We spend a lot of time performing thorough assessments. Are we missing something really, really important that can help with prognosis?
The research continues to strongly indicate exactly what FOTO team takes into consideration in the risk adjustment process. When a patient begins services, the amount of perceived disability matters with regard to the outcome of care. The level of functional ability is a very strong predictor. The research below indicates it was the highest predictor of outcome.
The next findings are interesting. How often do you ask if the patient believes services will be beneficial and that their condition will improve? This proves to be a powerful question. Patients who expected services to be beneficial had better outcomes.
Pain self-efficacy also proved to be valuable. Although the patients were experiencing pain, their belief about their ability to complete tasks while in pain provided insight into outcomes. Those who had high pain self-efficacy beliefs tended to attain better outcomes.
The findings suggest that gaining information from patients about expectations and pain self-efficacy are helpful pieces of information to help in providing care or making care decisions. FOTO does have self-efficacy measures included as optional assessments for you to include when gaining baseline information.
The abstract is included below for you to review.
Self-efficacy and risk of persistent shoulder pain:results of a Classification and Regression Tree (CART) analysis.
To (i) identify predictors of outcome for the physiotherapy management ofshoulderpainand (ii) enable clinicians to subgroup people intoriskgroups forpersistentshoulderpainand disability.
1030 people aged ≥18 years, referred to physiotherapy for the management of musculoskeletalshoulderpainwere recruited. 810 provided data at 6 months for 4 outcomes:ShoulderPainand Disability Index (SPADI) (total score,painsubscale, disability subscale) and Quick Disability of the Arm,Shoulderand Hand (QuickDASH). 34 potential prognostic factors were used in thisanalysis.
Fourclassificationtrees (prognostic pathways or decision trees) were created, one for each outcome. The most important predictor was baselinepainand/or disability: higher or lower baseline levels were associated with higher or lower levels at follow-up for all outcomes. One additional baseline factor split participants into four subgroups. For the SPADI trees, highpainself-efficacyreduced the likelihood of continuedpainand disability. Notably, participants with low baselinepainbut concomitant lowpainself-efficacyhad similar outcomes to patients with high baselinepainand highpainself-efficacy. Cut-off points for defining high and lowpainself-efficacydiffered according to baselinepainand disability. In the QuickDASHtree, the association between moderate baselinepainand disability with outcome was influenced by patient expectation: participants who expected to recover because of physiotherapy did better than those who expected no benefit.
Patient expectation andpainself-efficacyare associated with clinical outcome. These clinical elements should be included at the first assessment and a lowpainself-efficacyresponse considered as a target for treatment intervention.
Br J Sports Med.2019 Jan 9. pii: bjsports-2018-099450. doi: 10.1136/bjsports-2018-099450. [Epub ahead of print]
See what happens after a patient takes an assessment!