Implementing Patient-Reported Outcome Measures in Outpatient Rehabilitation Settings: A Systematic Review of Facilitators and Barriers Using the Consolidated Framework for Implementation Research

Arch Phys Med Rehabil. 2020 Oct;101(10):1796-1812. doi: 10.1016/j.apmr.2020.04.007. Epub 2020 May 19.


Objective: This systematic review examines the facilitators and barriers to the use of patient-reported outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies to improve care to maximize patient outcomes.

Data sources: Eleven databases were systematically searched from November 2018 to May 2019.

Study selection: Two reviewers independently assessed articles based on the following inclusion criteria: English text, evaluate barriers and facilitators, include PROMs, and occur in an outpatient rehabilitation setting (physical therapy, occupational therapy, speech language pathology, or athletic training). Of the 10,164 articles initially screened, 15 articles were included in this study.

Data extraction: Data were extracted from the selected articles by 2 independent reviewers and put into an extraction template and into the Consolidated Framework for Implementation Research (CFIR) model. The Appraisal Tool for Cross-Sectional Studies (AXIS) was conducted on each study to assess study design, risk of bias, and reporting quality of the eligible studies.

Data synthesis: Ten studies were identified as high quality, according to the AXIS. Based on the CFIR model, the top barriers identified focused on clinician training and time in the implementation process, lack of recognized value and knowledge at the individual level, lack of access and support in the inner setting, and inability of patients to complete PROMs in the intervention process. Facilitators were identified as education in the implementation process, support and availability of PROMs in the inner setting, and recognized value at the individual level.

Conclusions: More barriers than facilitators have been identified, which is consistent with PROM underuse. Clinicians and administrators should find opportunities to overcome the barriers identified and leverage the facilitators to improve routine PROM use and maximize patient outcomes.

Keywords: Implementation science; Occupational therapy; Physical therapy specialty; Rehabilitation; Speech-language pathology.

Publication types

  • Systematic Review

MeSH terms

  • Cross-Sectional Studies
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Outcome Assessment, Health Care / methods
  • Outpatients
  • Patient Reported Outcome Measures*
  • Rehabilitation Centers / organization & administration*
  • Rehabilitation Centers / standards
  • Time Factors