The Influence of Education and Environment on Patient-Reported Outcome Use in Athletic Training Clinical Practice

Abstract

Context There have been multiple education reforms aimed at incorporating patient-reported outcome measures (PROMs) into routine clinical care. However, many factors can impact PROM use, including employment setting/policies or access to literature. Objective To explore the influence of educational background and employment setting/policies on athletic trainer (AT) attitudes and practices related to PROM use in the secondary and collegiate settings. Design Cross-sectional survey. Setting Secondary schools; National Collegiate Athletic Association Division I, II, and III; National Association of Intercollegiate Athletics; and junior colleges. Patients or Other Participants Five hundred and seven ATs working in secondary and collegiate settings. Data Collection and Analysis An established scale evaluating attitudes toward PROMs was distributed to a purposeful sample of 4000 ATs. Also included were questions concerning use of PROMs, employer policies related to PROMs, access to non–National Athletic Trainers' Association (NATA) journals, and educational background. Scores on each scale were compared based on educational background, employment setting/policies, and access to non-NATA scientific journals using Kruskal-Wallis tests with a Bonferroni correction. Frequency of PROM use was evaluated using chi-square tests (α = .05). Results PROMs were viewed positively across all participants, with more positive attitudes toward PROMs observed among those with clinical doctorates (P = .029) compared to those with master's or bachelor's degrees and by those with an athletic training-–related postprofessional master's degree (P = .030) compared to a non–athletic training master's degree. There were no differences in attitudes based on timing of professional degree completion. There were no differences in the usage of PROMs based on educational background or employment setting, with only 10% of respondents reporting routine PROM use. However, access to non-NATA scientific journals (P = .016) and employer policies related to the use of PROMs were associated with increased use of PROMs (P < .001). Conclusion Educational reforms have enhanced the attitudes of practicing ATs toward PROMs; however, environmental facilitators, such as expanded access to scientific literature and policies regarding the use of PROMs, are necessary to increase the use of PROMs.