Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain

RESEARCH ARTICLE Difference between physical therapist estimation and psychological patientreported outcome measures in patients with low back pain Takahiro Miki ID1☯, Yu Kondo1☯, Tsuneo Takebayashi2, Hiroshi Takasaki ID3* 1 Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Hokkaido, Japan, 2 Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Hokkaido, Japan, 3 Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama, Japan a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Miki T, Kondo Y, Takebayashi T, Takasaki H (2020) Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain. PLoS ONE 15(1): e0227999. https://doi.org/ 10.1371/journal.pone.0227999 Editor: Stefan Hoefer, Medical University Innsbruck, AUSTRIA Received: September 25, 2019 Accepted: January 3, 2020 Published: January 21, 2020 Copyright: © 2020 Miki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. ☯ These authors contributed equally to this work. * Abstract Minimizing the number of patient-reported outcome measures (PROMs) can reduce patient burden. The primary aim of the present study was to investigate whether physical therapists (PTs) can estimate psychological PROM scores in patients with low back pain (LBP) through physical therapy evaluation. The secondary aims were; 1) to investigate whether the clinical experiences of PTs influence correlations between PT estimates and psychological PROM scores, and 2) to investigate the sensitivity and specificity of PT estimates for the psychological features detected by the PROMs. We recruited hospitalized patients owing to LBP, who underwent evaluation by PTs on the initial day of hospitalization. Patients completed PROMs, including the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale immediately before the initial physical therapy session. PTs rated the magnitude of patient kinesiophobia, pain catastrophizing, anxiety, and depression using an 11-point numerical rating scale (NRS; 0 = not detected at all, 10 = very highly detected) through physical therapy evaluation immediately after the initial session. The PTs were blinded to the PROM results. We categorized PTs into two subgroups (PTs with �4 years and those with <4 years of clinical experience). Data from 78 patients (mean [SD] age = 60.5 [16.3] years) and 21 PTs were analyzed. A statistically significant but weak correlation (P = .04, Spearman’s ρ = .24) was detected only in the total PCS scores and PT NRS scores in a dataset of all patients and PTs. Further, there were no statistically significant differences in correlations (all P >.05) between the two subgroups of PTs in all measures. Low sensitivity and high specificity of PT estimates for psychological features through physical therapy evaluation were identified in all PROMs when PT NRS scores were categorized into the binary score by 5 (negative: <5; positive: �5). Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0227999 January 21, 2020 1 / 10 Difference between physical therapist estimation and patient-reported outcome measures Introduction Low back pain (LBP) causes substantial burden globally, and the disability level and prognosis of LBP are known to be associated with psychological features, including kinesiophobia, pain catastrophizing, anxiety, and depression [1,2,3]. Thus, it is important for physical therapists (PTs) to understand a patient’s magnitude of psychological deficits in order to undertake LBP management from biopsychosocial perspectives. Minimizing the number of patient-reported outcome measures (PROMs) can reduce patient burden [4]. It is reported that general practitioners have low sensitivity with regard to the identification of kinesiophobia and pain catastrophizing in patients with acute LBP. However, a previous study reported the possibility of identifying the characteristics of patients with increased kinesiophobia through clinical gait assessment [5]. Therefore, it can be hypothesized that PTs, who are experts in movement evaluation, may be able to estimate similar features of psychological deficits through physical therapy evaluation including clinical interview/ subjective and physical assessments. The clinical experiences of PTs can be a confounding factor of the ability to estimate some psychological features through physical therapy evaluation [6]. It is demonstrated that the clinical experiences of PTs influenced the accuracy of PT estimates for the patient anxiety rating scale in the 10-item Örebro Musculoskeletal Pain Screening Questionnaire (OMSQ) [6]. However, this study [6] had limitations as psychological deficits were not evaluated with established measures and cutoff values were not considered. Therefore, a new study involving PROMs that are commonly used in research and clinical practice with cutoff scores is required to further understand whether the clinical experiences of PTs influence the accuracy of PT estimates for the psychological PROM scores in patients with LBP through physical therapy evaluation. Further, it would be beneficial to understand the sensitivity and specificity of PT estimates for the psychological status through physical therapy evaluation by considering the cutoff values in the PROMs in order to consider strategies to minimize patient burden associated with responding to many PROMs. The primary aim of the present study was to investigate whether PTs can estimate psychological PROM scores, including kinesiophobia, pain catastrophizing, anxiety, and depression, in patients with LBP through physical therapy evaluation. The secondary aims were; 1) to investigate whether the clinical experiences of PTs influence correlations between PT estimates and psychological PROM scores, and 2) to investigate the sensitivity and specificity of PT estimates for the psychological status detected by the PROMs. Material and methods Design This cross-sectional study was performed at a single hospital. The institutional research ethics committee (Sapporo Maruyama Orthopedic Hospital, #000016) approved the study protocol. All participants and PTs provided written consent before data collection. Participants Using convenience sampling, we recruited patients with LBP from an orthopedic hospital in Hokkaido, Japan (Sapporo Maruyama Orthopedic Hospital). The inclusion criteria were; 1) in-patient hospital stay for (...truncated)