Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain

Abstract

Minimizing the number of patient-reported outcome measures (PROMs) can reduce patient burden. The primary aim of the present study was to investigate whether physical therapists (PTs) can estimate psychological PROM scores in patients with low back pain (LBP) through physical therapy evaluation. The secondary aims were; 1) to investigate whether the clinical experiences of PTs influence correlations between PT estimates and psychological PROM scores, and 2) to investigate the sensitivity and specificity of PT estimates for the psychological features detected by the PROMs. We recruited hospitalized patients owing to LBP, who underwent evaluation by PTs on the initial day of hospitalization. Patients completed PROMs, including the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale immediately before the initial physical therapy session. PTs rated the magnitude of patient kinesiophobia, pain catastrophizing, anxiety, and depression using an 11-point numerical rating scale (NRS; 0 = not detected at all, 10 = very highly detected) through physical therapy evaluation immediately after the initial session. The PTs were blinded to the PROM results. We categorized PTs into two subgroups (PTs with �4 years and those with <4 years of clinical experience). Data from 78 patients (mean [SD] age = 60.5 [16.3] years) and 21 PTs were analyzed. A statistically significant but weak correlation (P = .04, Spearman's ρ = .24) was detected only in the total PCS scores and PT NRS scores in a dataset of all patients and PTs. Further, there were no statistically significant differences in correlations (all P >.05) between the two subgroups of PTs in all measures. Low sensitivity and high specificity of PT estimates for psychological features through physical therapy evaluation were identified in all PROMs when PT NRS scores were categorized into the binary score by 5 (negative: <5; positive: �5).

Exploring physiotherapists’ use of clinical practice guidelines, screening, and stratification tools for people with low back pain in New Zealand

“…Although 37% of participants reported using formal screening tools, 51% of these participants indicated they used clinical judgement to guide when and with whom they were used, rather than routinely using screening tools with all patients. The interrater agreement between expert clinicians' clinical judgement for patient risk allocation and the risk allocation determined by the SBST has been shown to be "fair" (Hill et al, 2010;Miki et al, 2020). Therefore, this inconsistency in patient screening is of concern and shows that clinical judgement is probably not the best basis for deciding when/if to screen for psychosocial risk factors (Miki et al, 2020).…”

“…The interrater agreement between expert clinicians' clinical judgement for patient risk allocation and the risk allocation determined by the SBST has been shown to be "fair" (Hill et al, 2010;Miki et al, 2020). Therefore, this inconsistency in patient screening is of concern and shows that clinical judgement is probably not the best basis for deciding when/if to screen for psychosocial risk factors (Miki et al, 2020). A systematic review of qualitative studies by Synnott et al (2015) found that although physiotherapists recognised psychosocial factors in LBP patients, they preferred to treat the mechanical aspects of LBP and may stigmatise people based on psychosocial factors.…”

Ability of Therapists Trained in Mechanical Diagnosis and Therapy to Guess Pain Catastrophizing and Kinesiophobia Scores for Patients with Low Back Pain

“…Considering and appropriately addressing psychosocial barriers is a widely ac-cepted measure for successful management of low back pain (LBP) [1] [2] [3]. A study by Miki et al [4] included 78 patients with LBP and 21 physical therapists, and investigated whether the physical therapists could guess the scores of psychological Patient Reported Outcome Measures (PROMs) through physical therapy evaluation. The physical therapists could not guess the psychological PROM scores and the clinical experiences of the physical therapists did not enhance the accuracy of their guess.…”

“…However, another study [5] showed that trained physical therapists could guess patient anxiety through physical therapy evaluation. A potential reason for the discrepancy between the studies [4] [5] is the physical therapists' training level, and it was added to a research agenda to investigate whether certain post-graduate training programs might affect the ability of physical therapists to guess patient psychological PROM scores through physical therapy evaluation [4]. One promising post-graduate training program available around the world is the Mechanical Diagnosis and Therapy (MDT).…”

“…The primary aim of the current study was to investigate the possibility that a physical therapist trained through the MDT diploma program could guess PROM scores of individuals with LBP, which were used in the previous study [4], through history taking and physical evaluation. In this study, we conducted a pilot test with one MDT therapist.…”