PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists.
Abby L Cheng, Ryan Calfee, Graham Colditz and 1 others
PMID 30609319WHAT IT FOUND
Patients choosing physiatrists reported worse physical and emotional health than those seeing surgeons or other specialists.
This holds true even after adjusting for age, sex, and race. Clinicians should expect higher baseline symptom burden and potential biopsychosocial complexity in this referral group.
Key findings
01Physiatric patients had significantly worse average scores for all PROMIS domains compared to surgical and other non-surgical patients.
02A higher proportion of physiatric patients met threshold scores for heightened anxiety and depression compared to other groups.
03The difference in PROMIS scores between provider types remained significant even after adjusting for patient age, sex, and race.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was conducted at a single tertiary academic center, so referral patterns and provider reputations unique to this institution may not apply elsewhere. The design is cross-sectional, so it cannot prove that seeing a physiatrist causes these outcomes; rather, it reflects who chooses to see them. The authors did not adjust for specific musculoskeletal diagnoses, so differences in symptom burden may be driven by the types of conditions treated by each specialist. Some patients who report no anxiety or depression symptoms (floor scores) may be under-reporting due to discomfort discussing mental health with musculoskeletal providers, rather than truly having no symptoms.
Declared interests
The authors declare no conflicting interests. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not interpret these results as evidence that physiatric treatment leads to worse health outcomes. The study shows that patients who choose or are referred to physiatrists start with worse physical and emotional health scores than those seeing surgeons, reflecting selection bias rather than treatment failure.