Patient reported outcome measures (PROM) in chiropractic practice in Australia: Can targeted education designed to enhance knowledge and understanding, promote clinical behaviour change and result in increased PROM utilisation

Patient reported outcome measures (PROMs) are commonly utilised in clinical practice within healthcare and are considered an effective tool for communication between clinician and patient. Patient reported outcome measures are defined as any report of the status of a patient’s health condition that comes directly from the patient. The aims of this research project were: (i) to identify the most commonly cited PROMs for low back pain (LBP) within the chiropractic literature; (ii) to establish the current utilisation of PROMs for LBP amongst chiropractors in Australia and to identify the potential barriers and facilitators for use; (iii) to evaluate factors that are associated with utilisation of PROMs in chiropractic practice; and (iv) using the New World Kirkpatrick Model (NWKM), to determine whether an education package intervention increases chiropractors’ knowledge, modifies attitudes and beliefs and creates clinical behaviour change (v) to determine whether knowledge to action (KTA) was an appropriate framework for educating the chiropractic profession regarding PROMs. A systematic narrative review was conducted to determine the most commonly cited PROMs for LBP within the chiropractic literature. The review identified 144 articles and 75 different PROMs. The four most cited PROMs were the Oswestry Disability Index, Numeric Rating Scale, Visual Analogue Scale and Roland Morris Questionnaire. The cohort surveys determined the current utilisation of PROMs for LBP amongst chiropractors in Australia, identified barriers and facilitators for clinical use, and reported chiropractors’ knowledge, understanding, beliefs and utilisation of PROMs. Cohort survey 1 included 558 participants and found that the LBP PROM utilisation rate in clinical practice was 72.5%. The second cohort survey, consisted of three online surveys (2a, 2b and 2c) and the delivery of an educational package intervention. The education intervention was evaluated using the NWKM. This model established that the reaction to the education package was very positive with a mean response scores (1–5 Likert scale) for the reaction questions ranged from 3.75 to 4.43. There was a small, but significant, increase in knowledge (score out of 32) at four weeks (27.2 ± 5.5) and 12 weeks after receiving the education package (27.4 ± 5.1), when compared to baseline scores (24.2 ± 6.1). Additionally, there was a small and significant (p<0.05) increase in utilisation of health-related PROMs 12 weeks after the intervention. While there was a small improvement in PROM knowledge, the utilisation of other PROMs did not change. The survey revealed that the main barriers to PROM use were a lack of understanding/knowledge of PROMs, which PROMs to use, how to use them and the perception of PROMs being time consuming to apply and score. The predictive factor which increased PROM utilisation in chiropractic practices was their use by principal chiropractors (Wald = 4.101, p = 0.04, OR = 1.4 (1.0–2.1)) compared to associate chiropractors. Other demographic factors and the perceived value clinicians placed on PROMs were not associated with the frequency of usage. The research suggested the KTA framework was a useful guide to translating knowledge of PROMs into clinical practice. This research is considered important and resulted in multiple original contributions to knowledge in the field of PROMs. Creating a unique list of the most frequently cited PROMs for LBP in the chiropractic literature provides information which had not previously been established. The longitudinal surveys established the most commonly utilised PROMs for LBP, the current knowledge, beliefs and attitudes regarding PROMs and barriers and facilitators to their clinical use. An additional finding determined that being a principal chiropractor was associated with an increase in the utilisation of PROMs. The education package intervention was well received by the target audience and improved PROM knowledge amongst the participants. Finally, the KTA framework was useful to identify gaps in PROM literature and clinicians’ knowledge and uncovering operational issues when translating research into clinical practice. These factors had not previously been investigated within the chiropractic profession of Australia and therefore add unique value to the chiropractic research space.