Risk Adjustment of the Modified Low Back Pain Disability Questionnaire and Neck Disability Index to Benchmark
Adam D Lutz1, John M Brooks2, Cole G Chapman3
1Department of Exercise Science, University of South Carolina, 200 Patewood Dr, Suite 150C, Greenville, SC 29615 (USA); ATI Physical Therapy, Greenville, South Carolina; and SC Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina.
Physical Therapy
|April 15, 2020
Summary
Risk-adjusted outcomes show that most physical therapists meet expectations for spine condition management. This study benchmarks performance using patient-reported outcomes like the Modified Low Back Pain Disability Questionnaire and Neck Disability Index.
Area of Science:
- Orthopedics
- Physical Therapy
- Health Services Research
Background:
- Patient-reported outcomes (PROs) are crucial for assessing healthcare quality, especially in managing common orthopedic spine conditions.
- Validated PROs like the Modified Low Back Pain Disability Questionnaire (MDQ) and Neck Disability Index (NDI) are essential for evaluating back and neck pain management.
- However, the utility of MDQ and NDI as performance measures requires rigorous evaluation.
Purpose of the Study:
- To benchmark physical therapists' performance in non-surgical spine condition management.
- To utilize risk-adjusted MDQ and NDI outcomes for performance evaluation.
- To establish a standardized method for assessing physical therapy quality in spine care.
Main Methods:
- Retrospective observational study analyzing 182,276 patient treatment episodes (2015-2018).
- Employed linear models for risk adjustment, controlling for baseline PROs and patient characteristics.
- Calculated aggregated performance ratios (actual vs. predicted PRO change) and used bootstrapping for median ratio determination.
Main Results:
- 10-11% of physical therapists outperformed, 78-79% met expectations, and 11% underperformed based on risk-adjusted MDQ and NDI.
- Risk adjustment revealed significant performance differences compared to unadjusted scores, even in homogeneous patient subsets.
- Clinically meaningful improvements were noted in outperforming therapists' patient-reported outcomes.
Conclusions:
- Risk-adjusted PROs provide a more accurate assessment of physical therapist performance in spine care than raw scores.
- The study highlights the importance of risk adjustment for fair performance benchmarking.
- Further research is needed to define clinically meaningful performance ratio differences for practical application.
