Ability of Patient Reported Outcomes to Characterize Patient Acceptable Symptom State (PASS) After Attending a Primary Care Physical Therapist/Medical Doctor Collaborative Service: Cross Sectional Study

Publication date: Available online 13 September 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jeff Houck, Daniel Kang, Tyler Cuddeford, Sarah Rahkola

Abstract

Objectives

To determine if the patient reported outcome information system (PROMIS) physical function (PF), pain interference (PI), self-efficacy (SE) and global rating of normal function (GRNF) scales are able to accurately characterize a patient's acceptable symptom state (PASS).

Design

A cross sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80/95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales.

Setting

Phone survey after primary care

Participants

Ninety-four patients attending primary care for musculoskeletal problems.

Interventions

Not Applicable

Main Outcomes Measures

Accuracy and proportion of patients classified as PASS Yes or No.

Results

Receiver operator curve analysis showed significant area under the curve(AUC) values for each PROMIS scale (AUC >0.72) and the GRNF rating (AUC=0.74). Identified PROMIS thresholds suggested PASS was achieved when scores were at or slightly worse than the US population average. A score of 7 or higher and 4 or lower characterized patients that were PASS Yes/No, respectively, on the GRNF rating. A moderate (80%) specificity/sensitivity criteria yielded 72.3-73.5%% accuracy for a majority of participants (>69.9%).

Conclusion

This analysis suggests the PROMIS and GRNF scales are able to characterize PASS status with moderate accuracy (∼70%) for a large portion of patients (∼70%). New to this study is the association of self-efficacy with PASS status. PROMIS scales at or slightly worse than the US population average characterized PASS status.

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