Abstract
Background: Value-based care models call for better interpretation of patient-reported outcomes. Patients may reference health status differently when appraising if an intervention was successful versus if their current state is acceptable. The purpose of this study was to determine the association between success of treatment (SOT), patient acceptable symptom state (PASS), and PROMIS measure T-scores, following a single primary care physical therapy encounter.
Methods: Cross-sectional study. Ninety-two patients with musculoskeletal complaints were administered standard SOT and PASS questions, and PROMIS Physical Function, Pain Interference, and Self-Efficacy for Managing Symptoms measures. Association of PASS and SOT was determined using rank biserial correlation and chi-squared analysis. Accuracy of PROMIS T-scores to discriminate PASS and SOT was determined through receiver-operator curve analysis and likelihood ratios.
Results: There was significant association between PASS and SOT (r=.393, p<0.001; X2=15.7, p=0.001). The three PROMIS measures discriminated PASS with AUCs of 0.73 to 0.88 (accuracy 67.3% to 82.6%), Self-Efficacy being the strongest discriminator. Only Pain Interference T-scores discriminated SOT with AUC >0.70 (accuracy 76.1%).
Conclusion: PASS was more strongly associated with health status than SOT. Patients make a meaningful distinction between these two questions. Accurate clinician interpretation of PASS, SOT, and PROMIS T-scores can allow more targeted goal setting and treatment decision making.