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How Good Are Physical Therapists at Identifying Relevant Psychosocial Factors?

We have mounds of data showing pain is a biopsychosocial phenomenon and many of the risk factors for developing chronic pain and protracted recovery are psychosocial factors. Identifying those factors will help physios develop more accurate prognoses and tailor treatments. So, how good are we at identifying those factors? We have validated questionnaires that can assist us, such as the STarT MSK tool, but most physios (63% according to some research) do not use these screening tools. How accurate is our judgment? This recent scoping review (PMID: 36564962) sought to answer that question. The review included 20 studies (9 observational, 4 qualitative, 4 surveys, 1 randomized control trial, and one retrospective note audit).

Regardless of the assessment strategy (single questionnaire or a battery of assessments), the agreement levels between the assessments and PT judgments were poor. The only good correlation between assessment and judgment (r=0.602) was ‘distress’. While only a single study blinded PTs, reducing performance biases and improving validity, the consistency of the poor outcomes is concerning. One study showed three-quarters of physios routinely assess psychosocial factors and are confident in their ability to identify them. Confidence and actual ability appear to be in contrast. With the administrative burden already high, it’s not realistic (or even advisable) to bombard patients with multiple questionnaires. Instead, we may consider implementing shorter ones (e.g., PHQ-2 for depression), validated ones with wide nets (e.g., STarT MSK tool), or single longer questionnaires to confirm suspicions (e.g., Tampa Kinesiophobia Scale).

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