Scientific/Clinical Article| Volume 30, ISSUE 4, P516-521, October 2017

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The relationship between therapist–rated function and patient-reported outcome measures

Published:November 29, 2016DOI:


      Study Design

      Prospective cohort study.


      Some third-party payers require hand therapists to rate patient's functional disability based on patient self-rating using patient-reported outcome measures (PROMs), objective measurements of impairment, and observation of functional tasks—hand therapist–rated function (HTRF).

      Purpose of the Study

      To test the correlation between HTRF and PROMs (upper limb functional index [ULFI] and Patient-Reported Outcomes Measurement Information System upper extremity [PROMIS UE]) and its association with psychological factors.


      In 2014, 100 new patients with upper extremity illness presenting to hand therapists were asked to participate in an observational cross-sectional study. Demographic-, condition-related, and psychological factors were obtained in addition to PROMs and HTRF.


      HTRF correlated moderately with PROMIS UE (r = −0.49, P < .001) and ULFI (r = −0.56, P < .001). Correlation between PROMIS UE and ULFI was strong (r = 0.78, P < .001). Psychological factors explained most of the variations in both HTRF and PROMs.


      Hand therapists' ratings of patient function correlate less strongly with PROMs than PROMs correlate with one other. The discrepancy between HTRF and PROMs may offer an opportunity to address stress, distress, or ineffective coping strategies that can interfere with recovery—an opportunity for therapists and patients to collaborate and develop goals and for future research to develop effective and feasible strategies for hand therapists.

      Level of Evidence

      Level II, diagnostic study.


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      JHT Read for Credit

      Quiz: #513

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The demand for PRO measures has increasingly been driven by
        • a.
          institutional peer review committees
        • b.
          hand therapists
        • c.
          hand surgeons
        • d.
          third party payers
      • #2.
        The study's primary purpose was to determine the
        • a.
          relationship between perceived patient results by therapists and surgeons
        • b.
          optimal number of post op therapy visits for specific surgical procedures
        • c.
          correlation between therapists' opinions regarding patients' results and patients' opinions of their results
        • d.
          correlation between PROs and standardized functional tests
      • #3.
        The study design is
        • a.
          prospective cohort
        • b.
        • c.
          a case series
        • d.
      • #4.
        The authors suggest their results provide evidence for an opportunity for
        • a.
          surgeons, therapists, and patients to set treatment goals together
        • b.
          therapists and patients to do a better job of collaborating in crafting goals for therapy
        • c.
          third party payer reps to play an active role in setting pre-treatment goals
        • d.
          home care givers to consult with therapists in establishing treatment plans
      • #5.
        The study consistently demonstrated a strong agreement between patients and therapists when evaluating outcomes
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.