COSMIN database

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

Fennelly, O., Blake, C., Desmeules, F., Stokes, D., and Cunningham, C.
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.
Musculoskeletal Care
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Physical functioning
Role functioning
General health perceptions / HRQoL:
Health-related quality of life
Overall quality of life:
Overall quality of life
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
3 - Diaries
Adapted Stanford exercise behavior scale
ALBPSQ - Acute Low Back Pain Screening Questionnaire   
AQOL-4D - Assessment of Quality of Life 4D
ASES - Arthritis Self-Efficacy Scale (versions: ASES-8; ASES-AS - Ankylosing Spondylitis)
BBQ - Brace Beliefs Questionnaire
Boston patient expectations and satisfaction questionnaire
Constant Score [alias: Constant-Murley Shoulder Score] (versions: Adjusted Constant)   
DASH - Disabilities of the Arm, Shoulder and Hand (versions: DASH Modified)   
Days off work
DD - Deyo and Diehl satisfaction questionnaire
DRAM - Distress and Risk Assessment Method
DRP - Disease Repercussion Profile
Employment questionnaire
EQ-5D - EuroQoL-5 Dimensions   
EQ-VAS - EuroQol Visual Analogue Scale
FABQ - Fear-Avoidance Beliefs Questionnaire   
Goldstein's instrument
GRC - Global Rating of Change
HADS - Hospital Anxiety and Depression Scale   
HAQ - Health Assessment Questionnaire (versions:MHAQ - Modified HAQ; HAQ-II)   
HOOS - Hip disability and Osteoarthritis Outcome Score   
KOOS - Knee injury and Osteoarthritis Outcome Score (versions: KOOS-Child; KOOS-Joint Replacement; KOOS-12; KOOS-PF - KOOS PatelloFemoral pain and osteoarthritis)   
Leeds patient satisfaction questionnaire
LEFS - Lower Extremity Function Scale
Likert satisfaction Scale
Modified group health Association of America's consumer satisfaction survey
NRS function
NRS health
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
ODI - Oswestry Disability Index (versions: ODI 2.0; ODI AAOS/MODEMS; chir ODI - chiropractor ODI)   
Patient perception of grade of improvement
PDI - Pain Disability Index   
PIVAS - Perceived improvement evaluation
QPP - Quality of care from the Patient's perspective
Return to usual activities
RMDQ - Roland Morris Disability Questionnaire    
Satisfaction survey
Self‐efficacy for managing chronic disease
Self‐reported recovery
Self‐reported subsequent healthcare costs
SF-12 - 12-item Short Form Health Survey [alias: RAND-12]
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SF-6D - Short-Form 6D (derived from SF-36 or F-12)
SF-MPQ - McGill Short Form Pain Questionnaire
SIP - Sickness Impact Profile (versions: SIP-8; SIP-68; SIP-136; SIP-SV; UKSIP)   
SPADI - Shoulder Pain and Disability Index   
St Michael's hospital patient self‐evaluation
Symptom relief
Treatment expectations questionnaire
VAS pain - Visual Analogue Scale pain (versions: VAS pain-parental)
VAS Satisfaction - Visual Analog Scale for Satisfaction
VSQ-9 - Modified visit‐specific satisfaction questionnaire
WOMAC - Western Ontario and McMaster Universities Osteoarthritis Index (versions: Individualized WOMAC; WOMAC-Likert Scale; WOMACsf; WOMAC-12)