The Influence of Various Psychological Variables on Patient-Reported Versus Clinician-Reported Global Rate of Change Among Individuals with Lumbar Spine Impairment Receiving Outpatient Rehabilitation
Mentor 1
Dr. Bhagwant Sindhu
Mentor 2
Dr. Leigh Lehman
Mentor 3
Ying-Chih Wang
Location
Union Wisconsin Room
Start Date
24-4-2015 2:30 PM
End Date
24-4-2015 3:45 PM
Description
Background: Various psychological factors, such as depression, anxiety, somatization, and fear-of-pain, have been found to negatively affect estimates of functional change among people with lumbar spine disorders. However, it is not known how psychological factors influence patient-reported vs. clinician-reported rehabilitation outcomes. The purpose of this study is to determine how depression, somatization, and fear-of-pain impact patient-reported vs. clinician-reported global ranting of change, which is commonly used measure of functional change. Methods: A sample of 737 individuals with musculoskeletal conditions of the lumbar spine, who attended outpatient rehabilitation clinics, was used in a secondary data analysis. Data were collected using the Focus On Therapeutic Outcomes (FOTO), Inc. system called Patient Inquiry®. Using global ratings of change (GROC), patients and clinicians rated the perceived amount they have changed since admission on a scale frequently ranging from -7 to +7. A negative number indicates that the condition has worsened, zero indicates no change, and a positive number indicates varying degrees of improvement since admission. Numerous studies provide evidence for the validity of patient and clinician global ratings. At intake and discharge, function was measured using the lumbar computerized adaptive test (CAT), and pain-intensity was measured using a numeric rating scale (NRS). At intake, a single-item screen was used to classify patients into low versus elevated fear-of-pain, and the Symptom Checklist 90 Revised (SCL-90-R), a self-report clinical rating scale, was used to determine the presence of somatization, and depression symptoms Hierarchal regression analysis determined the predictability of clinician and patient GROCs. The independent variables were entered as three blocks: block one included age and gender, block two included intake pain-intensity, intake functional status, change in functional status, and change in pain-intensity, block three included fear-of-pain level, intake depression score, and intake somatization score. Model R–squared change values were used to determine the amount of variance explained by each block. Significance level was set as p=.05. Statistical analyses were conducted using the software SPSS version 22. Results: For Patient-Reported GROC, Model R-squared change increased significantly when block two variables were added (R2 = 0.119, Fchange = 13.100, p<.0001) as well as when block three variables were added (R2 = 0.129, Fchange = 3.358, p=.018). For Clinician-Reported GROC, Model R-squared change increased significantly when block two variables were added (R2 =.540, Fchange = 97.487, p=.000). When block three variables were added, there was no significant Model R-squared change (R2= .543, Fchange = 1.466, p=.223). Conclusion: Psychological factors seem to impact patient perception of recovery with rehabilitation. However, psychological factors do not seem to impact clinician perception of recovery with rehabilitation.
The Influence of Various Psychological Variables on Patient-Reported Versus Clinician-Reported Global Rate of Change Among Individuals with Lumbar Spine Impairment Receiving Outpatient Rehabilitation
Union Wisconsin Room
Background: Various psychological factors, such as depression, anxiety, somatization, and fear-of-pain, have been found to negatively affect estimates of functional change among people with lumbar spine disorders. However, it is not known how psychological factors influence patient-reported vs. clinician-reported rehabilitation outcomes. The purpose of this study is to determine how depression, somatization, and fear-of-pain impact patient-reported vs. clinician-reported global ranting of change, which is commonly used measure of functional change. Methods: A sample of 737 individuals with musculoskeletal conditions of the lumbar spine, who attended outpatient rehabilitation clinics, was used in a secondary data analysis. Data were collected using the Focus On Therapeutic Outcomes (FOTO), Inc. system called Patient Inquiry®. Using global ratings of change (GROC), patients and clinicians rated the perceived amount they have changed since admission on a scale frequently ranging from -7 to +7. A negative number indicates that the condition has worsened, zero indicates no change, and a positive number indicates varying degrees of improvement since admission. Numerous studies provide evidence for the validity of patient and clinician global ratings. At intake and discharge, function was measured using the lumbar computerized adaptive test (CAT), and pain-intensity was measured using a numeric rating scale (NRS). At intake, a single-item screen was used to classify patients into low versus elevated fear-of-pain, and the Symptom Checklist 90 Revised (SCL-90-R), a self-report clinical rating scale, was used to determine the presence of somatization, and depression symptoms Hierarchal regression analysis determined the predictability of clinician and patient GROCs. The independent variables were entered as three blocks: block one included age and gender, block two included intake pain-intensity, intake functional status, change in functional status, and change in pain-intensity, block three included fear-of-pain level, intake depression score, and intake somatization score. Model R–squared change values were used to determine the amount of variance explained by each block. Significance level was set as p=.05. Statistical analyses were conducted using the software SPSS version 22. Results: For Patient-Reported GROC, Model R-squared change increased significantly when block two variables were added (R2 = 0.119, Fchange = 13.100, p<.0001) as well as when block three variables were added (R2 = 0.129, Fchange = 3.358, p=.018). For Clinician-Reported GROC, Model R-squared change increased significantly when block two variables were added (R2 =.540, Fchange = 97.487, p=.000). When block three variables were added, there was no significant Model R-squared change (R2= .543, Fchange = 1.466, p=.223). Conclusion: Psychological factors seem to impact patient perception of recovery with rehabilitation. However, psychological factors do not seem to impact clinician perception of recovery with rehabilitation.
