Patient Centered Outcomes: Domain Importance Predicts Health Care Use
following Physical Therapy
Abstract
Rationale, aims, objectives: Identifying patients with musculoskeletal
pain at risk for additional health care use following physical therapy
is important for improving the value proposition of physical therapists.
We previously identified 3 patient subgroups based on importance of
improvement in specific outcomes: 1) Multiple Outcome Domains Important
(MDI), 2) Pain and Function Outcomes Important (PFI), and 3) Pain
Important (PI). Outcome importance subgroup membership has not been
investigated as a potential predictor of future care use. The aim of
this study was to determine whether patient-determined outcome
importance subgroup membership predicts healthcare utilization
subsequent to an episode of physical therapy for musculoskeletal pain.
Methods: 246 patients seeking physical therapy that provided 12-month
outcome data in the Orthopedic Physical Therapy Investigative Network’s
(OPT-IN) Optimal Screening for Prediction of Referral and Outcome
(OSPRO) cohort. Demographics, health-related history, numeric pain
rating, region specific disability, and comorbidly were collected at
baseline. Outcome importance subgroup membership was assigned based on
responses to the Patient Centered Outcome Questionnaire (PCOQ). At 1
year, patients reported use of health care since discharge from physical
therapy. Separate logistic regression models determined whether outcome
importance subgroup membership predicted additional healthcare or use of
specific services. Results: The PI subgroup had higher adjusted odds
(95% CI) of at least one additional health care service [aOR = 2.40
(1.01-5.71)]; and when specific services were further evaluated there
were higher odds of opioid use [aOR = 11.25, (3.50-36.20)],
injection [aOR = 4.41, (1.41-13.79)] and surgery [aOR = 5.58,
(1.32-23.66)]. There were no differences between the PFI and MDI group
for odds of additional health care use or any specific services.
Conclusions: Patients with a singular focus on improvements in pain are
at higher risk for opioid use, injection, and surgery following an
episode of care with a physical therapist.