Using Patient-Reported Outcome Measures to Promote Patient-Centered Practice: Building Capacity Among Pediatric Physiotherapists in Rwanda

Monika Mann; Ines Musabyemariya; Linn Harding; Ben Braxley

doi:10.9745/GHSP-D-19-00408

Key Findings

After completing the training:

Ninety-two percent of respondents stated that they felt either “quite” or “very” confident in their abilities to establish functional goals.
Seventy percent of respondents stated that they continue to use patient-reported outcome measures either “a lot” or “quite a bit” 26 months after the close of the grant.

Key Implications

Program managers should consider:

Targeting stakeholders from a range of health system levels to facilitate systemic and institutional support of practice changes as well as maximize adoption, penetration, and sustainability of new skills and concepts
Adopting culturally appropriate outcome measure tools
Using multimodal strategies for capacity building

ABSTRACT

Background:

Patient-reported outcome measures (PROMs) assess disability and progress toward functional goals while promoting patient-centered practice. They can be used by health professionals in any specialty and in a multitude of settings. This study reviews implementation strategies and lessons learned in a capacity-building program that took place with pediatric physiotherapists in Rwanda.

Methods:

Use of PROMs and patient-centered practice were integrated into 4 consecutive continuing professional development courses offered to 164 participants in Rwanda. We sought to identify a simple generic measure with proven validity in cross-cultural settings. The Patient-Specific Functional Scale was chosen due to its ease of use and ability to measure change in a wide range of patient conditions. Didactic classroom training and clinical site visits were 2 essential pedagogical elements of the capacity-building strategy. Site visits allowed for evaluation of skill levels and facilitation of knowledge transfer to patient care settings. Unique pairs of Rwandan colleagues were trained to serve as coteachers in each course to maximize sustainability of new techniques. This study presents data on a subset of 65 participants who completed a 48-hour pediatric rehabilitation course.

Results:

After classroom instruction, 78% of participants were observed independently determining functional limitations with their patients. Additionally, pre- and post-tests indicated that therapists substantially increased their understanding of patient-centered practice after attending courses. Interviews conducted 26 months after the conclusion of the project revealed mixed success in sustainability of the use of PROMs, although perceived confidence remained high.

Conclusion:

Challenges in long-term sustainability of new practices call attention to the need to target not only clinicians when introducing new methodologies, but also the Ministry of Health, hospital administration, and university faculty. Lessons learned from this study may be useful to other medical professionals planning capacity-building programs in low- and middle-income countries.

Received: November 25, 2019.
Accepted: June 12, 2020.
Published: October 1, 2020.

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