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Patient Centered Outcomes: Domain Importance Predicts Health Care Use following Physical Therapy
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  • Giorgio Zeppieri,
  • Steven George,
  • Joel Bialosky,
  • Trevor Lentz
Giorgio Zeppieri
UF Health

Corresponding Author:[email protected]

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Steven George
Duke University
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Joel Bialosky
University of Florida
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Trevor Lentz
Duke University
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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.
02 Sep 2021Published in PM&R. 10.1002/pmrj.12680