Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Miranda Materi, and we are Hand Therapy Academy.
josh MacDonald: So I just got back from the ASHT conference in St. Louis. And one of the things that came up a couple of different times was patient reported outcome measures, PROMs. And I always get it confused with pass the range of motion when it's, whenever I'm reading it or listening to someone say prom. So, um, but, but they talked about all these different like little research vignettes that they covered all these little things in the conference. And they were talking about lots and lots and lots of different kinds.
josh MacDonald: of patient -reported outcome measures that they use for all these different diagnoses. And some of them were for burn patients, and some were for wrists, and some were for a carpal tunnel. So wanted to touch base a little bit on that. Miranda, what do you use as a patient -reported outcome measure in your clinics?
Miranda Materi: We definitely always use the quick dash and we don't usually get too far from do anything else. Bye -bye.
josh MacDonald: okay We are pretty much the same. We're using the QuickDash for pretty much everybody. There are some patients, we see some kiddos, and so there's just not a good patient -reported outcome measure for them. There's too much variability. There's a couple of tests you can use, um but yeah, we're pretty much using the QuickDash for everybody.
Miranda Materi: I think it's too because that's what a lot of like our insurance companies are requiring, right? Like, um so it's kind of just part of our like standard of care and standard of practice. And there are times where we're like, well, I think we need to do another outcome measure because this isn't really capturing what we're trying to capture. But I would say that is pretty rare where we'll utilize that or where someone on our team will pull up something different. It doesn't happen that often. And I think another limitation is we have to change um we'd have to enter in extra documentation stuff, right?
Miranda Materi: So when you're in a busy outpatient clinic and you try to find another assessment and it's not within your documentation system, what are you doing?
josh MacDonald: Yeah.
josh MacDonald: Yeah, yeah. and And in a world where we're trying to streamline as many things as possible to be as efficient as possible, it just adds layers to it. Sometimes it's ah it's helpful. It gives you good information. Sometimes I think the QuickDash lacks some things, but it gives us a quick measure that insurance companies know and reference, and we're all speaking the same language.
Miranda Materi: right and then they say oh you I think it's like nine point something or ten point something if you have a ten point change on their scale it means that they've made significant improvements right so they say oh that's good job you guys you're doing a great job in therapy and if you don't then you're like well we didn't quite make as much of a change as we needed to and so I think that is
josh MacDonald: Yeah.
Miranda Materi: oh A good thing, but also a limitation if your patients aren't scoring it or they're having a bad day, I feel like they might score it a little differently. So when you're doing it, and I know you're not supposed to, do you do any coaching?
josh MacDonald: We have the same script we give everybody every time. And I think it might be slightly off of the standardized script you're supposed to give people, but we say fill out these 11 questions.
josh MacDonald: Take your whole body into account. and answer as if you're just trying to, like, don't overthink it, just answer the questions as if I gave you a hard, difficult container to open, or if I gave you something to carry, just take it at face value. Because so many people want to like, well, I can't carry something with my left hand because it's fractured. And then, well, but I'm right -handed, so that doesn't, does it matter? And people get caught up in that. So I just try to like, don't overthink it. Could you carry a suitcase kind of thing?
Miranda Materi: Yeah, I know that's a a hard one, right? Because then they'll get really detailed or they'll write in notes on it.
josh MacDonald: and not circle anything, just write in a narrative explanation. Yeah, yeah.
Miranda Materi: a i Okay, we gotta put it in a score for this one.
josh MacDonald: Yeah, and i'm I would love to have more detail that came with the full dash, but gosh, some of our patients take so long to fill out the 11 question quick dash. I can't imagine giving them the two or three times as many questions to fill out.
josh MacDonald: It would take forever on intake.
Miranda Materi: Right, it would take forever. And I mean, I have done it before too, where I'm like, oh, you go, you can do this in the lobby before your appointment or something, but it does take more significantly more time.
josh MacDonald: Yeah, one of the limitations, ah first of all, we also pretty much don't use any other outcome measures, just that one. One of the limitations I feel like patient recorded outcome outcome measures have across the board is that when you fill them out on intake,
josh MacDonald: your scope, your frame of reference is I just had film like fifth metacarpal fracture. And so you haven't yet explored all of the things of life that you want to get back to. You're in this thin um like polaroid of here's where my function is and I'm um' okay, I'm not awful. But the further in we get, the more aware of their Like if we're doing our job and saying like, well, what other things do you struggle with?
josh MacDonald: Well, I can't play pick a ball and I can't change my oil yet. They get more aware of these deeper layers. And so their score may not reflect their progress because now they're thinking about more depth of life, things that they can't go back to that they weren't even considering on initial intake.
Miranda Materi: Right.
josh MacDonald: So the score doesn't always reflect that.
Miranda Materi: Yeah. That's definitely true. And you bring up a good point when patients are during the patient interview, I feel like you can capture a lot of these things that you might capture on um an outcome measure, right?
Miranda Materi: If you can really like listen to your patient, you can get a pretty good idea. And then it's making sure your documentation reflects that patient interview.
josh MacDonald: Yeah, yeah. I do feel like if you've done a good thorough interview, you could if you need to do, but you shouldn't fill out the quick dash for them because you should know all of those answers because you had those conversations.
Miranda Materi: Right, yep, definitely.
josh MacDonald: Yeah, yeah. I will say I mentioned earlier the pediatric population. I'll have because insurance companies still want something. I'll use it for kids down as low as like 10 or 12 sometimes.
josh MacDonald: It's still a useful tool. It's no longer following the standardized protocol on how to use it, but it's still a useful cross section of where they are. And I've got lots of people who say, I don't do any how heavy household chores because I've got a maid for that. I say, well, imagine if you did, how would that go? I can say the same thing to a kid and maybe now it's not standardized, but I get a pre and post session or, you know, month read on how they're progressing.
Miranda Materi: Right. Yeah. And that can be very helpful. I think another aspect of doing the outcome measures is for research, right? So if we have this large bank of data, it really makes it easier for us to pull data out to measure the success of our interventions.
josh MacDonald: Yeah, yeah. It gives us something to pull back from later on in mass. Lots and lots of lots of data samples.
Miranda Materi: Right. So I think that would be an advantage, but I think the feasibility and how realistic that is, is, is not right. No one wants to fill out another form when they come in, they're already filling out the HIPAA form.
Miranda Materi: Then, you know, like there's so many, we have like seven or eight forms that we just fill out because that's what the attorney says we need to do. Right.
josh MacDonald: Right?
Miranda Materi: And <unk>s and then they have a hurt hand and then you're like, well, and actually, can you fill out five more pieces so we can track your data?
josh MacDonald: Yeah, yeah. We're trying to have as little impact negative impact on them as possible and giving them the long form dash or a second rating or yeah it just adds more negative impact on their their experience.
Miranda Materi: Right, when when what patients really want I feel is for you to really listen to them and understand them, right? They want to be heard or they want to be understood. So I feel like that you don't really always get that from them filling out a piece of paper.
Miranda Materi: You get that from your time spending your time with that patient interviewing them and talking to them.
josh MacDonald: Right.
josh MacDonald: Yeah. Yeah. All right. Well, let us know what measures you use. Maybe you have another go -to that you use all the time instead of the quick dash. Let us know. Give us some feedback. And if you have any questions, you can reach us at our email info at handtherapyacademy .com or on our social media platforms, handtherapyacademy.
