Barriers and Facilitators to Routine Outcome Measurement

This review aimed to address the question: what are the barriers and facilitators to routine outcome measurement by allied health professionals in practice? Few studies define what they mean by routine outcome measurement in practice. This study adopts Colquhoun and colleagues’ [7 (link)] recent definition of routine outcome measurement as: “the systematic use of a standardised outcome measure(s) in clinical practice with every patient as a part of a standardised assessment practice guideline” (p.49). Outcome measures can be completed by either the patient or a therapist. This study includes both. A systematic literature review was conducted using an explicit search strategy to retrieve relevant publications. The review’s methods, search strategy and inclusion criteria used to identify relevant papers conform to established systematic review procedures [16 ]. No restrictions on professional group were applied at this stage in order to maximise the search’s sensitivity. As the identified literature was heterogeneous, a modified narrative synthesis [17 ] framework for mixed-methods reviews was applied during the quality appraisal, data extraction, analysis, and synthesis stages. The search strategy involved electronic searches of the electronic bibliographic databases MEDLINE (1966–2010), PsycINFO (1967–2010), and CINHAL (1982–2010) for published work. The search strategy comprised of two search filters: ‘outcome measures’ and ‘facilitators and barriers’. The ‘outcome measures’ search filter was adapted from the published search strategy of Gilbody, House and Sheldon (pp.91-96) [18 ] who investigated outcome measurement in psychiatric research and practice. The ‘facilitators and barriers’ search filter was developed in a series of iterations by both authors. The search strategy filters comprised relevant terms and synonyms combined with the BOOLEAN operator “OR” and were then combined using the BOOLEAN operator “AND”. Detailed information on the search terms can be consulted in Additional file 1. Additional papers were sought by hand searching the reference lists of papers which were included in the review. Retrieved papers were included if a) they were concerned with identifying or researching factors which acted as facilitators and/or barriers in the routine use of outcome measures by allied health professionals in practice; and b) were published in English. No restrictions on year of publication, type of outcome measurement, study design or publication type were applied. Papers were excluded if a) the topic covered was not of direct relevance (e.g., validating or standardizing an outcome measure, whereby the perceived facilitators would be largely theoretical and applicable to the trial of the particular measure alone); b) the sample was not clearly defined (e.g., where only a general term such as ‘clinicians’ was used); or c) if the sample was not composed wholly of allied health professionals, those being: arts therapists, chiropodists, podiatrists, dietitians, occupational therapists, orthoptists, physiotherapists, prosthetists, orthotists, radiographers, speech and language therapists.
Included papers were first categorised into six mutually exclusive domains [19 (link)]: quantitative research; qualitative research; mixed methods research; conceptual paper; opinion or literature review; practice based project or audit. Within each of these categories, the quality of each paper was assessed by one of the authors using a descriptive checklist based on the Centre for Reviews Dissemination and Research [16 ]. Quality appraisal was checked and confirmed by the other author and any differences were resolved following discussion.
Following published thematic analysis guidelines [20 (link)] and narrative analysis guidance [17 ], key factors were identified and extracted from each paper into a summary table by one of the authors (JM). Factors were then compared with each other to identify higher level themes. Themes were composed of factors that had occurred in several papers and/or mirrored themes already found in the general literature about barriers and facilitators to ROM. Themes were refined and synthesized through critical discussion between the authors until an agreement on the final themes was consensually reached.
Paper inclusion, quality appraisal, data extraction and data synthesis were undertaken by one of the authors (JM). JM identified 14 papers (of the final 15 included) to be included in the review. Of these 14, five were randomly selected [7 (link),21 (link)-24 (link)] to blindly assessed for match on emerging themes by the other author (ED). Agreement was 100%. Of the remaining papers (not included in the review), a sample of 11 were blindly assessed for inclusion/exclusion. Of these, six were elected for possible inclusion by JM based on sample or possible suitability to the review’s aims. The other five papers were selected at random. Of the five random papers, agreement for exclusion from the review was 100% between the authors. Of the six papers selected for possible inclusion, following discussion, both authors agreed that one of the papers [9 ] fit the review’s requirements for inclusion. While agreements on papers were clearly high, any disagreements were resolved through discussion and clarification.