June 26, 2024 | Judy Holder

7 min read

The Critical Role of Patient-Reported Outcome Measures in Rehab Therapy

By Judith Holder FOTO Analytics Account Executive, Net Health

One of my favorite stories illustrating the critical role patient-reported outcomes play in rehab therapy has to do with climbing stairs.

As nearly any rehab therapist will attest, the ability of a patient to climb stairs safely and successfully is often directly related to her or his ability to live an independent life. Not all homes have stairs, of course, but the world is filled with entryways, curbs, buses, and several other obstacles that require people to step up.

So, when a patient is recovering from injury, surgery, or a medical emergency such as a stroke, regaining the ability to climb stairs is often one of the primary long-term goals a patient may have. This was the case for one patient who surprised her physical therapists when, in a patient-reported questionnaire, stated she looked forward to regaining the ability to climb stairs.

“But you can climb stairs,” the physical therapist responded after reading the comment. “You’ve mastered that ability here in the clinic.”

“Oh, I can climb these stairs,” the patient responded, pointing at the ones in the clinic. “They’re easy. But I live in an old house. The stairs there are steep and narrow, and they’re still very difficult to navigate.”

This is an actual anecdote told to me by one of our Focus On Therapeutic Outcomes (FOTO) clients. It was an ah-ha moment for the physical therapist—a realization that despite all the objective clinical measures clinicians have at their disposals, patients are truly the only ones who can accurately answer the question, “Are you able to do the stuff you want and need to do in your life?”

This is why patient-reported outcome measures exist, and it’s why these measures often supersede clinical outcomes when evaluating the value and success in rehab therapy treatments.

Patient-Reported Outcome Measures (PROMS) in Rehab Therapy

Patient-reported outcome measures (PROMs) are evaluation tools used in medical settings, including rehab therapy, that capture a patient’s perspective on their health, functional status, and treatment experience.

Presented to patients and self-reported questionnaires—sometimes via pen and paper, but most often through computer-adaptive testing (CAT)—PROMs provide physical therapists, occupational therapists, and speech-language pathologists with data regarding a patient’s symptoms, functionality, quality of life, and overall satisfaction.

There are many key ways that patient-reported outcome measures play a crucial role in rehab therapy.

Fostering Patient Communication and Engagement

Just the act of regularly collecting patient-reported outcome measures opens important streams of dialogue between rehab therapists and their patients, ensuring both sides are on the same page and working toward common goals.

In addition, learning what activities are most important to patients allows providers to establish clinical goals that are more meaningful to patients. This helps ensure patient buy-in to specific plans of care, increasing the likelihood they will show up to future appointments and comply with home exercise programs.

Such conversations can further help uncover issues unrelated to physiology, but which may prevent certain patients from achieving positive outcomes through rehab therapy. Fear avoidance, for instance, can be difficult to detect despite having the power to keep patients from performing important activities of daily living.

Improving Clinical Decision-Making

It’s one thing to know how far a patient can bend his knee. It’s another thing altogether to know if he can walk down the street, safely ascend a set of stairs, or get in and out of his car. PROMs help in revealing the real success or failure of a treatment plan. By regularly collecting this data from the patient, rehab therapy providers can know when the patient’s on the right treatment path or if a new or alternative treatment would be more effective.

So, instead of getting to the finish line and discovering the patient is unable to accomplish what they set out to accomplish, PROMs alert rehab therapists that it may be time to tweak the treatment plan.

Supporting Value-Based Care

In the context of payment models where providers are rewarded for achieving positive patient outcomes, PROMs can help demonstrate the value or impact of a specific therapeutic intervention.

Medicare’s Merit-based Incentive Payment System (MIPS) primarily uses patient-reported outcomes to assess the quality and effectiveness of rehab therapy services, which can impact reimbursement adjustments for those rehab therapy providers who participate in MIPS.

Patient-reported outcomes are used as measures within the Quality category under MIPS, for example, capturing patients’ perspectives on their own health and the quality of the care they receive. This may involve assessments around pain levels, functional status, or overall well-being.

In addition, engaging patients in their care through the collection and use of PROMs is recognized as an improvement activity, allowing rehab therapist to use the data collected to track progress and inform care plans.

Providing Patient-Centered Care

Placing risk-adjusted PROM data directly into the hands of providers, who then share that information with patients and families during the rehab therapy visit, embodies the very definition of patient-centeredness.

This patient-centered approach is strongly advocated by the National Quality Forum, which operates around the philosophy that such an approach results in optimal patient accountability and success. In addition, the use of PROMs is recommended in clinical practice guidelines as a standard component of evaluation and management for multiple provider types, including physical therapists.

Are You Using PROMs Effectively in Your Rehab Therapy Clinic?

Providing a means for patients to share their views on their symptoms, levels of satisfaction, and their feedback on how conditions and treatments are impacting their overall well-being is only half the battle. The rest is using this data to effectively improve the care provided at your clinic.

How do you know if you are using PROMs effectively? Start by asking yourself the following questions.

Once I’ve Collected PROM Data, What Do I Do with It?

Do you collect the data and just note the results in the patient’s chart? Do you use the information to guild informed changes to their plan of care? Do findings lead to engaging discussions with your patients? To get the most of our PROMs, it’s not enough to just collect the data. Have a plan in place to utilize your findings to improve not just the plan of care, but the overall patient experience.

Do I Know if My Patients Can Do the Activities that Are Important to Them?

Clinical outcome measures will typically indicate improved strength, flexibility, range of motion, and more, but these are only partial measures of success. To fully understand if treatments are working, rehab therapists must fully understand the goals of their patients. Collecting patient-reported outcome measures is the ideal time to discuss not only their wellness goals, but what they envision as their ideal rehab therapy outcomes.

Are Patients Generally Satisfied with My Services?

If so, this is typically a reflection of achieving positive outcomes not just in a clinical sense, but as they relate to the lives of your patients. High satisfaction rates may also indicate that patient-reported outcome measures were not just collected, but appropriately applied to engage patients while developing more personalized care plans.

PROMS Give Patients a Voice

Ultimately, the power of PROMs lies in their ability to bring the patient’s voice into the center of the rehab therapy experience. By leveraging these measures, therapists can better align their treatment plans with the real-life needs and goals of their patients, creating a more personalized and effective therapeutic experience.

This patient-centric approach not only fosters better communication and engagement but also ensures that the therapy provided is genuinely improving the patient’s ability to navigate their daily environment.

As healthcare continues to evolve toward value-based care models, it’s difficult to overstate the importance of PROMs. These measures provide tangible evidence of treatment effectiveness from the patient’s perspective, which is crucial for demonstrating value in a system that rewards positive patient outcomes.

By actively incorporating PROMs into their practice, outpatient rehab therapists can not only enhance patient satisfaction and outcomes but also position themselves as leaders in delivering high-quality, patient-centered care.

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