title: Defining patient acceptable symptom state thresholds for commonly used patient reported outcomes measures in general orthopedic practice.
abstract: BACKGROUND
  Patient reported outcomes measures are distributed regularly within musculoskeletal physical therapy practice in an effort to track patient progress and response to treatment. A number of studies have reported on the amount of change necessary to identify the minimal clinically important difference. Few studies have identified thresholds signifying patient satisfaction with treatment and what patient specific factors may be influential in identifying patient satisfaction.
  
  
  OBJECTIVE
  To identify thresholds amongst commonly used patient reported outcomes measures associated with the patient acceptable symptom state (PASS). To identify the confounding effects of demographic and psychosocial variables on reported PASS estimates.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A sample of convenience consisting of consecutive patients referred for outpatient physical therapy for general orthopaedic conditions fulfilling the eligibility criteria were included. All patients completed baseline demographic information as well as baseline pain and functional outcomes measures. The PASS question was used as the anchor in this study to identify patient thresholds. Patients completed outcomes measures every 2 weeks and at patient discharge. PASS thresholds were identified using receiver-operating curves maximizing sensitivity and specificity.
  
  
  RESULTS
  PASS thresholds were found to vary depending on baseline pain levels, functional status, socioeconomic status, educational level, and psychosocial status.
  
  
  CONCLUSIONS
  Multiple factors are influential in determining patient success following treatment. Clinicians should be aware of patient baseline pain and functional status as well as socioeconomic status, educational level, and psychosocial status and stratify patients accordingly when determining patient prognosis and developing a plan of care.
authors.affiliation: Department of Physical Therapy, Institute for Human Health and Sports Science Research, High Point University, 833 Montlieu Ave., Drawer 67, High Point, NC 27262, USA. Electronic address: awright@highpoint.edu.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: Physical Therapy Department, The University of Chicago Medicine, 5841 S. Maryland Ave. Rm. W 107, MC1081, Chicago, IL 60637, USA.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Hensley
authors.affiliation: Physical Therapy Department, The University of Chicago Medicine, 5841 S. Maryland Ave. Rm. W 107, MC1081, Chicago, IL 60637, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gilbertson
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Ave. Rm. E 309, MC3079, Chicago, IL 60637, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Leland
authors.affiliation: Physical Therapy Department, The University of Chicago Medicine, 5841 S. Maryland Ave. Rm. W 107, MC1081, Chicago, IL 60637, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D009985:Orthopedics / Q000379:methods; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011594:Psychometrics; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Orthopaedics; Outcomes measures; Psychometrics; Responsiveness