The association between screened psychological risk for disability and appropriateness of orthopedic surgery in patients with musculoskeletal disorders–data from a Swedish RCT in primary care 2009–2011

Abstract

Introduction: To understand, diagnose and treat patients with musculoskeletal disorders, psychological risk factors should be assessed, and the association between psychological risk for disability and appropriateness of orthopedic surgery should be investigated. Purpose: To investigate the association between screened psychological risk for disability and appropriateness of orthopedic surgery, and to examine a physiotherapist’s ability to assess risk for disability in patients referred for orthopedic consultation. Method: Patients (n = 192) were assessed by a physiotherapist or an orthopedic surgeon to determine the need for surgery. The Pain Belief Screening Instrument (PBSI) was used to screen for psychological risk. The physiotherapist assessed psychological risk for disability based on yellow flags. Association between PBSI risk profile and appropriateness of orthopedic surgery was analyzed using logistic regression. Sensitivity and specificity of the physiotherapist’s assessment of risk was calculated using a binary classification model. Results: Orthopedic surgery was 2.28 times more likely to be considered an appropriate intervention for patients with a high PBSI risk profile (95% CI 1.09;4.78). The physiotherapist’s risk assessment correctly identified 88% of those at low risk (specificity) and 32% of those at high risk for disability (sensitivity). Conclusion: The findings suggest that orthopedic surgery is likely to be considered appropriate for patients with a high PBSI risk profile. The high specificity of the physiotherapist’s assessment implies good awareness of psychological factors. The low sensitivity suggests a need for using a screening tool such as the PBSI, to guide management decisions. Trial registration: Clinical Trials NCT02265172, retrospectively registered June 10, 2014.