Background: Patient identified problems (PIP) are a component of hypothesis oriented algorithm for clinician (HOAC) model.
Objective: This study evaluated the statistical properties of an outcome tool (PIP scale) developed from the PIP in the model.
Design: Observational retrospective.
Methods: Blinded records were used to measure change in the PIP scale and individual problem scores in a patient population that did not receive treatment and patients that received treatment. The analysis included measurements of construct and concurrent validity, reliability, responsiveness including AUC, likelihood ratios, specificity and sensitivity, and establishment of minimal clinical important difference (MCID).
Results: Construct validity was demonstrated by showing no significant change when no treatment was provided (avg change -0.59 (95% CI-1.8 to 0.6, p = 0.34) and significant change when treatment was provided (avg change 14.46, (12.57 to 16.35 p < 0.0001) a weak/moderate positive correlation with ODI, NDI, DASH, and LEFS (r = 0.27, 0.41, 0.45, 0.30 respectively) established a level of concurrent validity. Scale reliability was excellent (ICC = 0.96, 95% CI 0.93 to 0.97). Excellent Responsiveness was demonstrated by AUC 0.78, +LR 7.55, -LR 0.39, specificity 91.46, and sensitivity 64.45. MCID was determined to be 3.8 points (95% CI 1.4 to 8.2).
Limitations: The validity of this study was established under specific conditions where reporting was done several days removed from treatment, using self-recording dialogue, and with the prior scores provided. Findings need to be replicated in future studies.
Conclusions: This study demonstrated that the PIP scale is a simple, versatile tool and has good validity both for day to day clinical use and large-scale research.
Keywords: Outcome measures, HOAC model, rehabilitation, physical therapy, back pain, neurological rehabilitation