Patient‐reported outcome measures in advanced musculoskeletal physiotherapy practice: a systematic review

Objective

Advanced practice physiotherapists (APPs), also known as extended scope physiotherapists, provide a new model of service delivery for musculoskeletal (MSK) disorders. Research to date has largely focused on health service efficiencies, with less emphasis on patient outcomes. The present systematic review aimed to identify the patient‐reported outcome measures (PROMs) being utilized by APPs.

Method

A wide search strategy was employed, including the PubMed, Embase, CINAHL, CENTRAL and PEDro databases, to identify studies relating to PROMs utilized by APPs in MSK healthcare settings. PROMs identified were classified into predetermined outcome domains, with additional contextual data extracted.

Results

Of the initial 12,302 studies, 38 met the inclusion criteria. These involved APPs across different settings, utilizing 72 different PROMs and most commonly capturing: Patient Satisfaction, Quality of Life (QoL), Functional Status, and Pain; and, less frequently: Global Status (i.e. overall improvement), Psychological Well‐Being, Work ability, and Healthcare Consumption and Costs. The quality of the PROMs varied greatly, with Satisfaction most commonly measured utilizing non‐standardized locally‐devised tools; the EuroQol five‐dimensions questionnaire (EuroQoL‐5D) and 36‐Item Short‐Form (SF‐36) cited most frequently to capture QoL; and the Visual Analogue Scale (VAS) to capture Pain. No key measure was identified to capture Functional Status, with 15 different tools utilized.

Conclusion

APPs utilized a multiplicity of PROMs across a range of MSK disorders. The present review will act as an important resource, informing the selection of outcomes for MSK disorders, with a view to greater standardization of outcome measurement in MSK clinical practice, service evaluation and research.     

The additive miotic effects of dapiprazole and pilocarpine

Background: Since dapiprazole on alpha-adrenergic agent, produces miosis by paralyzing the dilator muscle, and pilocarpine, a parasympathetic drug, causes miosis by affecting the sphincter, we speculated that the two drugs might have additive effects. Methods: The additive miotic actions of pilocarpine 2% and dapiprazole 0.5% were evaluated by comparing the effects of two drugs given together and alone on the reversal of mydriasis induced by tropicamide (0.5%) and phenylephrine (10%) in one eye each of 60 healthy volunteers. Results: Dapiprazole and pilocarpine together induced miosis significantly faster than each drug alone, showing additive effects. Conclusion: Co-administration of dapiprazole and pilocarpine at the end of the eye examination will induce fast pupillary constriction, which might be useful in preventing the development of an acute attack of angle-closure glaucoma in patients with anatomically narrow angles.     

The effect of injecting botulinum toxin type a into the calf muscles on freezing of gait in Parkinson's disease: a double blind placebo-controlled pilot study.

OBJECTIVE: To assess the effect on freezing of gait (FOG) of botulinum toxin type A (BTX-A) injections in advanced Parkinson's disease (PD) patients. METHOD: BTX-A 150 IU or normal saline was injected into each leg's calf muscles by a blinded investigator. FOG severity was assessed at set intervals (6-month follow-up). RESULTS: Eleven age- and disease severity-matched PD patients with disabling FOG participated. Six patients received BTX-A and 5 received saline. No improvement was observed in either group over time. Leg weakness and falls lead to early termination. CONCLUSION: BTX-A injections to the legs did not improve FOG and might increase fall risk.     

Effect of state Medicaid reimbursement rates on hospitalizations from nursing homes

OBJECTIVES: To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents. DESIGN: Cross-sectional sample of nongovernment-owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993, with 6 months follow-up on mortality and hospitalizations. SETTING: Two hundred fifty-three nursing homes. PARTICIPANTS: Eight to 16 randomly selected residents from each facility, totaling 2,080. MEASUREMENTS: Minimum Data Set assessments conducted by research nurses at baseline. A three-category 6-month outcome was defined as (1) any hospitalization; for those not hospitalized, (2) death versus (3) alive in the facility. RESULTS: Using multinomial logistic regression, adjusted to survey design, controlling for resident and facility characteristics, a 10 dollar increase in 1993 Medicaid reimbursement rate above the mean rate of approximately 75 dollars resulted in a 9% reduction in a resident's risk of hospitalization (P<.05). CONCLUSION: State Medicaid reimbursement rates appear to affect clinical decisions regarding the need for hospital admission and thresholds for nursing home use. The findings from this study reemphasize the importance of properly aligning state Medicaid and federal Medicare long-term care policies because, currently, states have no incentive to increase reimbursement rates to avoid hospitalization.