PMID- 34324693
OWN - NLM
STAT- MEDLINE
DCOM- 20211215
LR  - 20211215
IS  - 1538-6724 (Electronic)
IS  - 0031-9023 (Linking)
VI  - 101
IP  - 10
DP  - 2021 Oct 1
TI  - Predicting Clinical Improvement for Patients With Low Back Pain: Keeping It 
      Simple for Patients Seeking Physical Therapy Care.
LID - pzab176 [pii]
LID - 10.1093/ptj/pzab176 [doi]
AB  - OBJECTIVE: This study sought to develop and validate an original prediction 
      formula that estimated the probability of success for patients with low back pain 
      (LBP) to achieve a minimal clinically important difference (MCID) on the Modified 
      Low Back Disability Questionnaire (MDQ). METHODS: Patients were 10 to 90 years 
      old in this retrospective cohort study. Data were extracted from Intermountain 
      Healthcare's registry, Rehabilitation Outcomes Management System: 62,858 patients 
      admitted to physical therapy from 2002 to 2013 formed the training dataset, and 
      15,128 patients admitted 2015 to 2016 formed the verification dataset. Predicted 
      probability to achieve MCID was compared with the actual percentage who 
      succeeded. Two models were developed: 6-point improvement and 30% improvement. 
      MDQ assessed disability, and numeric pain score assessed pain intensity. 
      Predictive models used restricted cubic splines on age, initial pain, and 
      disability scores for non-linear effects. Sex, symptom duration, and payer type 
      were included as indicator variables. Predicted chance of success was compared 
      with the actual percentage of patients that succeeded. Relative change in 
      R-squared was calculated to assess variable importance in predicting success. 
      Odds ratios for duration of injury and payer were calculated. RESULTS: A positive 
      trend was observed in both models between predicted and actual success achieved. 
      Both "verification" models appear accurate and closely approximate the "training 
      dataset." Baseline MDQ score was the most important factor to predict a 6-point 
      improvement. Payer type and injury duration were important factors to predict 30% 
      improvement. Best odds to achieve an MCID was having a workers compensation 
      insurance payer and seeking care within 14 days. CONCLUSION: The 2 models 
      demonstrated an accurate visualization of the chance of patients achieving 
      significant improvement compared with the usual representation of the average 
      rate of improvement for all patients. IMPACT: Enhancing physical therapists' 
      understanding of the probability of a patient achieving significant clinical 
      improvement can enhance decision-making processes and help physical therapists 
      manage a patient's care more effectively.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      American Physical Therapy Association. All rights reserved. For permissions, 
      please email: journals.permissions@oup.com.
FAU - Brennan, Gerard P
AU  - Brennan GP
AD  - Intermountain Healthcare, Salt Lake City, Utah, USA.
FAU - Snow, Gregory L
AU  - Snow GL
AD  - Intermountain Healthcare, Salt Lake City, Utah, USA.
FAU - Minick, Kate I
AU  - Minick KI
AUID- ORCID: 0000-0003-4683-1937
AD  - Intermountain Healthcare, Salt Lake City, Utah, USA.
FAU - Hunter, Stephen J
AU  - Hunter SJ
AD  - Intermountain Healthcare, Salt Lake City, Utah, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Phys Ther
JT  - Physical therapy
JID - 0022623
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Disability Evaluation
MH  - Humans
MH  - Low Back Pain/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Minimal Clinically Important Difference
MH  - Outcome Assessment, Health Care
MH  - Pain Measurement
MH  - Physical Therapists/*psychology
MH  - *Physical Therapy Modalities
MH  - Predictive Value of Tests
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Surveys and Questionnaires
MH  - Young Adult
OTO - NOTNLM
OT  - Low Back Pain
OT  - Outcome Assessment (Health Care)
OT  - Prognosis
EDAT- 2021/07/30 06:00
MHDA- 2021/12/16 06:00
CRDT- 2021/07/29 17:35
PHST- 2020/08/25 00:00 [received]
PHST- 2021/06/28 00:00 [revised]
PHST- 2021/07/04 00:00 [accepted]
PHST- 2021/07/30 06:00 [pubmed]
PHST- 2021/12/16 06:00 [medline]
PHST- 2021/07/29 17:35 [entrez]
AID - 6326850 [pii]
AID - 10.1093/ptj/pzab176 [doi]
PST - ppublish
SO  - Phys Ther. 2021 Oct 1;101(10):pzab176. doi: 10.1093/ptj/pzab176.