Associations Between Treatment Processes, Patient Characteristics, and Outcomes in Outpatient Physical Therapy Practice

Deutscher, Daniel; Horn, Susan D.; Dickstein, Ruth; Hart, Dennis L.; Smout, Randall J.; Gutvirtz, Moshe; Ariel, Ilana

doi:10.1016/j.apmr.2009.02.005

Cited by 74 publications

(107 citation statements)

References 83 publications

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“…5 One of the more common methods of risk adjusting FS outcomes is a multiple linear regression model, which controls categorical and continuous variables simultaneously. 8 48 educational level, 35 and ethnicity. 35 Because the burden of collecting clinical data is significant, not all variables have been included in any one model.…”

Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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“…Use of CAT and single-item screens reduces the burden associated with assessments of multiple constructs. 7,10,21 Given our positive experience with the wellness program and the software used to collect the data, we recommend that complex data sets like the one described here be used to develop large of psychological distress did not decrease (adjusted least squares mean 72.4, SE 4.0) (P = .017).…”

Section: Resultsmentioning

confidence: 97%

“…Patient selection bias can negatively affect statistical results and make databases from which the interdependence of multiple constructs affecting people with MS can be examined and treatments associated with better outcomes for individual patients can be determined. 21 Given the interest in assessing multiple constructs for people with MS, future investigations should provide insight into how to select measures that represent the most important "outcomes" for people with MS participating in wellness programs. For example, most outpatient rehabilitation programs emphasize improvements in functional status, but such improvements may not be the most important sign of the success of an intervention program.…”

Section: Discussionmentioning

confidence: 99%

“…The database has been described previously. 7,21 Briefly, while in the clinic, patients enter demographic, functional status, and a variety of clinician-selected data into a computer. Staff members enter other demographic, clinical, and administrative data into the computer using the same software.…”

Section: Methodsmentioning

confidence: 99%

“…Finally, computerized outcomes data collection can be integrated into electronic health record systems, facilitating assessments of which treatments are associated with better outcomes for specific individuals. 21 The overall purpose of this study was to describe development, implementation, and initial outcomes data results related to a multidimensional, conservative wellness program designed to facilitate positive health choices in people with MS. For initial outcomes data assessment, specific purposes were to determine whether, over the course of the wellness program, participants reported changes in functional status, fear-avoidance beliefs of physical activities, depression, somatization, fatigue, and pain intensity. We hypothesized that over the course of the program, participants would demonstrate improvement in the domains assessed.…”

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confidence: 99%

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Developing a Wellness Program for People with Multiple Sclerosis

Hart¹,

Memoli²,

Mason³

et al. 2011

International Journal of MS Care

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Because multiple sclerosis (MS) is a multidimensional chronic disease, effective management of the illness requires a multidimensional approach. We describe a wellness program that was designed to facilitate positive health choices throughout the course of MS and present initial data analyses. We hypothesized that over the course of the program, participants would demonstrate improvement in the domains assessed. The wellness program included educational sessions in physical, mental, social, intellectual, and spiritual domains specifically targeting improved self-efficacy, physical functioning, coping skills, symptom management, and nutrition. An outcomes data collection software program was adapted to facilitate real-time patient self-report and clinician entry data collection for many domains throughout the wellness program. Initial assessment of serial measures (intake to discharge) from 65 people with MS showed improvement in several domains, including functional status (P < .05), fatigue (P < .05), fear-avoidance beliefs regarding physical activities (P < .05), depression (P < .05), somatization (P < .05), and pain (P < .05). In addition, using a model of risk for interpersonal distress, patients whose risk of elevated depression and anxiety decreased over the course of the program reported greater gains in functional status (P < .05). The results suggest possible future treatment strategies and indicate strengths and weaknesses of the wellness program, which are being used to improve the program. Int J MS Care. 2011;13:154-162.

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Deep learning: A taxonomy of modern weapons to combat Covid‐19 similar pandemics in smart cities

Saeedvand

Jafari

Aghdasi

et al. 2022

Concurrency and Computation

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Summary The Covid‐19 pandemic has affected many lives over the past year. In addition to the enormous health cost, the necessary lockdowns and government‐mandated suspension to prevent the spread of the virus had a huge economic impact. The new challenges in 2021 were combating new virus mutations and providing effective vaccines globally. Artificial intelligent (AI) and machine learning have made significant improvements in many different applications during the last decades. One of the advanced and robust technologies in machine learning is deep learning (DL), which can be employed to help prevent initial infections and detect and monitor their progress and side effects. Fast and accurate Covid‐19 infection detection and treatment of suspected patients is essential to make better decisions, ensure treatment, and even save patients' lives. Modern technologies are required to achieve these objectives and create a sustainable society. This article presents a taxonomy in DL algorithms to cover both the technical novelties and empirical results techniques for Covid‐19 in smart cities. In this regard, (i) we demonstrate possible DL algorithms capable of combating Covid‐19; (ii) we propose an up‐to‐date perspective of DL algorithms in social prevention and medical treatment; and (iii) we identify the challenges in combating Covid‐19 outbreaks.

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Associations Between Treatment Processes, Patient Characteristics, and Outcomes in Outpatient Physical Therapy Practice

Cited by 74 publications

References 83 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Developing a Wellness Program for People with Multiple Sclerosis

Deep learning: A taxonomy of modern weapons to combat Covid‐19 similar pandemics in smart cities

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