Better Care: Qualitative Analysis in Physical Therapy

According to the November 13, 2026 PLoS One study, Dutch-Flemish PROMIS CATs were generally feasible, acceptable, and useful for monitoring symptoms and functioning in primary care physical therapy, but implementation remained limited by legacy questionnaires, interpretation challenges, and digital workflow barriers.

The study demonstrates why qualitative analysis in physical therapy matters: interview themes explained why survey results showed strong clinician interest but inconsistent routine use.

• The November 2026 study covered 14 physical therapy practices, with 25 therapists completing a survey and 10 therapists plus 9 patients participating in interviews.
• In the May 2 to June 20, 2022 survey, 80% of therapists expressed interest in using PROMIS CATs, but only 28% reported regular daily use.
• In the 2022 survey, 100% of therapists found PROMIS CATs easy to administer, while only 40% believed the CATs took little time.
• PROMIS CATs administered between March 2021 and January 2023 used a minimum of 4 items and a maximum of 12 items, stopping earlier when the precision threshold was reached.
• The study authors concluded in November 2026 that wider adoption requires replacing legacy PROMs, improving score-interpretation training, supporting reimbursement, and embedding PROMIS in clinical guidelines.

The 2026 PLoS One study used a concurrent mixed-methods design to assess acceptability, demand, practicality, and implementation in routine primary care physical therapy.

The researchers integrated Dutch-Flemish PROMIS CATs into electronic health records across 14 practices in the Netherlands. The CATs selected subsequent questions based on each patient's previous answer, with a minimum of 4 and maximum of 12 completed items and a target reliability of approximately 0.95.

The quantitative component was an online survey completed by 25 physical therapists between May 2 and June 20, 2022. The qualitative component consisted of semi-structured interviews with 10 therapists and 9 patients conducted between March 21 and November 23, 2022. The researchers analyzed the interview transcripts using hybrid inductive-deductive thematic analysis.

Two researchers independently performed open coding, compared codes in consensus meetings, and used a third researcher to resolve disagreements when necessary. The researchers then mapped inductively developed themes onto Bowen's feasibility domains.

The study identified a central implementation tension: therapists generally preferred PROMIS CATs to legacy measures, but they did not want to administer PROMIS CATs in addition to mandatory questionnaires. One therapist summarized the issue as, "If the CAT can replace NPRS, PSFS, and Quebec while giving the same information, that’s a win-win" (PT#6).

The study also showed why patient and clinician perspectives should be analyzed separately. Only 24% of surveyed therapists believed patients were satisfied with PROMIS CATs, while interviewed patients generally described the CATs as quick, simple, and relevant.

Qualitative analysis adds the reasons behind PROMIS CAT adoption patterns, which the 2026 PLoS One study demonstrated by comparing survey percentages with interview themes.

The study found that visual feedback supported discussions about progress, but therapists worried that labels such as "severe" or red color coding could alarm patients. One therapist said, "Using words like ‘severe’ might unintentionally worry patients or make the problem feel bigger" (PT#7).

The study found that patients were more willing to complete PROMs when clinicians explained the purpose and discussed the results. A patient said, "Answering the questions made me reflect on my symptoms and what I want help with" (Patient#5).

The study also identified content and usability concerns that frequency counts alone could miss. Some participants found upper-extremity items repetitive or insufficiently specific, while patients wanted access to individual item responses and the ability to review answers before submission.

• For implementation researchers, code interviews around acceptability, demand, practicality, and implementation so findings connect directly to adoption decisions.
• For clinical teams, compare clinician perceptions with patient accounts because the 2026 study found a divergence between therapist estimates of patient satisfaction and interviewed patient experiences.
• For survey designers, treat open-ended comments and interviews as evidence about questionnaire burden, portal friction, item relevance, and interpretation.
• For healthcare leaders, use cross-segment analysis to distinguish barriers caused by the CAT itself from barriers caused by legacy PROMs, reimbursement, training, or electronic health record workflows.

The 2026 PROMIS CAT feasibility study shows that qualitative analysis can reveal the operational conditions behind successful patient-reported outcome measurement. The strongest opportunity is not simply to collect more scores, but to connect patient experience, clinician interpretation, questionnaire design, and workflow evidence in one analysis. AI-enabled tools can make that synthesis faster while preserving a researcher-led validation process for sensitive healthcare data. Teams studying PROMIS CATs, rehabilitation services, or patient-reported outcomes can Try Evidano for free to organize transcripts, compare participant groups, and develop evidence-grounded themes.