Patients’ scores on psychological questionnaires

...can physiotherapists make an accurate estimation?

  • Therapists badly estimate outcomes of questionnaires 
  • Work experience therapist does not make a difference
  • Advice: keep using PROMs

After intake, physiotherapists are not capable of estimating how patients with low back and leg pain score on questionnaires about kinesiophobia, depression, fear or pain catastrophising. Most therapists even underestimate the presence of psychological problems. This was the conclusion of a study by Japanese researchers, in which they investigated the correlation between scores of 78 patients on several psychological Patient Reported Outcome Measures (PROMs) with the estimation of 21 physiotherapists.

Study design

Researchers recruited 78 patients who visited a Japanese hospital for low back and leg pain caused by a lumbar canal stenosis or hernia. Prior to the intake they completed the Pain Catastrophising Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and the Hospital Anxiety and Depression Scale (HADS) for objectifying fear and depressive complaints. Subsequently, the patients underwent an intake by one of the 21 physiotherapists. They performed a non-standardised interview and conducted a physical examination which could consist of assessing mobility, measuring strength, neurological tests, gait analysis and assessment of functional movement. After the intake, the physiotherapist scored the kinesiophobia, pain catastrophising, the degree of fear and the degree of depressive complaints on an 11-point scale. Ofcourse, the therapist was not allowed to view the outcomes of the questionnaires.

Hardly any agreement

Researchers only found a weak but significant agreement between the questionnaire and the estimation of the therapists for pain catastrophising. All other calculations showed that physiotherapists were not capable of estimating to what degree patients experienced psychological problems. 

> From: Miki et al., PLoS One 15 (2020) e0227999 . All rights reserved to The Author(s). Click here for the online summary. Translation by Casper Martens

Want to read this study? A free version of the full text is available here!


Expert opinion by Annemarieke Fleming

Research shows again and again that physiotherapists spend most of their time and attention to biomedical aspects, and that other factors keep getting overlooked. Luckily, if you (secretly) recognise this a little, this can be easily overcome with thanks to the used questionnaires: Pain Catastrophising Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and the Hospital Anxiety and Depression Scale (HADS). 

Before you ask your patients to fill in these questionnaires to complete your anamnesis (in your presence or at home), it is, ofcourse, wise to give at least some education about the intertwining between body and mind, and to appoint that you as a physiotherapist want to focus on the whole person. For some people this might take some getting used to, and of course no one is obligated to fill in the questionnaires. The fear of mapping psychosocial aspects, however, lies more often with the practitioner than with the patient. 

Most patients are grateful for a true biopsychosocial approach when you explain the outcomes of the questionnaires in adjunct to the biomedical explanation, because people feel heard and seen in all aspects of being human. Often, this even causes a form of relief: ‘From myself, I don’t talk about this easily, but now that it is asked so explicitly…’ If the outcomes give reason for it, you can advise the patient to ask for consultation with the general practitioner to discuss this. You can also ask for permission to share the outcomes in your report to the general practitioner.

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