Ability of Patient-Reported Outcomes to Characterize Patient Acceptable Symptom State (PASS) After Attending a Primary Care Physical Therapist and Medical Doctor Collaborative Service: A Cross-Sectional Study

Arch Phys Med Rehabil. 2019 Jan;100(1):60-66. doi: 10.1016/j.apmr.2018.07.443. Epub 2018 Sep 13.


Objectives: To determine if the Patient-Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, self-efficacy, and global rating of normal function (GRNF) scales are able to accurately characterize a patient's acceptable symptom state (PASS).

Design: A cross-sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80% and 95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales.

Setting: Phone survey after primary care.

Participants: Patients (N=94) attending primary care for musculoskeletal problems.

Interventions: Not applicable.

Main outcomes measures: Accuracy and proportion of patients classified as PASS Yes or No.

Results: Receiver operator curve analysis showed significant area under the curve (AUC) values for each PROMIS scale (AUC>.72) and the GRNF rating (AUC=.74). Identified PROMIS thresholds suggested PASS was achieved when scores were at or slightly worse than the US population average. A score of ≥7 and ≤4 characterized patients that were PASS Yes and No, respectively, on the GRNF rating. A moderate (80%) specificity/sensitivity criteria yielded 72.3%-73.5% accuracy for a majority of participants (>69.9%).

Conclusion: This analysis suggests the PROMIS and GRNF scales are able to characterize PASS status with moderate accuracy (∼70%) for a large portion of patients (∼70%). New to this study is the association of self-efficacy with PASS status. PROMIS scales at or slightly worse than the US population average characterized PASS status.

Keywords: Orthopedics; Pain interference; Patient reported outcome measure; Physical function; Rehabilitation; self-efficacy.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Area Under Curve
  • Cross-Sectional Studies
  • Female
  • Humans
  • Intersectoral Collaboration
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / psychology*
  • Musculoskeletal Diseases / rehabilitation
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Reported Outcome Measures*
  • Physical Therapy Modalities
  • Primary Health Care / methods
  • Primary Health Care / statistics & numerical data*
  • Self Efficacy
  • Surveys and Questionnaires
  • Symptom Assessment / psychology
  • Symptom Assessment / statistics & numerical data*