Exploring the barriers and enablers to the standardized and routine use of patient-rated outcomes for clients presenting with hand injuries at an Australian public hospital.

Abstract

Background: The utilization of standardized patient-rated outcome measures (PROMs) by hand therapists is essential to evaluate treatment and clinical outcomes and underpins evidence-based and patient-centered practice. However, research indicates that the routine use of PROMs is inconsistent in clinical practice.

Purpose: To explore the barriers and enablers experienced by hand therapists in the routine use of standardized and valid PROMs. Additionally, it aimed to describe appropriate strategies, based on the barriers and enablers identified, to improve the administration of PROMs in hand therapy practice.

Study design: Qualitative.

Methods: Semistructured interviews were used to explore the experiences of hand therapists in routinely using PROMs in clinical practice at two Australian tertiary public hospital hand clinics. Qualitative data were analyzed for themes using reflexive thematic analysis described by Braun and Clarke.

Results: Ten participants were interviewed. Interview findings generated three core themes-Culture is King, It's All Too Hard and When I do it, I value it. The core themes-Culture is King and It's All Too Hard reflected the cultural and institutional factors that present as barriers to the routine uptake of standardized PROMs, such as lack of infrastructure to support data collection and a lack of knowledge of PROMs. The third core theme, "When I do it, I value it" reflects the value and importance of completing PROMs to facilitate evidence-based practice and benefits in tracking treatment progress and providing feedback regarding their progression. Suggested strategies for addressing barriers included using appropriate and standardized methods of collecting and storing PROM data, improving accessibility to PROMs in clinical practice and forming peer education groups and training opportunities.

Conclusions: Hand therapists identify the value and importance of completing PROMs in daily practice; however, culture in the workplace and organizational infrastructure adversely influence the routine use of standardized PROMs by hand therapists.