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Patient-reported outcome measurements (PROMs): Use during the physical therapy practice and associated factors. Musculoskelet Sci Pract 2023; 64:102744. [PMID: 36913901 DOI: 10.1016/j.msksp.2023.102744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE To assess the current level of routine use of psychosocial-related patient-reported outcome measurements (PROMs) in physical therapy practice and which physical therapist-level factors are associated with the use of these measurement instruments. METHODS We conducted an online survey study among Spanish physical therapists involved in the treatment of LBP patients in Public Health Service, Mutual Insurance Companies, and private practice during 2020. Descriptive analyses were conducted for reporting the number and instruments utilized. Thus, sociodemographic and professional features differences between PTs using and not using PROM were analyzed. RESULTS From 485 physiotherapists completing the questionnaire nationwide, 484 were included. A minority of therapists routinely used psychosocial-related PROMs (13.8%) in LBP patients and only 6.8% did so through standardized measurements instruments. The Tampa Scale for Kinesiophobia (28.8%) and the Pain Catastrophizing Scale (15.1%) were used most frequently. Physiotherapists working in Andalucía and País Vasco regions, in private practice environments, educated in psychosocial factors evaluation and management, considering psychosocial factors during the clinical practice and expecting patients' collaborative attitudes demonstrated significantly greater use of PROMS (p < 0.05). CONCLUSIONS This study showed that the majority of physiotherapists in Spain do not use PROMs for evaluating LBP (86.2%). From those physiotherapists using PROMs, approximately the half use validated instruments such as the Tampa Scale for Kinesiophobia or the Pain Catastrophizing Scale while the other half limit their evaluation to anamnesis and non-validated questionnaires. Therefore, developing effective strategies to implement and facilitate the use of psychosocial-related PROMs would enhance the evaluation during the clinical practice.
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Knoop J, van Lankveld W, Beijer L, Geerdink FJB, Heymans MW, Hoogeboom TJ, Hoppenbrouwers S, van Overmeeren E, Soer R, Veenhof C, Vissers KCP, van der Wees PJ, Sappelli M, Staal JB. Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care. BMC Musculoskelet Disord 2022; 23:834. [PMID: 36057717 PMCID: PMC9440317 DOI: 10.1186/s12891-022-05718-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling. Methods Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis. Results Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice. Conclusions We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05718-7.
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Affiliation(s)
- J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.
| | - W van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands
| | - L Beijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Research and Innovation Department, Sint Maartenskliniek, Nijmegen, Netherlands
| | - F J B Geerdink
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands
| | - M W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - S Hoppenbrouwers
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - E van Overmeeren
- Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands
| | - R Soer
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Pain Center, Groningen, Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, Netherlands
| | - K C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - P J van der Wees
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - M Sappelli
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - J B Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
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Karstens S, Zebisch J, Wey J, Hilfiker R, Hill JC. Validation of the German version of the STarT-MSK-Tool: A cohort study with patients from physiotherapy clinics. PLoS One 2022; 17:e0269694. [PMID: 35776764 PMCID: PMC9249194 DOI: 10.1371/journal.pone.0269694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The STarT-MSK-Tool is an adaptation of the well established STarT-Back-Tool, used to risk-stratify patients with a wider range of musculoskeletal presentations. OBJECTIVE To formally translate and cross-culturally adapt the Keele STarT-MSK risk stratification tool into German (STarT-MSKG) and to establish its reliability and validity. METHODS A formal, multi-step, forward and backward translation approach was used. To assess validity patients aged ≥18 years, with acute, subacute or chronic musculoskeletal presentations in the lumbar spine, hip, knee, shoulder, or neck were included. The prospective cohort was used with initial data collected electronically at the point-of-consultation. Retest and 6-month follow-up questionnaires were sent by email. Test-retest reliability, construct validity, discriminative ability, predictive ability and floor or ceiling effects were analysed using intraclass correlation coefficient, and comparisons with a reference standard (Orebro-Musculoskeletal-Pain-Questionnaire: OMPQ) using correlations, ROC-curves and regression models. RESULTS The participants' (n = 287) mean age was 47 (SD = 15.8) years, 51% were female, with 48.8% at low, 43.6% at medium, and 7.7% at high risk. With ICC = 0.75 (95% CI 0.69; 0.81) test-retest-reliability was good. Construct validity was good with correlations for the STarT-MSKG-Tool against the OMPQ-Tool of rs = 0.74 (95% CI 0.68, 0.79). The ability of the tool [comparison OMPQ] to predict 6-month pain and disability was acceptable with AUC = 0.77 (95% CI 0.71, 0.83) [OMPQ = 0.74] and 0.76 (95% CI 0.69, 0.82) [OMPQ = 0.72] respectively. However, the explained variance (linear/logistic regression) for predicting 6-month pain (21% [OMPQ = 17%]/logistic = 29%) and disability (linear = 20%:[OMPQ = 19%]/logistic = 26%), whilst being comparable to the existing OMPQ reference standard, fell short of the a priori target of ≥30%. CONCLUSIONS The German version of the STarT-MSK-Tool is a valid instrument for use across multiple musculoskeletal conditions and is availabe for use in clinical practice. Comparison with the OMPQ suggests it is a good alternative.
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Affiliation(s)
- Sven Karstens
- Department of Computer Science, Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
- * E-mail:
| | | | - Johannes Wey
- Department of Computer Science, Formerly Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Jonathan C. Hill
- School of Medicine, Keele University, Staffordshire, United Kingdom
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Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden. Musculoskelet Sci Pract 2021; 55:102414. [PMID: 34153691 DOI: 10.1016/j.msksp.2021.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physiotherapists in primary health care are required to use patient reported outcome measures (PROMs) to manage patients with low back pain (LBP). OBJECTIVE Our aim was to explore and describe how physiotherapists in primary care managing patients with LBP, experience the use of PROMs with a focus on facilitating and hindering factors. METHODS We undertook a qualitative study with semi-structured interviews. Fifteen physiotherapists (9 female and 6 male) were included. The interviews were audio-recorded and transcribed verbatim and analysed by inductive manifest content analysis. RESULTS Our findings resulted in eight main categories: PROMs give structure and increase patient involvement; Patients' motivations to use PROMs; Time and the physiotherapist's clinical priorities; Physiotherapists' routines steer their use of PROMs; Physiotherapists' competences in using PROMs; Organizations and managers steer the use of PROMs; Prerequisites for future use of PROMs; Using PROMs develops the physiotherapy profession. CONCLUSION Our findings show that using PROMs gives structure and increases patient involvement, but the patient's motivation to use PROMs needs to be taken into consideration. Time and routines influence the use of PROMs and these factors depend on organizational and managerial levels. Using PROMs is believed to help develop the physiotherapy profession. Prerequisites for future use, such as digitalization and increased competence, need to be fulfilled. Future studies should focus on increasing physiotherapists' knowledge about relevant PROMs, and study implementation in clinical practice, thereby improving the physiotherapy profession's quality of care.
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