Knowledge ◽

Convenience Sample ◽

Patient Reported ◽

Board Of Certification ◽

Over Time

Context: To maintain certification, athletic trainers (ATs) are required to obtain continuing education units (CEUs) in the area of evidence-based practice (EBP). Longitudinal analysis of outcomes after attending a Board of Certification–approved Foundations of EBP course is lacking. Objective: To evaluate ATs' knowledge retention of and confidence in EBP concepts 12 months after a Foundations of EBP course. A secondary aim was to determine ATs' perceptions regarding barriers to, use of, and resources for EBP. Design: Repeated measures within-subjects survey. Setting: Online survey. Patients or Other Participants: Twenty-seven respondents (22% response rate) from a convenience sample of 123 ATs. Intervention(s): Board of Certification–approved Foundations of EBP category workshop. Main Outcome Measure(s): The survey instrument, Evidence-Based Concepts: Knowledge, Attitudes, and Use (EBCKAU), ascertained ATs' perceived EBP knowledge over a 12-month period. Descriptive statistics and correlations were calculated; repeated measures analysis of variance determined differences between scores. Responses to open-ended questions were catalogued according to themes and coded. Results: For the knowledge score, a statistically significant increase in perceived knowledge (F2.0,52.0 = 18.91, P < .001) from preworkshop (6.40 ± 1.77) to immediately postworkshop (8.15 ± 1.51) and from before to 12 months after workshop (7.30 ± 1.64) was noted. Confidence in knowledge was statistically significantly different over time (z = −4.55, P < .001). Both before and since the workshop, ATs reported low levels of incorporating patient-reported outcome measures (PROM) and were equally likely to use compilation research findings in their clinical practice. Barriers of time and available resources were identified, and patient care was reported as the primary area in which ATs envision future use of EBP. Conclusions: Athletic trainers improved immediate perceived knowledge and retained knowledge of EBP concepts over time; however, confidence in knowledge decreased over time. ATs did not implement the workshop concepts into their daily clinical practice.

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Association of Physical Morbidity and Health-Related Quality of Life in a Representative Sample of Older German People

European Journal of Health Psychology ◽

10.1027/2512-8442/a000019 ◽

2018 ◽

Vol 25 (4) ◽

pp. 140-151

Author(s):

Markus A. Wirtz ◽

Matthias Morfeld ◽

Elmar Brähler ◽

Andreas Hinz ◽

Heide Glaesmer

Keyword(s):

Quality Of Life ◽

Representative Sample ◽

Short Form ◽

Physical Symptoms ◽

German Population ◽

Health Related Quality ◽

Patient Reported ◽

Related Quality ◽

Health Related

Abstract. The association between health-related quality of life (HRQoL; Short-Form Health Survey-12; SF-12) and patient-reported morbidity-related symptoms measured by the Patient Health Questionnaire-15 (PHQ-15) is analyzed in a representative sample of older people in the general German population. Data from 1,659 people aged 60 to 85 years were obtained. Latent class analysis identified six classes of patients, which optimally categorize clusters of physical symptoms the participants reported: musculoskeletal impairments (39.8%), healthy (25.7%), musculoskeletal and respiratory/cardiac impairments (12.8%), musculoskeletal and respiratory impairments, along with bowel and digestion problems (12.9%), general impairments (4.9%), and general impairments with no bowel and digestion problems (4.8%). The participants’ SF-12 Physical Health Scores (η2 = .39) and their Mental Health Scores (η2 = .28) are highly associated with these latent classes. These associations remain virtually identical after controlling for age. The results provide evidence that profiles of patient-reported physical impairments correspond strongly with reduced HRQoL independently from aging processes.

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The Inflammatory Bowel Disease Symptom Inventory: A Patient-report Scale for Research and Clinical Application

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz038 ◽

2019 ◽

Vol 25 (8) ◽

pp. 1277-1290 ◽

Cited By ~ 7

Author(s):

Kathryn A Sexton ◽

John R Walker ◽

Laura E Targownik ◽

Lesley A Graff ◽

Clove Haviva ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Factor Analysis ◽

Bowel Disease ◽

Convergent Validity ◽

Short Form ◽

Self Report ◽

Measurement Properties ◽

Systemic Complications ◽

Patient Reported ◽

Inflammatory Bowel

Abstract Objectives Existing measures of inflammatory bowel disease (IBD) symptoms are not well suited to self-report, inadequate in measurement properties, insufficiently specific, or burdensome for brief or repeated administration. We aimed to develop a patient-reported outcome measure to assess a broader range of IBD symptoms. Methods The IBD Symptoms Inventory (IBDSI) was developed by adapting symptom items from existing clinician-rated or diary-format inventories; after factor analysis, 38 items were retained on 5 subscales: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. Participants completed the IBDSI and other self-report measures during a clinic visit. A nurse administered the Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) or the Powell-Tuck Index (PTI) for ulcerative colitis (UC), and a gastroenterologist completed a global assessment of disease severity (PGA). Results The 267 participants with CD (n = 142) or UC (n = 125), ages 18 to 81 (M = 43.4, SD = 14.6) were 58.1% female, with a mean disease duration of 13.9 (SD = 10.5) years. Confirmatory factor analysis supported the 5 subscales. The total scale and subscales showed good reliability and significant correlations with self-report symptom and IBD quality of life measures, the HBI, PTI, and PGA. Conclusions The IBDSI showed strong measurement properties: a supported factor structure, very good internal consistency, convergent validity, and excellent sensitivity and specificity to clinician-rated active disease. Self-report HBI and PTI items, when extracted from this measure, produced scores comparable to clinician-administered versions. The 38-item IBDSI, or 26-item short form, can be used as a brief survey of common IBD symptoms in clinic or research settings.

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SYMPERHEART: an intervention to support symptom perception in persons with heart failure and their informal caregiver: a feasibility quasi-experimental study protocol

BMJ Open ◽

10.1136/bmjopen-2021-052208 ◽

2021 ◽

Vol 11 (7) ◽

pp. e052208

Author(s):

Gabrielle Cécile Santos ◽

Maria Liljeroos ◽

Roger Hullin ◽

Kris Denhaerynck ◽

Justine Wicht ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Informal Caregiver ◽

Informal Caregivers ◽

Self Care ◽

Symptom Perception ◽

Convenience Sample ◽

Failure Index ◽

Patient Reported ◽

Quasi Experimental

IntroductionSymptom perception in heart failure (HF) has been identified as crucial for effective self-care, and is related to patient and health system outcomes. There is uncertainty regarding the feasibility and acceptability of symptom perception support and doubts regarding how to include informal caregivers. This study aims to test the feasibility, acceptability and outcome responsiveness of an intervention supporting symptom perception in persons with HF and their informal caregiver.Methods and analysisA feasibility study with a quasi-experimental pretest and post-test single group design is conducted. The convenience sample consists of 30 persons with HF, their informal caregivers and six nurses. SYMPERHEART is an evidence-informed intervention that targets symptom perception by educational and support components. Feasibility is measured by time-to-recruit; time-to-deliver; eligibility rate; intervention delivery fidelity rate. Acceptability is measured by rate of consent, retention rate, treatment acceptability and the engagement in the intervention components. Outcome responsiveness includes: HF self-care (via the Self-care of Heart Failure Index V.7.2); perception of HF symptom burden (via the Heart Failure Somatic Perception Scale V.3); health status (via the Kansas City Cardiomyopathy Questionnaire-12); caregivers’ contribution to HF self-care (via the Caregiver Contribution to Self-Care of Heart Failure Index 2); caregivers’ burden (via the Zarit Burden Interview). Clinical outcomes include HF events, hospitalisation reason and length of hospital stay. Descriptive statistics will be used to report feasibility, acceptability, patient-reported outcomes (PRO) and clinical outcomes. PRO and caregiver-reported outcome responsiveness will be reported with mean absolute change and effect sizes.Ethics and disseminationThe study is conducted according to the Declaration of Helsinki. The Human Research Ethics Committee of the Canton of Vaud, Switzerland, has approved the study. Written informed consent from persons with HF and informal caregivers are obtained. Results will be published via peer reviewed and professional journals, and further disseminated via congresses.Trial registration numberISRCTN18151041.

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