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Research Article| Volume 35, ISSUE 2, P233-244, April 2022

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Pediatric hand therapists’ experiences with outcomes measurement: An interpretive descriptive study

Published:April 10, 2022DOI:https://doi.org/10.1016/j.jht.2022.01.009

      Highlights

      • A gold standard patient reported outcome measure (PROM) for pediatric hand therapy practice is lacking.
      • While barriers to PROM utilization exist, pediatric hand therapists attribute value to using PROMs.
      • Design characteristics for a PROM applicable to a pediatric hand therapy population are elucidated.

      Abstract

      Background

      Demonstrating that pediatric hand therapy patients are achieving improved functional and health status outcomes is critical as reimbursement for therapy services shifts to value-based reimbursement. Yet, practice patterns of outcomes assessment in pediatric hand therapy are unknown.

      Purpose

      Explore how pediatric hand therapists describe their experience measuring treatment outcomes and using patient reported outcome measures (PROMs). Secondarily, to elucidate what therapists perceive children and adolescents receiving hand therapy desire as treatment outcomes.

      Study Design

      Interpretive descriptive qualitative study

      Methods

      Pediatric hand therapists were recruited through an email invitation sent to members of the Pediatric Hand Study Group to participate in one-on-one interviews over a teleconference link. Interviews were transcribed verbatim and coded to derive themes. Data collection and analysis were iterative.

      Results

      Ten therapists with a median 13 years (range, 2-25 years) of experience practicing in pediatric hand therapy completed interviews. Overall, participants reported using 52 unique outcomes measures, including 20 PROMs. The following themes were elucidated: (1) Complexity and variability in pediatric hand therapy practice and outcomes assessment; (2) Barriers to PROM use; (3) Value of PROM utilization; (4) Desired characteristics of an optimal PROM for pediatric hand therapy.

      Conclusion

      Practice with outcomes assessment is variable. PROM utilization in pediatric hand therapy practice may be improved with the development of a PROM that is aligned with the pediatric population's outcomes priorities.

      Keywords

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      References

      1. Association AOT. Reimbursement changes: what's happening, how will it affect you, and what AOTA is doing about it? Accessed April 10, 2021, 2021. https://www.aota.org/Publications-News/otp/Archive/2019/Reimbursement-Changes.aspx.

        • Leland NE
        • Crum K
        • Phipps S
        • Roberts P
        • Gage B.
        Advancing the value and quality of occupational therapy in health service delivery.
        Am J Occup Ther. 2015; 69: 1-7
        • Takata SC
        • Wade ET
        • Roll SC.
        Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: a mapping review linking research to practice.
        J Hand Ther. 2019; 32: 1-9https://doi.org/10.1016/j.jht.2017.05.018
        • Rose BW
        • Kasch MC
        • Aaron DH
        • Stegink-Jansen CW.
        Does hand therapy literature incorporate the holistic view of health and function promoted by the World Health Organization?.
        J Hand Ther. 2011; 24: 84-88
        • Weinstock-Zlotnick G
        • Bear-Lehman J.
        How therapists specializing in hand therapy evaluate the ability of patients to participate in their daily lives: an exploratory study.
        J Hand Ther. 2015; 28: 261-268
        • Amadio PC.
        Outcome assessment in hand surgery and hand therapy: an update.
        J Hand Ther. 2001; 14: 63-67
        • Robinson LS
        • Brown T
        • O'Brien L
        Embracing an occupational perspective: occupation-based interventions in hand therapy practice.
        Aust Occup Ther J. 2016; 63: 293-296
        • Squitieri L
        • Bozic KJ
        • Pusic AL.
        The role of patient-reported outcome measures in value-based payment reform.
        Value Health. 2017; 20: 834-836
        • Valdes K
        • MacDermid J
        • Algar L
        Hand therapist use of patient report outcome (PRO) in practice: a survey study.
        . 2014; 27: 299-308
        • Truong WH
        • Price MJ
        • Agarwal KN
        • et al.
        Utilization of a wide Array of nonvalidated outcome scales in pediatric orthopaedic publications: can't we all measure the same thing?.
        J Pediatr Orthop. 2019; 39: e153-e158
        • Phillips L
        • Carsen S
        • Vasireddi A
        • Mulpuri K.
        Use of patient-reported outcome measures in pediatric orthopaedic literature.
        J Pediatr Orthop. 2018; 38: 393-397
      2. Weldring T, Smith S. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMS) Health Services Insights. 2013; 6: 61–68. doi:10.4137/HSI. S11093[PMC free article][PubMed][Cross Ref]. 2013 2013.

        • Bartlett SJ
        • Ahmed S.
        Montreal accord on Patient-Reported Outcomes (PROs) use series - Paper 1: introduction.
        J Clin Epidemiol. Sep 2017; 89: 114-118https://doi.org/10.1016/j.jclinepi.2017.04.012
        • Bele S
        • Chugh A
        • Mohamed B
        • Teela L
        • Haverman L
        • Santana MJ.
        Patient-reported outcome measures in routine pediatric clinical care: a systematic review.
        Front Pediatr. 2020; 8: 364
        • Chen J
        • Ou L
        • Hollis SJ.
        A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting.
        BMC Health Serv Res. 2013; 13: 1-24
        • Noonan VK
        • Lyddiatt A
        • Ware P
        • et al.
        Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management.
        J Clin Epidemiol. 2017; 89: 125-135https://doi.org/10.1016/j.jclinepi.2017.04.017
        • Velikova G
        • Booth L
        • Smith AB
        • et al.
        Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial.
        J Clin Oncol. 2004; 22: 714-724
        • Jack J
        • Estes RI.
        Documenting progress: hand therapy treatment shift from biomechanical to occupational adaptation.
        Am J Occup Ther. 2010; 64: 82-87
        • Enemark Larsen A
        • Carlsson G
        Utility of the Canadian Occupational Performance Measure as an admission and outcome measure in interdisciplinary community-based geriatric rehabilitation.
        Scand J of Occup Ther. 2012; 19: 204-213
        • Lee Y
        • McCormick B.
        Constraints of outcome measurement perceived by recreational therapists in physical medicine and rehabilitation.
        Annu Ther Recreation. 2002; 11: 1-10
        • Skeat J
        • Perry A.
        Exploring the implementation and use of outcome measurement in practice: a qualitative study.
        Int J Lang Commun Disord. 2008; 43: 110-125
        • Briggs MS
        • Rethman KK
        • Crookes J
        • et al.
        Implementing patient-reported outcome measures in outpatient rehabilitation settings: a systematic review of facilitators and barriers using the consolidated framework for implementation research.
        Arch Phys Med Rehabil. 2020; 101: 1796-1812
        • Greenberg KK
        • Schwartz AE
        • Kramer JM.
        Adoption of patient-reported outcome measures with youth with intellectual/developmental disabilities: Contextual influences and practice patterns.
        Child Care Health Dev. 2021; : 501-508
        • Hunt MR.
        Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work.
        Qual Health Res. 2009; 19: 1284-1292
        • Etikan I
        • Musa SA
        • Alkassim RS.
        Comparison of convenience sampling and purposive sampling.
        Am J Theor App Stat. 2016; 5: 1-4
      3. The Pediatric Hand Study Group. Accessed April 11, 2021. https://pediatrichandstudygroup.org/.

        • Watt D.
        On becoming a qualitative researcher: the value of reflexivity.
        Qual Rep. 2007; 12: 82-101
        • Creswell JW
        • Creswell JD.
        Research Design: Qualitative, Quantitative, and Mixed Methods Approaches.
        Sage publications, 2017
        • Graneheim UH
        • Lundman B.
        Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.
        Nurse Educ Today. 2004; 24: 105-112
      4. HealthMeasures transforming how health is measured. Updated 2021. Accessed April 11, 2021. https://www.healthmeasures.net/.

        • Law M
        • Baptiste S
        • McColl M
        • Opzoomer A
        • Polatajko H
        • Pollock N.
        The Canadian occupational performance measure: an outcome measure for occupational therapy.
        Can J Occup Ther. 1990; 57: 82-87
        • Hudak PL
        • Amadio PC
        • Bombardier C
        • et al.
        Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head).
        Am J Ind Med. 1996; 29: 602-608
        • Hefford C
        • Abbott JH
        • Arnold R
        • Baxter GD.
        The patient-specific functional scale: validity, reliability, and responsiveness in patients with upper extremity musculoskeletal problems.
        J Orthop Sports Phys Ther. 2012; 42: 56-65
        • Philpot LM
        • Barnes SA
        • Brown RM
        • et al.
        Barriers and benefits to the use of patient-reported outcome measures in routine clinical care: a qualitative study.
        Am J Med Qual. 2018; 33: 359-364
        • Boyce MB
        • Browne JP
        • Greenhalgh J.
        The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research.
        BMJ Qual Saf. 2014; 23: 508-518
        • Duncan EA
        • Murray J.
        The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review.
        BMC Health Serv Res. 2012; 12: 1-9
        • Kotronoulas G
        • Kearney N
        • Maguire R
        • et al.
        What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials.
        J Clin Oncol. 2014; 32: 1480-1510
        • Valier ARS
        • Jennings AL
        • Parsons JT
        • Vela LI.
        Benefits of and barriers to using patient-rated outcome measures in athletic training.
        J Athl Train. 2014; 49: 674-683
        • Sheffler LC
        • Hanley C
        • Bagley A
        • Molitor F
        • James MA.
        Comparison of self-reports and parent proxy-reports of function and quality of life of children with below-the-elbow deficiency.
        JBJS. 2009; 91: 2852-2859
        • Keeney T
        • Kumar A
        • Erler KS
        • Karmarkar AM.
        Making the case for patient-reported outcome measures in big-data rehabilitation research: implications for optimizing patient-centered care.
        Arch Phys Med Rehabil. 2021; : 1-6
        • Dorich JM
        • Cornwall R.
        A psychometric comparison of patient-reported outcome measures used in pediatric hand therapy.
        J Hand Ther. 2019; 33: 477-483
        • Wall LB
        • Vuillermin C
        • Miller PE
        • Bae DS
        • Goldfarb CA.
        Convergent validity of PODCI and PROMIS domains in congenital upper limb anomalies.
        J Hand Surg [Am]. 2019; https://doi.org/10.1016/j.jhsa.2019.08.003
      5. Who is a Certified Hand Therapist (CHT)? Accessed April 11, 2021. https://www.htcc.org/consumer-information/the-cht-credential/who-is-a-cht.

      JHT Read for Credit

      Quiz: # 854

      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 JHTReadforCredit.com. There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
          prospective cohort
        • b.
          RCTs
        • c.
          qualitative
        • d.
          case series
      • # 2.
        Interviews were conducted with
        • a.
          pediatric hand therapists
        • b.
          pediatric patients
        • c.
          the parents of pediatric patients
        • d.
          social workers of pediatric patients
      • # 3.
        Of the 10 interviewees
        • a.
          2 were uncooperative during their interviews
        • b.
          none of the 10 worked in clinics requiring the use of PROMs
        • c.
          all 10 worked in clinics requiring the use of PROMs
        • d.
          4 worked in clinics requiring the use of PROMs
      • # 4.
        A commonly cited barrier to PROM utilization was
        • a.
          institutional standards of care
        • b.
          pressure from colleagues
        • c.
          time constraints
        • d.
          resistance by management
      • # 5.
        A better more responsive PROM for the younger patient population is envisioned by the authors
        • a.
          false
        • b.
          true
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.