Gaps between patients' reported current and preferred abilities versus clinicians' emphases during an episode of care: any agreement?

Abstract

To be patient-centered, assessment must extract what patients prefer to be able to do along with what they can do now so health care can specifically address the gap between current and preferred abilities. In this project, we compared patient-perceived current-preferred gaps with the assessments and interventions reported by clinicians in a rehabilitation clinic. Sixty-two patients in outpatient physical therapy completed a computer-adaptive test version of the patient-reported Movement Ability Measure (MAM-CAT) at initial visit and discharge. The MAM-CAT calculated the gaps between the movement patients perceived that they could do "Now" and what movement ability they "Would Like" to have across six dimensions of movement: flexibility, strength, accuracy, speed, adaptability, and endurance. Physical therapists' notes regarding assessments and interventions were categorized based on these same six dimensions of movement. Frequency of agreement between the largest patient-perceived gaps and clinician-documented emphases was recorded (kappa analyses), along with MAM-CAT changes at discharge (paired t tests). Although patient progress was noted in both the MAM-CAT and the clinician notes (p < .05), comparison showed poor or slight agreement (kappa < .05) between the specific movement dimensions patients regarded as having the largest gaps and the dimensions on which clinicians focused. The MAM-CAT facilitated direct comparison of patients' current-preferred gaps at initiation and discharge with clinicians' emphases during episodes of care. While interventions were perceived as effective, collaboration between patients and clinicians using gap data could increase alignment between patient priorities and clinician emphases, potentially resulting in improved patient engagement and rehabilitative outcomes.