Can experienced physiotherapists identify which patients are likely to succeed with physical therapy treatment?

Abstract

BackgroundThe purpose of the study was to determine if clinician predicted prognosis is associated with patient outcomes.MethodsThe study was a secondary analysis of data that were collected in 8 physiotherapy outpatient clinics. Nine physiotherapists with post-graduate training in manual therapy (mean 20.3 years of experience) were asked at baseline to project the outcome of the patients evaluated. In total, 112 patients with low back (74 %) or neck (26 %) pain were treated pragmatically with interventions consisting of manual therapy, strengthening, and patient-specific education. Outcomes measures consisted of percent change in disability (Oswestry or Neck Disability Index), self-reported rate of recovery (0–100 %), and percent change in pain (numerical pain rating scale). Hierarchical logistic regression determined potential factors (clinician predicted prognosis score (1–10) at baseline, dichotomised as poor (1–6) and good (7–10); symptom duration categorised as acute, subacute or chronic; same previous injury (yes/no); baseline pain and disability scores; within-session improvement at initial visit (yes/no); and presence of ≥ one psychological factor) associated with meaningful changes in each of the three outcomes at discharge (disability and pain > 50 % improvement, rate of recovery ≥82.5 % improvement).ResultsClinician predicted prognosis (OR 4.15, 95%CI = 1.31, 13.19, p = 0.02) and duration of symptoms (OR subacute 0.24, 95%CI = 0.07, 0.89, p = 0.03; chronic 0.21, 95%CI = 0.05, 0.90, p = 0.04) were associated with rate of recovery, whereas only clinician predicted prognosis was associated with disability improvement (OR 4.28, 95 % CI 1.37, 13.37, p = 0.01). No variables were associated with pain improvement.ConclusionsClinician predicted prognosis is potentially valuable for patients, as a good predicted prognosis is associated with improvements in disability and rate of recovery.

Knee replacement outcome predicted by physiotherapists: a prospective cohort study

“…The present study is the first on physiotherapists’ prognoses of KA. Previously, it has been shown that physiotherapists’ prognoses during the initial clinical encounter for the projected outcome of patients with low back and neck pain they treated, was associated with the actual clinical outcome ( Cook et al, 2015 ).…”

“…In daily clinical physiotherapy practice at the orthopaedic wards, previous experiences, knowledge, and personal interaction with a patient altogether result in the physiotherapist’s intuition about the future course of a patient’s recovery. Previously, it has been shown that physiotherapists’ prognoses during the initial clinical encounter for the projected outcome of patients with low back and neck pain they treated, was associated with the actual clinical outcome ( Cook et al, 2015 ). However, it is unknown if such intuition is a reliable predictor of the outcome of KA.…”

Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury

“…However, this study included patients with sub-acute to chronic WAD undergoing a rehabilitation intervention and did not provide indication of the accuracy of predictions about later recovery made in the acute injury stage. Evidence of physiotherapists' accuracy in identifying the prognosis of people with other spinal pain conditions has been inconsistent [7][8][9][10]. Cook and colleagues investigated physiotherapist estimation of three patient outcomes two weeks after initial contact, in people with any duration neck and back pain and found significant associations between clinician-predicted and actual disability and patient-reported recovery outcomes, but not resolution of pain [10].…”

“…Evidence of physiotherapists' accuracy in identifying the prognosis of people with other spinal pain conditions has been inconsistent [7][8][9][10]. Cook and colleagues investigated physiotherapist estimation of three patient outcomes two weeks after initial contact, in people with any duration neck and back pain and found significant associations between clinician-predicted and actual disability and patient-reported recovery outcomes, but not resolution of pain [10]. Alternatively, Dagfinrud and colleagues investigated physiotherapist prediction of eight week disability outcome in a neck pain population and concluded that clinician predictions did not add value to the prognostic model [8].…”

Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series

“…37,49,85 Recently, a similar approach was conferred in orthopaedic manual physical therapist practice. 18,49 Within the differential diagnosis process, physical therapists gathered a cluster of clinical findings/tests (posture, cervical joint mobility, muscle tenderness, CFRT, CCFT, and SPNT) to recognize the clinical pattern of CGD presentations. Primary importance of physical examination items was noted in the following tests (TABLE 3): VOR, Motion Sensitivity Quotient, CFRT, upper cervical joint stiffness, and CCFT.…”