Exploring Factors in the Systematic Use of Outcome Measures: A Multi-Disciplinary Rehabilitation Team Perspective


Purpose: The implementation of routine outcome measurement was initiated as a quality improvement initiative in a unit delivering intensive functional rehabilitation for people with lower limb amputation. Two years post-implementation, completion rates remained low which raised the need to gain an indepth understanding of the factors that might impact the systematic use of Outcome Measures (OMs). Method: A qualitative exploratory study embedded in the ongoing quality improvement initiative was designed. Data were gathered through a focus group with members of a multidisciplinary rehabilitation team. A deductive content analysis was performed using Consolidated Framework for Implementation Research (CFIR) as a guide to explore factors that impact routine outcome measurement. Results: Respondents perceived OMs as valid and offering clear advantages in clinical practice. At the organizational level, lack of fit with clinical practice, loss of project leaders and lack of clear management directives had negative repercussions on the use of OMs. Conclusion: Our results suggest that a dedicated project leader throughout the implementation process and effective communication may contribute to bypassing barriers associated to practice changes leading to a more systematic use of OMs among clinicians.

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Zidarov, D. and Poissant, L. (2014) Exploring Factors in the Systematic Use of Outcome Measures: A Multi-Disciplinary Rehabilitation Team Perspective. Open Journal of Therapy and Rehabilitation, 2, 86-96. doi: 10.4236/ojtr.2014.22013.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Gallagher, P. (2004) Introduction to the Special Issue on Psychosocial Perspectives on Amputation and Prosthetics. Disability and Rehabilitation, 26, 827-830.
[2] Jelic, M. and Eldar, R. (2003) Rehabilitation Following Major Traumatic Amputation of Lower Limbs—A Review. Critical Reviews in Physical & Rehabilitation Medicine, 15, 235-252.
[3] Kent, R. and Fyfe, N. (1999) Effectiveness of Rehabilitation Following Amputation. Clinical Rehabilitation, 3, 43-50.
[4] Andresen, E.M. and Meyers, A.R. (2000) Health-Related Quality of Life Outcomes Measures. Archives of Physical Medicine and Rehabilitation, 81, S30-S45.
[5] Cella, D. and Nowinski, C. (2002) Measuring Quality of Life in Chronic Illness: The Functional Assessment of Chronic Illness Therapy Measurement System. Archives of Physical Medicine and Rehabilitation, 83, S10-S17.
[6] Condie, E., Scott, H. and Treweek, S. (2006) Lower Limb Prosthetic Outcome Measures: A Review of the Literature 1995 to 2005. Journal of Prosthetics and Orthotics, 18, 13-45.
[7] Deathe, B., Miller, W.C. and Speechley, M. (2002) The Status of Outcome Measurement in Amputee Rehabilitation in Canada. Archives of Physical Medicine and Rehabilitation, 83, 912-918.
[8] Miller, W.C., Deathe, A.B. and Speechley, M. (2001) Lower Extremity Prosthetic Mobility: A Comparison of 3 Self-Report Scales. Archives of Physical Medicine and Rehabilitation, 82, 1432-1440.
[9] Duncan, E.A.S. and Murray, J. (2012) The Barriers and Facilitators to Routine Outcome Measurement by Allied Health Professionals in Practice: A Systematic Review. BMC Health Services Research, 12, 1-15.
[10] Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A. and Lowery, J.C. (2009) Fostering Implementation of Health Services Research Findings into Practice: A Consolidated Framework for Advancing Implementation Science. Implementation Science, 4, 1-15.
[11] Zidarov, D., Swaine, B. and Gauthier-Gagnon, C. (2009) Quality of Life of Persons with Lower Limb Amputation during Rehabilitation and at 3-Month Follow-Up. Archives of Physical Medicine and Rehabilitation, 90, 634-645.
[12] Zidarov, D., Swaine, B. and Gauthier-Gagnon, C. (2009) Life Habits and Prosthetic Profile of Persons with Lower- Limb Amputation during Rehabilitation and at 3-Month Follow-Up. Archives of Physical Medicine and Rehabilitation, 90, 1953-1959.
[13] Fougeyrollas, P. and Noreau, L. (2003) La mesure des habitudes de vie. MHAVIE 3.0. Réseau International sur le Processus de Production du Handicap (RIPPH), Lac St-Charles, Contract No.: ISBN 2-922213-12-9.
[14] Gauthier-Gagnon, C. and Grisé, M.C. (1994) Prosthetic Profile of the Amputee Questionnaire: Validity and Reliability. Archives of Physical Medicine and Rehabilitation, 75, 1309-1314.
[15] Legro, M.W., Reiber, G.D., Smith, D.G., Del Aguila, M., Larsen, J. and Boone, D. (1998) Prosthesis Evaluation Questionnaire for Persons with Lower Limb Amputations: Assessing Prosthesis Related Quality of Life. Archives of Physical Medicine and Rehabilitation, 79, 93-39.
[16] Kitzinger, J. (1995) Introducing Focus Groups. British Medical Journal, 311, 299-302.
[17] Rabiee, F. (2004) Focus-Group Interview and Data Analysis. Proceedings of the Nutrition Society, 63, 655-660.
[18] Elo, S. and Kyngas, H. (2007) The Qualitative Content Analysis Process. Journal of Advanced Nursing, 62, 107-115.
[19] Hsieh, H.F. and Shannon, S. (2005) Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15, 1277-1288.
[20] Jette, D.J., Halbert, J., Iverson, C., Miceli, E. and Shah, P. (2009) Use of Standardised Outcome Measures in Physical Therapist Practice: Perceptions and Applications. Physical Therapy, 89, 125-135.
[21] Swinkels, R.A., van Peppen, R.P.S., Wittink, H., Custers, J.W.H. and Beurskens, A.J. (2011) Current Use and Barriers and Facilitators for Implementation of Standardised Measures in Physical Therapy in the Netherlands. BMC Musculoskeletal Disorders, 12, 106.
[22] Abrams, D., Davidson, M., Harrick, J., Harcourt, P., Zylinski, M. and Clancy, J. (2006) Monitoring the Change: Current Trends in Outcome Measure Usage in Physiotherapy. Manual Therapy, 11, 46-53.
[23] Huijbregts, M.P.J., Myers, A.M., Kay, T.M. and Gavin, T.S. (2002) Systematic Outcome Measurement in Clinical Practice: Challenges Experienced by Physiotherapists. Physiotherapy Canada, 54, 25-36.
[24] Russek, L., Wooden, M., Ekedahl, S. and Bush, A. (1997) Attitudes towards Standardized Data Collection. Physical Therapy, 77, 714-729.
[25] Copeland, J.M., Taylor, W.J. and Dean, S.G. (2008) Factors Influencing the Use of Outcome Measures for Patients with Low Back Pain: A Survey of New Zealand Physical Therapists. Physical Therapy, 88, 1492-1505.
[26] Kay, T.M., Myers, A.M. and Huijbregts, M.P.J. (2001) How Far Have We Come Since 1992? A Comparative Survey of Physiotherapists’ Use of Outcome Measures. Physiotherapy Canada, 53, 268-281.
[27] Hatfield, D.R. and Ogles, B.M. (2007) Why Some Clini-Cians Use Outcomes Measures and Others Do Not. Adminis- tration and Policy in Mental Health and Mental Health Services Research, 34, 283-291.
[28] Swinkels, C.S., van den Ende, C.H.M., de Bakker, D., Van der Wees, P.J., Hart, D.L., Deutscher, D., van den Bosch, W.J.H. and Dekker, J. (2007) Clinical Databases in Physical Therapy. Physiotherapy Theory and Practice, 23, 153-167.
[29] Van Peppen, R.P.S., Maissan, F.J.F., van Genderen, F.R., van Dolder, E. and Meeteren, N.L.U. (2008) Outcome Measures in Physiotherapy Management of Patients with Stroke: A Survey into Self Reported Use, and Barriers to and Facilitators for Use. Physiotherapy Research International, 13, 255-270.
[30] Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P. and Kyriakidou, O. (2004) Diffusion of Innovations in Service Organizations: Systematic Review and Recommandations. Milbank Quarterly, 82, 581-629.

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