Christian Mallen c.d.mallen@keele.ac.uk
Point-of-Care Prognosis for Common Musculoskeletal Pain in Older Adults
Mallen, Christian D.; Thomas, Elaine; Belcher, John; Rathod, Trishna; Croft, Peter; Peat, George
Authors
Elaine Thomas
John Belcher j.belcher@keele.ac.uk
Trishna Rathod
Peter Croft
George Peat
Abstract
Importance Many site-specific, multivariable risk models for predicting the outcome of musculoskeletal pain problems have been published. The overlapping content in these models suggests a common set of generic indicators suitable for use in primary care.
Objective To investigate whether a brief set of generic prognostic indicators can predict the outcome of musculoskeletal pain in older patients presenting to general practitioners.
Design, Setting, and Participants A prospective observational cohort study conducted from September 1, 2006, through March 31, 2007, of consecutive patients 50 years or older presenting with noninflammatory musculoskeletal pain to 1 of the 5 participating general practices in the United Kingdom.
Main Outcome Measures During consultation, the treating physician assessed and recorded 5 brief generic items (duration of present pain episode, current pain intensity, pain interference with daily activities, presence of multiple-site pain, and ultrashort depression screen) and recorded their overall prognostic judgment. The primary outcome was patient-rated improvement, which was measured 6 months after consultation and cross-validated with repeated measures up to 3 years.
Results A total of 194 (48.1%) of 403 participants were classified as having an unfavorable outcome at 6 months. Inclusion of 3 generic prognostic indicators (duration of present pain episode, pain interference with daily activities, and presence of multiple-site pain) in the prognostic model improved on reliance on physicians' prognostic judgment alone (C statistic = 0.72 vs 0.62; net reclassification index = 0.136; proportion correctly classified = 69%). The improvement in prognostic accuracy was attributable to correcting physicians' tendency toward overoptimistic expectations of outcome.
Conclusions and Relevance Three easy-to-obtain pieces of information followed by systematic recording of the general practitioners' prognostic judgment provide a simple generic assessment of prognosis at point of care in older persons presenting with musculoskeletal problems to primary care practices in the United Kingdom. Such an assessment offers a common foundation for investigating the usefulness of prognostic stratification for guiding management in the consultation across a range of common painful conditions.
Journal Article Type | Article |
---|---|
Acceptance Date | Feb 8, 2013 |
Online Publication Date | May 13, 2013 |
Publication Date | Jun 24, 2013 |
Deposit Date | Aug 25, 2023 |
Journal | JAMA INTERNAL MEDICINE |
Print ISSN | 2168-6106 |
Publisher | American Medical Association |
Peer Reviewed | Peer Reviewed |
Volume | 173 |
Issue | 12 |
Pages | 1119-1125 |
DOI | https://doi.org/10.1001/jamainternmed.2013.962 |
About Keele Repository
Administrator e-mail: research.openaccess@keele.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search