Patient-defined desired outcome, success criteria, and expectation in outpatient physical therapy: a longitudinal assessment

Giorgio Zeppieri, Steven Z. George

Patient-centered approaches offer an alternative method in evaluating treatment outcomes. This study investigated; 1) if patient's criteria for success (satisfaction of clinical outcomes) changes from pre to post treatment, 2) whether patients who met their success criteria also meet minimal clinical important difference scores (MCIDs), and 3) if patient's success criteria differed from their expected (what the patient believes will occur) and desired (what the patient wants to occur) outcomes following intervention. A consecutive sample of 225 subjects with complaints of musculoskeletal pain was referred to an outpatient, sports medicine physical therapy clinic. Participants completed the Patient Centered Outcome Questionnaire (PCOQ) prior to their initial evaluation session and a follow-up PCOQ at discharge. The PCOQ asks subjects to rate their pain, fatigue, emotional distress, and interference with daily activities for usual, desired, successful, and expected levels, and how important improvement is for each domain on a 101-point numerical rating scale. Paired-sample T-test were used to determine patient's pre and post success criterion and whether success criteria differed from desired and expected outcomes following intervention. Chi-squared were used to determine if individuals desired, expected, and success criteria for treatment outcome differed from established MCIDs. The results revealed no change in success criteria pre to post treatment for all domains. Chi-square test revealed patients desired, expected, and success criteria were independent of established MCIDs (P > .01). There were no differences between patients expected outcomes and success criteria. However, there were differences between patient's desired outcomes and expected and success outcomes, with patients reporting lower desired levels of pain, emotional distress, fatigue, and interference with daily activities following physical therapy intervention (P < .01). Patients in this setting do not appear to modify their success criteria throughout the course of outpatient physical therapy. Additionally, individually defined success criterion differs from established clinically important changes. Clinicians interested in a broader assessment of outcome need to consider patient determined criterion in addition MCIDs. Furthermore, desired outcomes are lower than both expectation and success criteria. In this setting, outcomes following physical therapy episodes were likely to meet patient's expectations and success criteria but not desired criterion.