Asking patients about how long their pain lasts; whether it affects their daily activities; and if more than one joint is affected, was found to be more effective in predicting disease outcome than a GP relying on their prognostic judgement alone, according to lead author Professor Christian Mallen from the Arthritis Research UK Primary Care Centre at Keele University. Although some GPs would ask these questions without such a prompt, the aim is to encourage GPs to take a more of a systematic and structured approach to ensure that key prognostic information is gathered.
The improvement in prognostic accuracy was attributable to correcting the GPs’ tendency to have an over-optimistic expectation of the outcome of disease.
A total of 194 of 403 participants were classified as having an unfavourable outcome at six months. Adding three simple questions (duration of their present episode of pain; whether pain interfered with their daily activities; and whether the pain was in one of more joints) into their initial consultation improved the ability of GPs to predict the outcome of their condition in 69% of cases. When GPs relied on their own prognostic judgement it was only 62%.
The research is published in the online Journal of the American Medical Association Journal, Internal Medicine (JAMA).
People with common musculoskeletal conditions make up between 20 and 30 per cent of primary care consultations, and Professor Mallen’s research has important implications for the way they are managed and treated.
The primary care centre is spearheading research to increasingly ‘stratify’ patients according to their need so that higher risk patents who are likely to do badly and have a poor long-term prognosis can be offered care specifically tailored to their needs. Professor Mallen carried out a prospective observational cohort study of patients aged 50 or over presenting with non-inflammatory conditions in one of five participating general practices.
Professor Mallen commented:” Estimating the likely future course of musculoskeletal conditions is an important consideration on primary care consultation for both patients and health professionals, as it enables them to plan and manage the condition . “Beyond the individual patient, being able to identify groups at high risk of poor prognosis has wider implications for public health initiatives.”
An accompanying commentary in JAMA said: “In order to tailor care by impact and prognostic risk, we need brief assessment tools which are suitable for routine use in primary care clinics. Simple generic questions could make routine prognostic evaluation of diverse patients with musculoskeletal pain more practical and efficient.”
Professor Mallen’s colleagues at the Arthritis Research UK Primary Care Centre have already developed a screening tool designed to identify people with back pain at highest risk of a poor prognosis and target them accordingly.
The STarTback screening tool has already been taken up by a number of primary care centres in the UK and in research published in The Lancet last year was shown to make a “significant difference to patients’ levels of pain.