Michelle Holmes

Patient reported outcome measures (PROMs) are increasingly being used to collect patient outcomes on a routine basis in healthcare. Theoretical analyses of PROMs remain under-developed and the evidence-base evaluating PROMs in clinical settings is relatively new – important questions remain about the consequences of PROMs, for patients, practitioners, and their interactions.

From a psychological perspective, PROMS can be viewed a potentially powerful components of complex clinical interventions because they involve patients actively monitoring and reporting their symptoms in detail. The process of using PROMs clinically might lead to improvements indirectly through contextual mechanisms. Using PROMs might also enhance specific treatment effects, by helping clinicians to better understand the minutiae of patients’ symptoms and individualize treatments accordingly. The act of monitoring symptoms through PROMS might itself directly trigger health changes.

My PhD  will use mixed qualitative and quantitative methods to identify the potentially beneficial and adverse effects of PROMs and examine the processes underpinning such effects, in the context of musculoskeletal health. This PhD is funded by the University of Southampton with the Anglo European College of Chiropractic, the Royal College of Chiropractors, and the Southampton Complementary Medicine Research Trust.

This PhD will comprise of a cluster randomised controlled trial to examine these potential effects when using different intensities of PROMs in specialist musculoskeletal care for low back pain. This study will compose of a variety of research techniques in order to understand how patients and chiropractors experience using PROMs in routine clinical practice for low back pain.

The PhD will be split into two phases, a feasibility study and a pilot study. The feasibility study will examine, recruitment of chiropractors and patients, the study design, measurement tools and participant experience of a trial. Within the pilot study, before and after their treatment, patients will be asked to complete a series of assessments to understand the effects PROMs has on the outcome and process of care and begin to explore the mechanisms behind any changes. Treatment sessions will be recorded to examine the patient-chiropractor interaction. Interviews will also be undertaken with both chiropractors and a subset of patients, in order to ask questions and get an in-depth understanding of their experiences.

By examining the clinical uses of PROMs within the management of non-specific low back pain, my PhD findings will contribute to the current agenda of finding new ways to improve the effectiveness and delivery of existing therapies for low back pain. 

Anglo-European College of Chiropractic