Patient versus Clinician Focus of Care: Who’s Minding the Gap?

Research Report
Population: Adult

Diane D. Allen, PT, PhD, Professor, University of California San Francisco/ San Francisco State University

Carolina Talavera, MA, Project Coordinator, University of California San Francisco

Stephen Baxter, PT, Physical Therapist, University of California San Francisco

Kimberly Topp, PT, PhD, Professor, University of California San Francisco

Keywords: Participation, outcomes, patient-clinician agreement, current-preferred movement ability gaps

Purpose/Hypotheses: Patient participation potentially improves health care, but its effect on outcomes has seldom been documented. We examined patient participation in physical therapy treatment planning, using success of the intervention as the primary outcome. Patients completed a computer-adaptive test version of the Movement Ability Measure (MAM-CAT) to identify gaps between what patients can do or be currently and what they prefer to do or be. Gap sizes were calculated for 6 movement dimensions: flexibility, strength, accuracy, speed, adaptability, and endurance. The movement dimensions with the largest gaps were compared to therapists’ foci of care according to the assessments and interventions recorded in clinical notes. Our purpose was to see if participation helped clinicians focus treatment on the movement abilities patients value enough to want to improve, thus minimizing “disability” with intervention by shrinking the current-preferred gap. We hypothesized that a discussion of MAM-CAT results between patient and therapist when planning treatment would result in a decrease in patients’ current-preferred gap at discharge and follow-up compared to gaps of patients who did not discuss the MAM-CAT with their therapist.

Subjects: 326 patients in outpatient physical therapy

Methods and materials: Patients completed the MAM-CAT at initial visit, discharge, and one-month follow-up. The MAM-CAT calculated the current-preferred gaps on the 6 dimensions of movement. Physical therapists’ notes regarding assessments and interventions were categorized according to the same 6 dimensions of movement. We assessed the patient-clinician agreement and decrease in total gap sizes for two groups: 1) the clinician did not see the MAM-CAT results; and 2) the clinician and patient reviewed the results together. Frequency of agreement between the largest patient-perceived gaps and clinician-documented foci of care were recorded for kappa analyses, and MAM-CAT changes at discharge for two groups were analyzed using t-tests.

Results: Agreement between patients and clinicians on the focus of care was no more than random chance (kappa < .02) when the clinicians did not see patients’ responses on the MAM-CAT, but improved when clinicians and patients reviewed results together. The average decrease in total gap size was significantly different (p<.001) when patients and clinicians viewed results together.

Conclusions: The MAM-CAT facilitated direct comparison of patients’ current–preferred gaps at initiation and discharge with clinicians’ treatment foci during episodes of care. While interventions were typically effective, effectiveness was greater when patients participated in determining the emphasis of care.

Clinical Relevance: Unless specifically discussing it, clinicians and patients do not consistently agree on which current-preferred gap to mind. Patient participation in treatment planning using MAM-CAT gap data can increase alignment between patient priorities and clinician emphases, resulting in improved patient engagement and increased therapeutic effectiveness.

Allen, Diane D., PT, PhD; Talavera, Carolina , MA; Baxter, Stephen , PT; Topp, Kimberly , PT, PhD. Patient versus Clinician Focus of Care: Who’s Minding the Gap?. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.