I realize that outcomes typically focuses on results of care. I can appreciate this interesting twist. I find it interesting to learn what a patient may define as a successful outcome, an expected outcome and a desired outcome.
What's nice to see is that the majority of patients may be realistic in their thoughts. It seems that patients define success and expectations in line with the outcomes of care that may actually happen. Although it doesn't seem that what patients desire to happen actually happens, what they desired to happen didn't determine success.
When I think back to the early 90's and how the world was then, I wonder if desired outcomes actually happened more frequently than compared to now? It just seems that physical therapists have more and more regulatory burdens and are monitored more on their outcomes that it feels that even we may have been lowering our focus to not provide the patient's actual desired outcome.
Here's a quick view of the abstract.
Patient-defined desired outcome, success criteria, and expectation in outpatient physical therapy: a longitudinal assessment.
Patient-centered approaches offer an alternative method in evaluating treatment outcomes. This study investigated; 1) if patient's criteria for success (satisfaction of clinical outcomes) changes from pre to post treatment, 2) whether patients who met their success criteria also meet minimal clinical important difference scores (MCIDs), and 3) if patient's success criteria differed from their expected (what the patient believes will occur) and desired (what the patient wants to occur) outcomes following intervention.
A consecutive sample of 225 subjects with complaints of musculoskeletal pain was referred to an outpatient, sports medicine physical therapy clinic. Participants completed the Patient Centered Outcome Questionnaire (PCOQ) prior to their initial evaluation session and a follow-up PCOQ at discharge. The PCOQ asks subjects to rate their pain, fatigue, emotional distress, and interference with daily activities for usual, desired, successful, and expected levels, and how important improvement is for each domain on a 101-point numerical rating scale. Paired-sample T-test were used to determine patient's pre and post success criterion and whether success criteria differed from desired and expected outcomes following intervention. Chi-squared were used to determine if individuals desired, expected, and success criteria for treatment outcome differed from established MCIDs.
The results revealed no change in success criteria pre to post treatment for all domains. Chi-square test revealed patients desired, expected, and success criteria were independent of established MCIDs (P > .01). There were no differences between patients expected outcomes and success criteria. However, there were differences between patient's desired outcomes and expected and success outcomes, with patients reporting lower desired levels of pain, emotional distress, fatigue, and interference with daily activities following physical therapy intervention (P < .01).
Patients in this setting do not appear to modify their success criteria throughout the course of outpatient physical therapy. Additionally, individually defined success criterion differs from established clinically important changes. Clinicians interested in a broader assessment of outcome need to consider patient determined criterion in addition MCIDs. Furthermore, desired outcomes are lower than both expectation and success criteria. In this setting, outcomes following physical therapy episodes were likely to meet patient's expectations and success criteria but not desired criterion.