Chiropractor perspectives on the use of patient reported outcome measures: a survey of Veterans Health Administration chiropractors

Abstract Background Patient reported outcome measure (PROM) use is a marker of high-quality chiropractic care. Limited information exists regarding use of PROMs by United States chiropractors, especially within integrated health systems like the Veterans Health Administration (VHA) that prioritize high-quality, data-driven performance monitoring. This study aimed to understand VHA chiropractor perspectives on PROM use, including specific measures, administration characteristics (initial and follow-up timing), workflow, and perceived utility. Methods A national electronic survey of VHA chiropractors was conducted using REDCap from May 7 to 28, 2024. Survey items covered frequency of use by region of chief concern, administration during initial versus follow-up visits, perceived usefulness for serial assessment, and perceived patient and clinician benefit or burden. Respondents also listed frequently used PROMs and provided details on administration workflow. Descriptive statistics were summarized. The relationship between self-reported PROM use at initial and follow-up visits was compared using the Wilcoxon signed-rank test (α = 0.05). Self-reported PROM use frequency across chief concerns (low back pain, neck pain, and all other chief complaints) was compared using a Kruskal-Wallis H Test (α = 0.05) and Bonferroni-corrected Dunn’s post-hoc tests. Results The survey achieved a response rate of 51.8% (189/365). The PROMs most frequently listed assessed disability, followed by pain intensity and interference. PROM administration was most often completed by the chiropractor (76.7%) using paper forms collected at the point of care (51.7%). Respondents reported a greater (r = 0.640, p < 0.001) percentage of patients over the past 12 months where they used PROMs at initial visits (median = 95.0%) compared to follow-up visits (median = 74.5%). A significant difference in PROM frequency was observed across chief complaint categories (χ² = 41.814, df = 2, p < 0.001) for both low back pain (r = 0.258, p < 0.001) and neck pain (r = 0.203, p < 0.001) compared to all other chief complaints. PROMs were overwhelmingly viewed as highly beneficial for individual patient management despite any perceived administrative burden. Conclusions We identified key themes related to VHA chiropractor perspectives on PROMs. VHA chiropractors show a commitment to PROM use, especially for spinal pain presentations. Existing workflows often rely on manual, paper-based, provider-driven methods. Addressing barriers to meaningful use is critical to optimally implement PROMs in VHA chiropractic practice.