File
Allen D.1, Baxter S.2, Topp K.2
1University of California San Francisco/ San Francisco State University, Graduate Program in Physical Therapy, San Francisco, United States, 2University of California, San Francisco, Physical Therapy and Rehabilitation Science, San Francisco, United States
Background: Although assumed to be beneficial, the effect of patient participation on health care outcomes is rarely measured directly. Evidence that patient-clinician collaboration enhances outcomes requires theory and methodology linking patient values to therapeutic results. We used a theory-based measure to assess the difference when patients and physical therapists collaborated to focus treatment. The instrument was a computer-adaptive test version of the Movement Ability Measure (MAM-CAT) in which patients self- identify what they can do currently and what they prefer to be able to do. The differences or gaps between current and preferred movement abilities are calculated for 6 movement dimensions: flexibility, strength, accuracy, speed, adaptability, and endurance. The movement dimensions with the largest gaps reveal the areas that patients are least satisfied with their current abilities. A smaller movement ability gap post-discharge reflects the success of therapy, showing decreased disability and optimized movement ability in ways that patients value.
Purpose: The purpose of this study was to examine the effect of patient-clinician discussion of the movement dimensions with the largest gaps between patients' current and preferred abilities. We expected that this discussion would help focus treatment on the dimensions of most value to patients, and hypothesized a resultant decrease in patients´ current-preferred gap post-treatment compared to gaps of patients who did not have these discussions with their therapist.
Methods: 326 patients in outpatient physical therapy completed the MAM-CAT at initial visit, discharge, and one-month follow-up. Current-preferred gaps for the 6 dimensions of movement were recorded. Physical therapists notes regarding assessments and interventions were categorized by two separate reviewers according to the same 6 dimensions of movement. Patient-clinician agreement on the movement dimensions on which to focus treatment were assessed under two conditions:
1) for 62 patients, the clinician did not see the MAM-CAT responses; and
2) for 264 patients, the clinician and patient reviewed the responses together to plan treatment.
Frequency of agreement between the largest patient-perceived gaps and clinician-documented foci of care were recorded for kappa analyses. MAM-CAT changes at discharge for the two groups of patients were analyzed using t-tests.
Results: 84% of patients had musculoskeletal diagnoses; 75% had pain as a primary problem. Agreement between patients and clinicians on the focus of care was no more than random chance (kappa .02) when the clinicians did not see patients responses on the MAM-CAT (condition 1), but improved in condition 2. The average decrease in total gap size at discharge was significantly different (p .001) when patients and clinicians viewed responses together at treatment initiation.
Conclusion(s): Examining current-preferred gap sizes on different movement dimensions facilitated direct comparison of patients perceptions at initial visit with clinicians treatment foci during episodes of care. While interventions were typically effective, effectiveness was greater with patient-clinician collaboration in determining the emphasis of care.
Implications: Unless specifically discussing it, clinicians and patients do not consistently agree on which current-preferred gap to mind. Patient-clinician collaboration in treatment planning using current-preferred gap data can increase alignment between patient priorities and clinician emphases, resulting in improved patient engagement and therapeutic effectiveness.
Funding acknowledgements: This study was partially funded by a grant to DDA from the Patient-Centered Outcomes Research Institute (PCORI_R120190).
Topic: Research methodology & knowledge translation
Ethics approval: The study was approved by the ethics boards of San Francisco State University and University of California San Francisco.
All authors, affiliations and abstracts have been published as submitted.
