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Baldwin J, Rodeghero J, Werneke MW, Mioduski JE, Jeffries L, Kucksdorf J, Shepherd M, Randall K, Dionne C, Dionne C. The effectiveness of post-professional physical therapist training in the treatment of chronic low back pain using a propensity score approach with machine learning. Musculoskeletal Care 2022; 20:625-640. [PMID: 35226394 PMCID: PMC9951186 DOI: 10.1002/msc.1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/07/2022]
Abstract
RATIONALE Low back pain (LBP) is a leading cause of disability in the United States creating substantial hardships through negative social, financial, and health effects. Chronic low back pain (CLBP) accounted for above half of patients treated in physical therapy (PT) clinics for LBP. However, research shows small benefit from PT in CLBP treatment. Preliminary evidence suggests clinician-level training variables may affect outcomes, but requires further investigation to determine whether patients with CLBP benefit from treatment by providers with post-professional training. This study examined the relationship between clinician training levels and patient-reported outcomes in CLBP treatment. METHODS Physical therapies were surveyed using a large patient outcome assessment system to determine and categorise them by level of post-professional education. To account for the possibility that clinicians with higher levels of training are referred more-complex patients, a machine learning approach was used to identify predictive variables for clinician group, then to construct propensity scores to account for differences between groups. Differences in functional status score change among pooled data were analysed using linear models adjusted for propensity scores. RESULTS There were no clinically meaningful differences in patient outcomes when comparing clinician post-professional training level. The propensity score method proved to be a valuable way to account for differences at baseline between groups. CONCLUSION Post-professional training does not appear to contribute to improved patient outcomes in the treatment of CLBP. This study demonstrates that propensity score analysis can be used to ensure that differences observed are true and not due to differences at baseline.
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Affiliation(s)
- Jonathan Baldwin
- The University of Oklahoma Health Sciences Center, College of Allied Health, Department of Medical Imaging and Radiation Sciences, Oklahoma City OK, USA
| | - Jason Rodeghero
- Tufts University, Department of Public Health & Community Medicine, School of Medicine, Boston MA, USA
| | | | | | - Lynn Jeffries
- The University of Oklahoma Health Sciences Center, College of Allied Health, Department of Medical Imaging and Radiation Sciences, Oklahoma City OK, USA
| | - Joseph Kucksdorf
- Bellin Health, Orthopedics and Sports Medicine, Green Bay WI, USA
| | - Mark Shepherd
- Bellin College, Physical Therapy Department, Green Bay WI, USA
| | - Ken Randall
- The University of Oklahoma Health Sciences Center, College of Allied Health, Department of Medical Imaging and Radiation Sciences, Oklahoma City OK, USA
| | - Carol Dionne
- The University of Oklahoma Health Sciences Center, College of Allied Health, Department of Medical Imaging and Radiation Sciences, Oklahoma City OK, USA
| | - Carol Dionne
- College of Allied Health, Department of Medical Imaging and Radiation Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Rufa A, Kolber MJ, Rodeghero J, Cleland J. The impact of physical therapist attitudes and beliefs on the outcomes of patients with low back pain. Musculoskelet Sci Pract 2021; 55:102425. [PMID: 34298493 DOI: 10.1016/j.msksp.2021.102425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common problem that places a major burden on individuals and society. It has been proposed that patients treated by biomedically oriented clinicians will have worse outcomes than those treated by biopsychosocially oriented clinicians. OBJECTIVE To investigate the impact of physical therapist LBP related attitudes and beliefs on the outcomes of patients with LBP. DESIGN Retrospective cohort design. METHOD United States based physical therapists utilizing the Focus on Therapeutic Outcomes, Inc. (FOTO) database were surveyed using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using average Computerized Lumbar Functional Scale change scores (CLFS) and CLFS residual scores. RESULTS Analysis was performed on outcome data from 78 physical therapist and included 2345 patients. HC-PAIRS was a univariate predictor of average CLFS change scores and average CLFS residual scores. PABS-PT Biomedical subscale was a univariate predictor of average CLFS change scores. After adjusting for confounding variables, higher HC-PAIRS scores and PABS-BM scores were associated with a greater change in average CLFS score, and higher PABS-BM scores were associated with higher CLFS residual scores. CONCLUSION Physical therapists who believed in a stronger relationship between pain and disability had improved patient outcomes.
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Affiliation(s)
- Adam Rufa
- SUNY Upstate Medical University, Syracuse, NY, USA; Nova Southeastern University, Fort Lauderdale, FL, USA.
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Affiliation(s)
- Paul E Mintken
- Department of Physical Therapy, University of Colorado School of Medicine, Aurora, CO, USA.,Wardenburg Health Center, University of Colorado, Boulder, CO, USA.,Rehabilitation, OSF Healthcare, Peoria, IL, USA.,South College, Knoxville, TN, USA.,Franklin Pierce University, Manchester, NH, USA
| | - Jason Rodeghero
- Rehabilitation, OSF Healthcare, Peoria, IL, USA.,South College, Knoxville, TN, USA.,Franklin Pierce University, Manchester, NH, USA
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Salamh PA, Reiman M, Cleland J, Mintken P, Rodeghero J, Cook CE. Risk Stratification for 4,837 Individuals with Knee Pain Who Receive Physical Therapy Treatment. Musculoskeletal Care 2017; 15:122-130. [PMID: 27374889 DOI: 10.1002/msc.1150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Risk stratification is a modelling method that is designed to target interventions toward patients with specific needs. The objective of the present study was to identify predictive characteristics related to patients with knee impairments who had a high risk of a bad prognosis (exceptional non-responders) as well as those who were at low risk of a bad prognosis (exceptional responders). A cohort of 4,837 patients with knee pain seen for physical therapy was retrospective analysed using univariate and multivariate multinomial regression analyses. Modelling was used to identify characteristics associated with those who were exceptional responders and those who were exceptional non-responders. Exceptional non-responders were significantly associated with older age, female gender, longer duration of symptoms, surgical history, lower functional status at baseline and a payer type. Exceptional responders were significantly associated with younger age, no previous surgical history, higher functional status at baseline and a payer type. Findings may be used for managing processes involving intensity of care service and in understanding probable prognoses for each patient. Future research should continue to examine variables predictive of treatment response in patients with knee pain. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Paul Mintken
- University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
INTRODUCTION The aim of the present study was to identify predictive characteristics related to patients with neck impairments who have a high risk of a poor prognosis (lowest functional recovery compared to visit utilization) as well as those who are at low risk of a poor prognosis (highest functional recovery compared to visit utilization). METHODS A retrospective cohort of 3,137 patients with neck pain who were seen for physiotherapy care was included in the study. All patients were seen at physiotherapy clinics in the United States and were provided with care in a manner in which the physiotherapists felt was appropriate and necessary. Univariate and multivariate multinomial regression analyses were used to identify significant patient characteristics predictive of treatment response. RESULTS Statistically significant predictors of high-risk categorization included longer duration of symptoms, surgical history and lower comparative levels of disability at baseline. Statistically significant predictors of low-risk categorization were younger age, shorter duration of symptoms, no surgical history, fewer comorbidities and higher comparative disability levels of function at baseline. DISCUSSION Few studies have analysed risk stratification models for neck pain, and the findings of the present study suggest that predictors of poor success are similar to those in most musculoskeletal prognostic models. Limitations of the study included those inherent in secondary analysis and the inability to identify the diagnoses of the patients. CONCLUSIONS Future research should continue to examine the variables predictive of treatment response in patients with neck pain. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jason Rodeghero
- OSF Saint James - John W. Albrecht Medical Center, Pontiac, IL, USA
| | | | - Paul Mintken
- University of Colorado, School of Medicine, Aurora, CO, USA
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Affiliation(s)
- Jason Rodeghero
- OSF Saint James-John W Albrecht Medical Center, Pontiac, IL 61764, USA
| | - Chad Cook
- Department of Orthopaedics, Duke University, Durham, NC 27514, USA.
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Rodeghero J, Smith, Jr. AR. Role of Manual Physical Therapy and Specific Exercise Intervention in the Treatment of a Patient with Cervicogenic Headaches: A Case Report. J Man Manip Ther 2013. [DOI: 10.1179/106698106790835768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Baker K, Rodeghero J, Cowley H, Bone A. On "A new evaluation method for lumbar spinal instability..." Kasai et Al. Phys Ther. 2006;86:1661-1667. Phys Ther 2007; 87:812; author reply 812-3. [PMID: 17545172 DOI: 10.2522/ptj.2007.87.6.812.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Rodeghero J. Managed care is forcing changes in physician compensation incentives. Med Netw Strategy Rep 1995; 4:11-2. [PMID: 10153142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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