Do clinical criteria based on PROMIS outcomes identify acceptable symptoms and function for patients with musculoskeletal problems.

BACKGROUND: Understanding how symptoms influence patient judgements of their health informs providers where to direct care. Patient reported physical outcomes (physical function, pain interference) and self-efficacy of symptom management (SEsm)) predict a patient's health state (i.e. patient acceptable symptom state (PASS)). However, it's unclear if therapist should consider a psychological outcome like SEsm separately or combine this outcome with other physical outcomes for clinical decisions.

OBJECTIVE: To determine if patient reported outcome information system (PROMIS) SEsm scale when combined with PROMIS physical function or pain interference is able to accurately predict a patient's health state defined by PASS.

METHODS: One hundred ninety-six patients (initial sample (n = 94) and separate sample (n = 102)) were surveyed by phone after care for a musculoskeletal problem. Patients completed PASS, PROMIS physical function, pain interference and SEsm outcomes. Logistic regression was used to estimate odds ratios (OR) for determining PASS in the initial sample. Criteria for determining PASS developed from the regression analysis were applied to a separate sample to assess accuracy. Accuracy for PASS status were also assessed at 1-7 days and 45-60 days.

RESULTS: Three combinations including SEsm/pain interference and SEsm/physical function showed significant OR's (<0.1) and varied from 2.5 to 4.2 for predicting PASS status. Criteria to predict PASS in the separate sample at 1-7 days and 45-60 days showed accuracies from 74.5% to 83.6%.

CONCLUSION: This study demonstrates that utilizing SEsm in combination with common physical outcomes used to assess patients with musculoskeletal diagnoses improves prediction of a patient's acceptable level of symptoms and activity.