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What factors do physical therapists consider when determining patient prognosis: A mixed methods study
Matthew P Smith1,2, Brad Tracy1, Jason Soncrant1
1Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA.
Musculoskeletal Care
|September 15, 2023
Summary
Physical therapists utilize a complex biopsychosocial framework to prognose patient outcomes in musculoskeletal pain. Factors like mood, pain, and disease severity significantly influence prognosis and patient function at discharge.
Area of Science:
- Clinical reasoning and prognosis in physical therapy.
- Biopsychosocial model in musculoskeletal rehabilitation.
Background:
- Accurate prognosis is crucial for patient care, guiding expected progress and outcomes.
- While physical therapists' (PTs) prognostic accuracy is recognized, the specific factors they use remain unclear.
Purpose of the Study:
- To identify the prognostic domains and factors influencing physical therapists' clinical reasoning.
- To explore the relationship between PT prognosis and patient outcomes.
Main Methods:
- Mixed Methods Design combining qualitative interviews and quantitative analysis of patient data.
- Semi-structured interviews with 29 PTs to identify prognostic factors.
- Linear regression to assess the link between initial prognostic scores and functional outcomes at discharge.
Main Results:
- Significant correlations found between prognosis scores and patient-reported outcomes (Focus on Therapeutic Outcomes, Numeric Pain Rating Scale, Global Rating of Change).
- Key prognostic domains identified include Mood, Motivation, Pain Behaviors, Disease Severity, Health Status, Social/Occupation/Environmental factors, and Genetics/Biology/Biomarkers.
- A substantial proportion of factors (86.2%) were categorized as 'Other,' indicating novel considerations.
Conclusions:
- PT prognosis for musculoskeletal pain is linked to patient outcomes.
- PTs employ a complex biopsychosocial framework, integrating diverse factors into their prognostic reasoning.
- Findings highlight the multifaceted nature of clinical decision-making in physical therapy prognosis.
