Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

Abstract

Objective: To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs.

Design: Online survey.

Participants: Surgeons who are members of the AO Foundation.

Measures: Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ² tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage.

Results: 1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine.

Conclusions: Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.

Keywords: adult orthopaedics; public health.

Figure 1

Scree plot showing the variance in the data (eigenvalues) of the explorative factor analysis for surgeons who used patient-reported outcome measures (PROM) in their daily routine. The line until factor 4 shows the four of 10 components with an eigenvalue >1 which were included in the explorative factor analysis. The first four factors accounted for 66% of the total cumulative variance.

Figure 2

Factor analysis path diagram displaying the variance of agreement/disagreement for each statement (why patient-reported outcome measures (PROM) are used in clinical routine) explained by the different factors. Factor 1: quality of care, factor 2: measurement of outcomes, factor 3: regulations, factor 4: limitations of PROMs.

Figure 3

Scree plot showing the variance in the data (eigenvalues) of the explorative factor analysis for surgeons who did not use patient-reported outcome measures (PROM) in their daily routine. The line until factor 2 shows the two of seven components with an eigenvalue >1 which were included in the explorative factor analysis. The first two factors accounted for 51% of the total cumulative variance.

Figure 4

Factor analysis path diagram displaying the variance of agreement/disagreement for each statement (why patient-reported outcome measures (PROM) are not used in clinical routine) explained by the different factors. Factor 1: overall assessment of PROMs, factor 2: institutional responses in regard to PROMs.