Chapter 16: Patient-reported outcome measures in sports medicine

INTRODUCTION

Sports medicine clinicians likely had their first encounter with patient-reported outcome measures (PROMs) in the research setting, as PROMs are commonly used to capture treatment response. However, PROMs can also be useful in clinical practice. This chapter outlines what PROMs are, why they are important to use in clinical practice and what constitutes a ‘good’ PROM. It also provides examples of generic PROMs to use in sports medicine patients, which can be used to complement more specific measures outlined in the regional chapters. We emphasise that the key letters in the term ‘PROMs’ are the first two—P and R—for ‘patient-reported.’ That is what differentiates PROMs from ‘objective’ clinical measures such as range of motion or strength.

WHAT ARE PROMS?

PROMs are measures in which the patient provides his or her own perspective of a health condition or treatment. This is particularly useful when the aspect of interest is either impossible or impractical to observe directly, such as pain or high-level sporting function.¹ PROMs can be specific for the region (e.g. knee), condition (e.g. tendinopathy) or intervention (e.g. anterior cruciate ligament reconstruction or exercise). The clinician may be familiar with measures such as the IKDC (International Knee Documentation Committee) for knee function, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for osteoarthritis, and the Victorian Institute of Sport Assessment (VISA) score which rates patients who have tendinopathy. All of these are examples of various types of PROMs.

A type of PROM can also provide a generic measure of overall health status (i.e. not ‘disease-specific’).² PROMs can measure a variety of constructs, such as pain, symptoms, physical function and quality of life. An example of a very simple, commonly used PROM in clinical practice is asking the patient to rate their pain severity on a scale from zero to ten—a visual analogue scale (VAS). Contemporary PROMs provide more comprehensive insight into a number of aspects that are important to consider in the patient’s condition.

WHY IS IT IMPORTANT TO USE APPROPRIATE PROMS IN SPORTS MEDICINE?

Clinicians who work in sports and exercise often use standard clinical tests to evaluate physical aspects, such as joint range of motion, ligament integrity and functional performance. While these provide important information about particular aspects of the patient’s condition, they are unable to measure how the patient feels and performs. PROMs complement clinical tests to evaluate the patient’s overall health and performance status more comprehensively.

In sports medicine, PROMs are mostly used to evaluate the effectiveness of treatment. However, they may also:

• focus the clinical appointment toward aspects that most concern the patient (i.e. by asking the patient to complete the PROM prior to the appointment)

• build a profile of the ...