The impact of repeated feedback of Patient Reported Outcome Measures (PROMs) with patients in musculoskeletal physiotherapy settings: A qualitative study


The study was undertaken as part of an individual PhD award. The aim was to explore the impact of Patient Reported Outcome Measure (PROMs) on patient care in musculoskeletal physiotherapy with the objective of finding approaches to enhance practice.


The study used a qualitative realist evaluation approach. One NHS trust and one private physiotherapy provider took part in recruitment of participants. Patients consenting to participate were provided with a PROM to complete at each appointment by their physiotherapist. Participant progress was fed back on a graph to compare to previous scores by their treating physiotherapist. Participants were interviewed by the author after their treatment was completed to talk about the process of using PROMs feedback. The ‘Contextualised Feedback Intervention Theory’ (CFIT) was used as a middle range theory from which to develop a framework as to how the repeated feedback of PROMs may impact patient behaviour. Context, mechanism and outcome configurations (CMOcs) were used to describe participant behaviours in response to feedback of PROMs data. PROMs scores were collected and the interviews with participants (n=25) were used to explore how repeated feedback had an impact on this group of participants, why, and under which circumstances


Results: Context, mechanism and outcome configurations were used to describe the interactions experienced between participants and physiotherapists and map patient behaviours with this process. Repeated PROMs feedback works in the way it is intended for patients when they feel the PROM tracks progress accurately, there is consonance with the feedback process and there is a positive rapport with their therapist. This produces an impact which is larger when both the patient and therapist are working together to manage the patient’s condition. thus creating individualised care. Improvement in PROMs scores identified positive clinical change but did not always identify those with positive outcomes from the repeated PROMs feedback.

Conclusion(s): The PROM as a tool enhances patient experience and thus provides quality care, but did not appear to measure experience or quality, only clinical change. This study proposes PROMs to be used to measure clinical change as a validated tool, but also to enhance patient management and experience via repeated feedback, encouraging patients to be at the centre of quality and individualised care.

Cost and savings

Minimal cost to service: paper copies printed of outcome measure for completion by patients at each appointment.


The physiotherapy community can implement the study findings into practice by using PROMs scores differently. By involving the patient further and feeding back repeated PROMs scores, patient management and patient experience can be enhanced, ensuring personalised and individual care. This approach was favourably received by the participants of this study.

Top three learning points

No further data 

Funding acknowledgements

University of Central Lancashire Arnoux PhD Bursary Scheme