Feasibility of patient-reported outcomes measurement information system (PROMIS) computerized adaptive tests in patients receiving physical therapy: A mixed-methods study

Introduction Patient-Reported Outcome Measures (PROMs) are widely used in physical therapy, but both clinicians and patients report respondent burden due to the number and the length of existing instruments. PROMIS ® Computerized Adaptive Tests (CATs) may reduce this burden, yet their feasibility in primary care physical therapy is unknown. This study examined the feasibility of Dutch-Flemish PROMIS CATs in patients with musculoskeletal (MSK) disorders of the spine and upper extremity. Methods We conducted a mixed-methods concurrent triangulation study in 14 physical therapy practices where PROMIS CATs were integrated into the electronic health record system and administered during routine care. A survey assessed physical therapists’ experiences and opinions regarding acceptability, demand, practicality, and implementation. Semi-structured interviews with physical therapists and patients further explored these domains. Survey data were analyzed descriptively, and interview transcripts were thematically analyzed by two independent researchers. Results Twenty-five physical therapists completed the survey. Ten physical therapists and nine patients participated in interviews. Most physical therapists reported that PROMIS CATs were easy to use and facilitated focused discussions about symptoms and functioning. Patients described CATs as quick to complete and relevant to their condition and were willing to complete PROMs if results were used in consultations. Reported barriers included the simultaneous use of legacy PROMs (patients), difficulties using the online portal, and uncertainty about interpreting CAT scores (therapists). Some participants reported that certain CAT items felt less relevant and expressed a desire to view individual item responses. Conclusions PROMIS CATs are considered feasible to implement in physical therapy practice and are generally experienced as acceptable, efficient, and clinically useful. Future implementation should focus on phasing out legacy PROMs to reduce respondent burden, improving skills in score interpretation, ensuring financial reimbursement for use, incorporating PROMIS into clinical guidelines, and evaluating additional PROMIS domains relevant to primary care physical therapy.