Allen Diane D, Talavera Carolina, Baxter Stephen, Topp Kimberly
Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA,
Qual Life Res. 2015 May;24(5):1137-43. doi: 10.1007/s11136-014-0888-0. Epub 2014 Dec 13.
To be patient-centered, assessment must extract what patients prefer to be able to do along with what they can do now so health care can specifically address the gap between current and preferred abilities. In this project, we compared patient-perceived current-preferred gaps with the assessments and interventions reported by clinicians in a rehabilitation clinic.
Sixty-two patients in outpatient physical therapy completed a computer-adaptive test version of the patient-reported Movement Ability Measure (MAM-CAT) at initial visit and discharge. The MAM-CAT calculated the gaps between the movement patients perceived that they could do "Now" and what movement ability they "Would Like" to have across six dimensions of movement: flexibility, strength, accuracy, speed, adaptability, and endurance. Physical therapists' notes regarding assessments and interventions were categorized based on these same six dimensions of movement. Frequency of agreement between the largest patient-perceived gaps and clinician-documented emphases was recorded (kappa analyses), along with MAM-CAT changes at discharge (paired t tests).
Although patient progress was noted in both the MAM-CAT and the clinician notes (p < .05), comparison showed poor or slight agreement (kappa < .05) between the specific movement dimensions patients regarded as having the largest gaps and the dimensions on which clinicians focused.
The MAM-CAT facilitated direct comparison of patients' current-preferred gaps at initiation and discharge with clinicians' emphases during episodes of care. While interventions were perceived as effective, collaboration between patients and clinicians using gap data could increase alignment between patient priorities and clinician emphases, potentially resulting in improved patient engagement and rehabilitative outcomes.
以患者为中心的评估必须了解患者希望能够做到的事情以及他们目前能够做到的事情，以便医疗保健能够具体解决当前能力与期望能力之间的差距。在本项目中，我们将患者感知的当前与期望差距与康复诊所临床医生报告的评估和干预措施进行了比较。
62名门诊物理治疗患者在初诊和出院时完成了患者报告的运动能力测量（MAM-CAT）的计算机自适应测试版本。MAM-CAT计算了患者在六个运动维度（灵活性、力量、准确性、速度、适应性和耐力）上感知到的“现在”能够进行的运动与“希望”具备的运动能力之间的差距。物理治疗师关于评估和干预措施的记录根据这相同的六个运动维度进行分类。记录最大的患者感知差距与临床医生记录的重点之间的一致频率（kappa分析），以及出院时MAM-CAT的变化（配对t检验）。
尽管在MAM-CAT和临床医生记录中均观察到患者有进步（p < .05），但比较显示，患者认为差距最大的特定运动维度与临床医生关注的维度之间的一致性较差或较弱（kappa < .05）。
MAM-CAT有助于直接比较患者在治疗开始和出院时当前与期望的差距以及临床医生在护理期间的重点。虽然干预措施被认为是有效的，但患者与临床医生利用差距数据进行合作可以提高患者优先事项与临床医生重点之间的一致性，有可能改善患者参与度和康复效果。
