Defining patient acceptable symptom state thresholds for commonly used patient reported outcomes measures in general...

Patient reported outcomes measures are distributed regularly within musculoskeletal physical therapy practice in an effort to track patient progress and response to treatment. A number of studies have reported on the amount of change necessary to identify the minimal clinically important difference. Few studies have identified thresholds signifying patient satisfaction with treatment and what patient specific factors may be influential in identifying patient satisfaction.

To identify thresholds amongst commonly used patient reported outcomes measures associated with the patient acceptable symptom state (PASS). To identify the confounding effects of demographic and psychosocial variables on reported PASS estimates.

Prospective cohort study.

A sample of convenience consisting of consecutive patients referred for outpatient physical therapy for general orthopaedic conditions fulfilling the eligibility criteria were included. All patients completed baseline demographic information as well as baseline pain and functional outcomes measures. The PASS question was used as the anchor in this study to identify patient thresholds. Patients completed outcomes measures every 2 weeks and at patient discharge. PASS thresholds were identified using receiver-operating curves maximizing sensitivity and specificity.

PASS thresholds were found to vary depending on baseline pain levels, functional status, socioeconomic status, educational level, and psychosocial status.

Multiple factors are influential in determining patient success following treatment. Clinicians should be aware of patient baseline pain and functional status as well as socioeconomic status, educational level, and psychosocial status and stratify patients accordingly when determining patient prognosis and developing a plan of care.