Page 199 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

questionnaires. This shows how hard it still is to accommodate these vulnerable native and minority patient populations with inadequate health literacy in both research and clinical settings.
THE USE OF QUESTIONNAIRES IN CLINICAL PRACTICE
According to the definition of the U.S. Department of Health and Human Services, Food and Drug Administration, completing the TTSQ produces Patient-Reported Outcomes (PROs). A PRO is defined as any report of the status of a patient’s health condition, behavior or experience with health care that comes directly from the patient without interpretation of the patient’s response by a clinician or anyone else [37]. Researchers and policy makers have spent the last three decades promoting the routine use of Patient-Reported Outcome Measures (PROMs) in clinical practice [9,38]. They believe that it helps to evaluate the burden of disease and treatment from the patient’s perspective [38], stimulate discussion of patient outcomes during consultations and increase patient satisfaction about provider- patient interactions [39]. This coincides with the increased demand for autonomy and self-determination of patients [40] and the ongoing effort that policymakers, researchers and health care professionals put into further development of shared decision-making and self- management in patients [41]. Furthermore, the use of PROMs clinically significantly reduces prevalence and severity of symptoms [39].
Researchers and policy makers use PROMs at an aggregate level for comparative effectiveness research [12], assessment of the performance of clinicians and organizations, public reporting and value-based payments [10]. They encourage routine application of PROMs by clinicians, believing aligning clinical practice and performance measurement will maximize the impact of PROMs on the quality of health care [9]. Among the implementation strategies that have been carried out in the past decade are the uptake of the use of PROMs into all guidelines for physical therapy practice, and health insurance companies making the use of PROMs obligatory or rewarding physical therapists financially for the use of PROMs [42]. Considering the results of this PhD thesis, which show how difficult it is for the majority of patients in a ‘real life clinical setting’ to complete questionnaires in a way which leads to valid results, one could ask oneself if all of this is justifiable.
General discussion
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