Assessing the needs of patients in pain: a matter of opinion?

Study Design: A prospective cohort study including patients with nonspecific spinal pain was performed.

Objectives: To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment.

Summary Of Background Data: A wide range of instruments and techniques are used to assess and treat patients with spinal pain. Many instruments are used without being clinimetrically tested.

Methods: A questionnaire concerning the patients' need of treatment and their potential to assimilate it was sent to experts in the health care arena: physicians, physical therapists, social insurance officers. The experts included were those connected with patients participating in a larger outcome study. Two cohorts of patients (sample 1, n = 217; sample 2, n = 257) were followed for 6 and 12 months, during which time the patients' health and work status were mapped.

Results: No acceptable agreement was found between any of the experts' ratings of patients' needs and potential for rehabilitation. Logistic regression showed that the experts' judgments were based almost solely on the age of the patient. The prediction analyses showed that the most consistent predictor of the patients' status at the 6-month follow-up assessment was the patients' own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition.

Conclusions: Expert judgment as exercised in routine practice cannot be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient's ability to benefit from treatment.