A Study of Outcomes Following Collaborative Medical Doctor/Physical Therapist Primary Care Service for Musculoskeletal Problems

Background and Purpose: Collaborative medical doctor/physical therapist primary care services are not described in the literature. The 2 purposes of this observational study were to describe a collaborative medical doctor/physical therapist primary care service, and to describe simple, one question, outcomes including patient acceptable symptom state (PASS), global rating of normal function (GRNF), and success of treatment (SOT) at intake, 1 to 7 days, and 45 to 60 days follow-up. Methods: Patients were seen for 1 to 2 visits and typically received exercise, hands on treatment, ie, manual therapy, and education. Medical doctor/physical therapist collaborative encounters and provider training are described. Outcome measures were recorded at the first visit, via phone once between 1 to 7 days and once between 45 to 60 days. Descriptive data was calculated at each time point. Findings: Examples of collaborative diagnosis and treatment opportunities are tabulated. A total of 31.9% of patients were PASS Yes at intake (n=402). At 1 to 7 days (n=157; 50.3%) and 45 to 60 days (n=93; 55.9%), the proportion of PASS Yes patients were higher. There was little difference in the GRNF scale at any follow-up. At 45 to 60 days, the SOT question indicated most patients (45.7%) reported “improved” and 29.3% of patients reported as “partly cured” or “cured.” Clinical Relevance: Collaborative opportunities for diagnosis and treatment in primary care are provided. A model using the PASS, GRNF, and SOT questions for judging the urgency which a service needs modification to meet patient needs is proposed. Conclusion: A collaborative medical doctor/physical therapist model is a viable option to improve primary care services. This descriptive data suggests some level of success, however, there is little relevant data for comparison

Predicting Patients Acceptable Symptom State at Short Term Follow Up of a Collaborative Primary Care PT/MD Service

Hypothesis: Patient Reported Outcome Tools will predict a patient’s acceptable symptom state (PASS

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

OBJECTIVES: To determine if the Patient-Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, self-efficacy, and global rating of normal function (GRNF) scales are able to accurately characterize a patient\u27s acceptable symptom state (PASS). DESIGN: A cross-sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80% and 95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales. SETTING: Phone survey after primary care. PARTICIPANTS: Patients (N=94) 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\u3e.72) and the GRNF rating (AUC=.74). Identified PROMIS thresholds suggested PASS was achieved when scores were at or slightly worse than the US population average. A score of ≥7 and ≤4 characterized patients that were PASS Yes and No, respectively, on the GRNF rating. A moderate (80%) specificity/sensitivity criteria yielded 72.3%-73.5% accuracy for a majority of participants (\u3e69.9%). 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