1/22/2016 PATIENT SUBGROUPING. Patient Subgrouping. Psychologically Informed Physical Therapy Practice: Pragmatic Application for Low Back Pain

Transcription

1 Patient Subgrouping Jason Beneciuk, PT, PhD, MPH Research Assistant Professor University of Florida Brooks Rehabilitation PHHP Research Collaboration Psychologically Informed Physical Therapy Practice: Pragmatic Application for Low Back Pain Jason Beneciuk, PT, PhD Research Assistant Professor, University of Florida; Brooks Rehabilitation PHHP Research Collaboration Carol M. Greco, PhD Assistant Professor of Psychiatry Licensed Psychologist University of Pittsburgh School of Medicine Steven George, PT, PhD Associate Professor DPT Program Director, University of Florida; Brooks Rehabilitation PHHP Research Collaboration Learning Module PATIENT SUBGROUPING 1

2 Patient Subgrouping Identify Patients Goal: Increased between-group variability Decreased within-group variability Patient Subgrouping Why? Clinicians believe in subgroups Ability to match what treatment works for whom Consistent research priority APTA NIH Foster, et al Patient Subgrouping Key Features Subgroups should be: Plausible ( they make sense ) Clinically useful Identified through efficient system Foster, et al

3 A feasible option for patient subgrouping Matching groups of patients with the most appropriate treatment based on their risk profile Foster, et al. 2013??? 3

4 Prognostic Factors Prognostic factors that are: Modifiable Influence outcomes High level of adverse prognostic factors Low level of adverse prognostic factors Patients are risk-stratified based on prognostic profile High Risk Medium Risk Low Risk Risk for persistent LBP disability 4

5 Identification Screening for persistent LBP disability Screening methods Unidimensional approach Multidimensional approach Key modifiable prognostic factors for LBP Physical factors (e.g., difficulty dressing or walking) Psychological factors (e.g., fear, pain catastrophizing) Screening Methods Fear avoidance beliefs Pain related fear Pain Catastrophizing Depressive symptoms Anxiety 69 items 9 items STarT Back Tool Thinking about the last 2 weeks tick your response to the following questions: Disagree Agree My back pain has spread down my leg(s) at some time in the last 2 weeks 2 I have had pain in the shoulder or neck at some time in the last 2 weeks 3 I have only walked short distances because of my back pain 4 In the last 2 weeks, I have dressed more slowly than usual because of back pain 5 It s not really safe for a person with a condition like mine to be physically active 6 Worrying thoughts have been going through my mind a lot of the time 7 I feel that my back pain is terrible and it s never going to get any better 8 In general I have not enjoyed all the things I used to enjoy 9 Overall, how bothersome has your back pain been in the last 2 weeks? Not at all Slightly Moderately Very much Extremely Total score (all 9): Sub Score (Q5-9): Keele University 01/08/07 Funded by Arthritis Research UK 5

6 Targeted Treatment Prognostic Factors Targeted Treatment Targeted Treatment THANK YOU Brooks-PHHP Research Collaboration 6