Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study.

BACKGROUND: Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. METHODS: Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. RESULTS: Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. CONCLUSIONS: The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation.

Combining aquatic physiotherapy with usual care physiotherapy for people with neurological conditions: A systematic review.

OBJECTIVE: The objective of this review was to determine whether the combination of aquatic physiotherapy with usual care and results in greater improvements in activity limitations and neurological-related impairments in individuals with neurological conditions than usual care physiotherapy alone. METHODS: A systematic review of controlled trials was utilized to compare usual care physiotherapy with usual care physiotherapy combined with aquatic physiotherapy for adults with any neurological condition. Standardized mean differences and 95% confidence intervals were calculated from postintervention means and standard deviations. RESULTS: Ten trials with a total of 490 participants met the inclusion criteria. Of the included trials, combined aquatic and usual care physiotherapy was evaluated in people with stroke in eight trials and in people with Parkinson's disease in two trials. Trial and outcome heterogeneity prevented the completion of meta-analyses. Data from five trials (n = 259) in people with stroke suggest that aquatic physiotherapy improves measures of balance, walking, mobility, and activities of daily living. No significant differences were detected in measures of activity limitation for people with Parkinson's disease nor measures of impairment for people with stroke or Parkinson's disease. CONCLUSION: This review provides preliminary evidence that the combination of aquatic physiotherapy with usual care physiotherapy may improve activity limitations in people with stroke. This review found no evidence to support the combination of aquatic physiotherapy with usual care physiotherapy to improve activity limitations in Parkinson's disease or other neurological populations. These results should be interpreted with caution due to the mixed quality of the included trials.

Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis.

BACKGROUND: Physiotherapy is a routine component of postoperative management following total knee arthroplasty (TKA). As the demand for surgery increases it is vital that postoperative physiotherapy interventions are effective and efficient. OBJECTIVES: Determine the most beneficial active physiotherapy interventions in acute hospital and inpatient rehabilitation for improving pain, activity, range of motion and reducing length of stay for adults who have undergone TKA. DATA SOURCES: Electronic databases MEDLINE, CINAHL, PUBMED and EMBASE. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials investigating the effect of active physiotherapy interventions in the acute hospital or inpatient rehabilitation setting for adults who have undergone TKA. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias for individual studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Standardised Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Quality of meta-analyses was assessed using the Grades of Research, Assessment, Development and Evaluation approach. RESULTS: Accelerated physiotherapy regimens were effective for reducing acute hospital length of stay (MD -3.50 days, 95% CI -5.70 to -1.30). Technology-assisted physiotherapy did not show any difference for activity (SMD -0.34, 95% CI -0.82 to 0.13). From high quality individual studies pain, activity and range of motion improved with accelerated physiotherapy regimens and activity improved with hydrotherapy. LIMITATIONS: Lack of blinding and small sample sizes across the included trials. CONCLUSION: After TKA, there is low level evidence that accelerated physiotherapy regimens can reduce acute hospital length of stay. Systematic review registration number PROSPERO (Registration number CRD42014013414) http://www.crd.york.ac.uk/PROSPERO.