Pain intensity can predict healthcare utilization for physical therapy patients

August 24, 2018 – A study by DCRI researchers finds that baseline disability and changes in pain levels can help predict which patients will require further treatment.

Monitoring for specific characteristics could help healthcare providers more accurately predict which patients will require additional care, according to a recent study by DCRI researchers.

The study, led by DCRI Fellow Trevor Lentz, PhD, appears in BMC Health Services Research.

Trevor LentzTreatment for musculoskeletal pain is a widespread and costly condition, with many patients requiring additional downstream care. Current payment models in the United States have led many health care services organizations to prioritize early identification of individuals at risk for downstream healthcare use at the onset of treatment.

In this study, the researchers examined data from the Orthopedic Physical Therapy – Investigative Network’s (OPT-IN) Optimal Screening for Prediction of Referral and Outcome (OSPRO) validation cohort study, a longitudinal prospective study of individuals with knee, shoulder, back or neck pain seeking physical therapy in the United States. They collected potential predictors by self-reported questionnaires at initial evaluation using an online study website. Participants were directed back to the study website four weeks after the initial evaluation to again complete questions on pain intensity, disability, and pain-related psychological distress. At six months and one year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests or imaging, and emergency room visits for their pain condition over the follow-up period.

Subsequent pain-related healthcare utilization was reported by 43 percent of the study sample that completed the one year follow-up. Baseline disability and four-week change in pain intensity were important global predictors of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and four-week changes in pain intensity, disability and pain-related psychological distress predicted specific service utilization.

These findings, the researchers concluded, suggest treatment monitoring of specific response variables could enhance identification of those at risk for future healthcare utilization in addition to baseline assessment.

In addition to Lentz, the study’s authors included the DCRI’s Steven George, PhD, and the University of Florida’s Jason M. Beneciuk.