Exploring the acceptability and usefulness of the Impact of Symptoms Questionnaire (IoSQ)

Abstract

Background Clinical and physiotherapy professional guidelines advocate enquiry into, and documentation of the impact of musculoskeletal pain on a range of psychosocial and functional aspects of life. However, there is no clinical tool to assist this process. The Impact of Symptoms Questionnaire (IoSQ) is patient-completed and was developed to meet the needs of outpatient physiotherapists. It explores the impact of health conditions on patients’ beliefs/concerns and their ability to undertake work/caring responsibilities and activities of daily living; and to enjoy their usual hobbies or activities. It also enquires into the impact on mood and relationships. It comprises a “Yes” or “No” response for each of the five domains with the option of providing written comments. There are also four numerical rating scales. A discharge version determines if patients’ needs and expectations have been addressed. However, the acceptability and usefulness of the IoSQ has not been explored in a department naive to its development.

Project purpose Two studies were undertaken, to explore: the role of the IoSQ for enhancing documentation of psychosocial and functional assessment; and the perceptions of staff and patients regarding the acceptability and clinical value of the IoSQ

Research questions Enquiry into the primary research question, “Is the introduction of the Impact of Symptoms Questionnaire to a physiotherapy outpatient department acceptable and clinically useful for patients and staff?” was undertaken through secondary questions which explored: patients’ experiences of psychosocial and functional assessment before and after the introduction of the IoSQ; the role of the IoSQ for the provision of documentation; evidence for staff and patients engaging with the IoSQ; and staff and patients’ experiences of using the IoSQ.

Project design and methods A pragmatic mixed model project was undertaken in a department comprising predominantly post-surgical orthopaedic patients. Study 1 explored current practice; study 2 explored the impact of introducing the IoSQ, with minimal training as to its role or use. Methods for both studies comprised sequential audits of patients’ notes, and surveys and focus groups for patients and staff.

Results The audits (study 1, n=60; study 2, n=55) highlighted that documentation by physiotherapists for assessing the impact across all five domains remained low at about 20%, with 40% of the notes in both studies not providing evidence of enquiry into any of the domains. Only one set of notes provided physiotherapist evidence that a domain was still affected at discharge. Study 2 showed that patients consistently completed the IoSQ with 62.6% of the domains being affected at assessment and 19% of the domains being unresolved at discharge, affecting 64.1% of the patients.

Survey feedback (study 1, n=19/60; study 2, n=33/55) identified that patients felt it was important to assess the broader impact of a health problem and staff and patients indicated that the IoSQ was relevant to the presenting conditions and was easy to use.

This was further explored in the three focus groups (patients, n=3 studies 1 and 2; physiotherapists n=8, study 2) where frustration with validated outcome questionnaires in current use was expressed. However, patients felt they took responsibility for raising issues, even when the IoSQ was provided. Patients and staff felt that if physiotherapists were able to engage with the IoSQ better, it could help to provide structure and prompts to identify patients’ questions or concerns about their condition and the functional impact. The potential for patients to describe the impact in their own words was particularly valued as well as its potential, to improve rapport and more effectively match expectations It was also demonstrated that the IoSQ can enhance documentation of the impact of health problem - from the patient’s perspective.

Conclusion Patients engaged well with the IoSQ and it has potential to be a useful tool to facilitate identification and discussion of the broader psychological, social and functional impact of a health problem. However, staff would need additional training to facilitate discussion with the completed forms and patients, and further research would be required to determine its impact on patient outcomes.