Adapting an online PROM portal for pediatric physiotherapy: a co-design process (Preprint)

BACKGROUND Patient-reported outcome measures (PROMs) and shared decision-making (SDM) are increasingly valued in Pediatric physiotherapy (PPT). Online PROM portals can facilitate PROM use and SDM, but require adaptation for its use in PPT. OBJECTIVE This study aimed to adapt the online KLIK PROM portal for primary PPT, identify preferences for data visualization, and explore integration of SDM. METHODS A co-design approach was used. Two co-creation sessions including adolescents, parents, patient representatives, PPTs, and researchers were organized and results were discussed in an analyze-session with the research team. Subsequently, a demo version of the adapted KLIK portal was tested for usability in twelve individual think aloud sessions with parents, adolescents, and PPTs. After discussing results in a second analyze-session, the final version of the KLIK PROM portal was developed. Thematic content analysis was applied to all qualitative data. RESULTS Key adaptations included automatically selecting predefined PROM sets based on the patient registration form depending on complaints and age, and the possibility to schedule a series of PROMs linked to evaluation moments. Literal responses on items without color coding were preferred by patients and parents, while PPTs favored line graphs with heatmaps indicating concerning scores. Both patients and PPTs emphasized the importance of discussing results in person using child-friendly visualizations. Aggregated data were valued for supporting reflective practice. SDM was integrated into the portal through information pages, subtle nudges to encourage PPTs and patients to engage in SDM, and by motivating patients to complete PROMs by personalizing the portal. CONCLUSIONS The adapted KLIK portal is ready for pilot implementation in primary PPT. Updates should be applied based on user feedback from ongoing evaluations. While PROM use can facilitate SDM, impact on SDM depends on effective patient-clinician dialogue and should be further investigated.