Lentz Trevor A, Beneciuk Jason M, George Steven Z
Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA.
Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
BMC Health Serv Res. 2018 Aug 20;18(1):648. doi: 10.1186/s12913-018-3470-6.
In the United States, value-based purchasing has created the need for healthcare systems to prospectively identify patients at risk for high healthcare utilization beyond a physical therapy episode for musculoskeletal pain. The purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode of physical therapy for musculoskeletal pain.
This study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) longitudinal cohort study that recruited individuals with a primary complaint of neck, low back, knee or shoulder pain in physical therapy (n = 440). Demographics, health-related information, review of systems, comorbidity and pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in pain intensity, disability, and pain-related psychological distress were measured as treatment response variables. At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models were developed for any subsequent care and service-specific utilization.
Subsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain intensity, disability and pain-related psychological distress predicted specific service utilization.
In those completing follow up measures, risk of additional pain-related healthcare utilization after physical therapy was best predicted by baseline characteristics and 4-week treatment response variables for pain intensity, disability and pain-related psychological distress. These findings suggest treatment monitoring of specific response variables could enhance identification of those at risk for future healthcare utilization in addition to baseline assessment. Further study is required to determine how specific characteristics of the clinical encounter influence future utilization.
在美国，基于价值的采购使得医疗保健系统需要前瞻性地识别出在肌肉骨骼疼痛的物理治疗疗程之外有高医疗利用率风险的患者。本研究的目的是确定肌肉骨骼疼痛物理治疗索引疗程后与疼痛相关的医疗保健利用的预测因素。
本研究评估了“转诊与结果预测的最佳筛查”（OSPRO）纵向队列研究的数据，该研究招募了在物理治疗中主要抱怨颈部、下背部、膝盖或肩部疼痛的个体（n = 440）。在基线评估时收集了人口统计学、健康相关信息、系统回顾、合并症和与疼痛相关的心理困扰测量数据。将疼痛强度、残疾和与疼痛相关的心理困扰从基线到4周的变化作为治疗反应变量进行测量。在基线评估后的6个月和1年，个体报告了在随访期间因疼痛状况使用阿片类药物、注射、手术、诊断测试或成像以及急诊就诊的情况。针对任何后续护理和特定服务利用情况分别建立了预测模型。
完成12个月随访（n = 246）的研究样本中有43%（n = 106）报告了后续与疼痛相关的医疗保健利用情况。基线残疾和疼痛强度4周的变化是后续医疗保健利用的重要总体预测因素。年龄、保险状况、合并症负担、基线疼痛以及疼痛强度、残疾和与疼痛相关的心理困扰4周的变化预测了特定服务的利用情况。
在完成随访测量的人群中，物理治疗后额外的与疼痛相关的医疗保健利用风险最好通过基线特征以及疼痛强度、残疾和与疼痛相关的心理困扰的4周治疗反应变量来预测。这些发现表明，除了基线评估外，对特定反应变量的治疗监测可以增强对未来有医疗保健利用风险人群的识别。需要进一步研究以确定临床接触的特定特征如何影响未来的利用情况。
