Should we take their word for it? Patient-reported vs observed functional outcomes

Pain is a subjective experience. There’s no direct means to measure what it is like to be in pain. Disability, or the impact of pain on what we do in daily life is, on the other hand, able to be observed as well as reported on by people with pain. A question that has always fascinated me is the relationship between what an individual says they can or can’t do, versus what they can be observed to do. One of the more common ways to determine disability by observation is the “functional capacity evaluation” – and readers of my blog will know that I’m not especially fond of them when they’re used to determine “work fitness”. There are instances though, where they make sense – particularly if the individual with pain is able to gain confidence about what he or she can do. Just don’t use them to predict whether a person can carry out a full working week. Alternatively, and for reasons of convenience and cost, self-report measures of disability are often used. These are thing like the Oswestry Disability Index (Fairbank & Pynsent, 2000), or the Oxford Scale for hip and knee function (Dawson, Fitzpatrick, Carr & Murray, 1996).  These pen and paper assessments are completed by patients, have excellent psychometric properties, and are often used for both assessment and outcome measurement. The question is: do they represent the real world experience of the person with pain? How accurate are they, really? In the ...
Source: HealthSkills Weblog - Category: Occupational Therapists Authors: Tags: Assessment Coping strategies Groupwork Interdisciplinary teams Occupational therapy Pain conditions Professional topics Chronic pain Clinical reasoning function pain management Research Source Type: blogs