Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…Previous reports suggest that the depressive symptoms of certain patients can worsen over the course of treatment. 7,66 Consistent with these reports, we found that 7 (6.3%) of the 111 patients who did not meet inclusion criteria for pretreatment levels of depression showed clinically significant levels of depressive symptoms at the posttreatment assessment. Although post hoc inclusion of these patients in the analysis did not influence the reported results, they may have clinical importance.…”

Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

“…Treatment monitoring via change in psychological measures has been established for patients with low back pain. 26, 43, 50, 55, 56 In this cohort we considered the OSPRO-YF tool for its treatment monitoring capacity across several other musculoskeletal pain conditions. Consistently the 4-week change in the 10 item OSPRO-YF tool contributed small amounts of additional variance to the prediction of 12-month outcomes for pain intensity, region-specific disability, and quality of life.…”

“…This approach provided a relatively high bar to determine the predictive validity of the new tools because models included previously established predictive factors and anatomical region as planned covariates. Based on prior studies showing that change in psychological factors may improve outcome prediction for low back pain 4, 26, 55, 57 we also entered 4 week change in the OSPRO-YF tool into the last step of the prediction models. Our over-riding hypotheses were that the OSPRO-YF tool would improve prediction of pain and disability outcomes, while the OSPRO-ROS tool would improve prediction of quality of life and comorbidity outcomes.…”

The STarT Back Screening Tool for Prediction of 6-Month Clinical Outcomes: Relevance of Change Patterns in Outpatient Physical Therapy Settings

“…7,12,25,31 For example, Dunn and Croft 7 found that in primary care settings, the presence of adverse prognostic indicators at initial assessment and 4 weeks later was associated with higher risk for poor outcomes at 12 months compared to the presence of adverse prognostic indicators at either time point or none at all. As a result, the authors suggested that combining information on prognostic indicators from initial assessment and 4 weeks later may provide improved classification for LBP clinical outcomes in primary care settings at 12 months.…”

“…While this approach may provide important initial clinical decision-making opportunities, it does not account for changes in patient variables that can occur following the initiation of treatment and can only be determined with multiple assessments. For example, changes in psychosocial risk factors during the course of treatment may provide important information for a patient's long-term prognosis 7,12,25,31 and more valuable information compared to that provided by baseline psychosocial risk-factor levels alone. 12 Therefore, establishing long-term prognosis in clinical practice should consist of a dynamic process incorporating both initial and frequent follow-up assessments, so that the magnitude and direction of change can be determined for a given prognostic measure, because initial assessment findings are likely to change early during an episode of care.…”