How can you learn from what you have measured?
Evidence suggests for clinicians and instructors to learn from their clinical experience and years of training, they must be provided with optimal patient feedback about what they are doing right or wrong at the patient bedside.
It is fascinating to see how the patient’s self-report outcome data tells a story. I love being able to know whether I should confirm or change a patient’s intervention based on serial and optimal “patient” feedback assessments.
Optimal “patient” feedback is:
-Patient self-report objective assessments
-Performed serially throughout patient’s episode of care
-Risk adjusted to improve the meaningfulness of your interpretation of that feedback
-A helpful compass for establishing patient rehabilitation prognosis
-A guide for clinical decisions regarding optimal treatment strategies
Mr. B was a 55-year-old computer analyst with complaints of intermittent low back and left leg pains to the mid-calf. Mr. B loved to exercise in his home gym; physical activity appeared to make him feel better. But his pain pattern persisted, especially with prolonged standing and walking.
If you are thinking unilateral stenosis, then you are correct. To me, Mr. B’s problem appeared to be a straightforward biomechanical case. However, my baseline psychosocial screening results were unexpected.
While the patient appeared to be managing his pain fairly well, his StarT (Subgroups for Targeted Treatment Back Screening Tool) classification was high. Furthermore, his intake self-efficacy measurement scores for coping and managing pain were very low.
Based on these baseline screening results, I augmented my treatment plan with a clinical cognitive behavioral approach (CBA). Pain neuroscience patient education, hierarchal & specific graded activity exposure, and patient problem solving are a few key components of CBA.
At discharge, Mr. B had fewer visits and higher functional status than originally predicted. His psychosocial screening results were now good. If I had not thoroughly screened Mr. B’s biopsychosocial status at intake, my outcome results may not have been as efficient or as effective.
The above example highlights the clinical utility of PROM data to optimize the patient’s voice and feedback regarding your treatments during the patient encounter. Listening and objectively measuring what the patient is telling you during the episode of care are important skills worth practicing to maximize the patient’s rehabilitation experience and treatment effectiveness.