Any Musculoskeletal Condition
Conditions
Keywords
Musculoskeletal, Orthopedics, Mental health, Patient-Clinician relationship
Brief summary
This study aims to test in what way a care strategy incorporating frequent contact can benefit patients with musculoskeletal condition that necessitates some adaptation and resiliency to symptoms and limitations that are expected to be either long-lasting or permanent. Patients will be randomized into either group A, where they will receive the standard amount of contact with their clinician, or group B, in which they will have contact with their clinican more frequently. The communication strategy may utilize text, email, portal, phone, video or other options as agreed on. The frequency will be at least once a week. All patients will complete a set of questionnaires at the end of the visit.
Detailed description
Irregular and uncomfortable bodily symptoms are common. Most are well adapted in a healthy life. People seek care when a symptom becomes a concern. Even the effort to attend a routine healthy check-up is usually based on not wanting to miss anything, which is accompanied by at least a slight concern that a problem might be found. People that are seeking care are unsettled to some degree. This unsettled feeling is often rooted in or worsened by unhelpful thoughts (less effective cognitive coping strategies). An example of a less effective cognitive coping strategy is rumination on worst-case thoughts (catastrophic thinking). The unsettled feeling is worse when thoughts are perceived as facts (cognitive fusion). Cognitive fusion is greater when people are under greater stress or distress. Clinicians can help people feel better and do more by gently correcting these misconceptions. And when correction of misconceptions is to some degree at odds with a person's experience of reality, expert advice may seem impersonal, dismissive, and uncaring. Adherence to medical expertise is enhanced by a trusting relationship with one's clinicians. There are several methods for nurturing a clinician-patient relationship. One is to make small agreements or compromises such as ordering a test that is not likely to yield useful information, has a small risk of harm, and uses resources and doing so in the context of efforts to move towards more effective cognitive coping strategies and greater self-efficacy. Another is to use educational tools such as decision aids to depersonalize the transfer of expertise. A third approach is use more frequent contact to deepen the relationship. This study posits that establishing a frequent-contact plan with a patient that might benefit from a healthier inner narrative can improve health using few resources other than clinician time, with a good patient experience compared to the typical single or infrequent in person specialist office visits.
Interventions
BEHAVIORALHigh-contact communication strategy
Patients will have contact with their clinician more frequently. The communication strategy may utilize text, email, portal, phone, video or other options as agreed on. The frequency will be at least once a week. All patients will complete a set of questionnaires at the end of the visit.
Sponsors
University of Texas at Austin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
New or return patients with some opportunity to better adapt to a long-standing or permanent symptoms will be randomized to a high-contact communication strategy agreed on by the clinician and patient or standard care (the patient initiates between visit contact as needed). The communication strategy may utilize text, email, portal, phone, video or other options as agreed on. The frequency will be at least once a week. All patients will complete a set of questionnaires at the end of the visit. At the end of the initial visit and 1 month after enrollment, people will be contacted by their method of choice to repeat the questionnaires.
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Adult patient * New or return visit * English or Spanish speaker * A musculoskeletal condition that necessitates some adaptation and resiliency to symptoms and limitations that are expected to be either long-lasting or permanent
Exclusion criteria
* Cognitive dysfunction * Language other than English or Spanish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Guttman Satisfaction scale | 1 month after enrollment | The Guttman Satisfaction Scale is a unidimensional questionnaire designed to measure the degree of patient satisfaction with the care they received. It consists of a series of hierarchically ordered yes/no items, with each successive item indicating a higher level of satisfaction. Total scores range from 0 to 7, with higher scores reflecting greater satisfaction, representing a better outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PROMIS Physical Function CAT | 1 month after enrollment | Patient-perceived physical function will be assessed using the PROMIS® Computer Adaptive Test (CAT) Physical Function v2.0. This instrument dynamically selects items from a calibrated item bank to measure physical functioning, including mobility, self-care, and instrumental activities. Scores are reported as T-scores, standardized with a mean of 50 and a standard deviation of 10 in the general U.S. population. Higher scores indicate better physical function and therefore a better outcome. |
| Negative Pain Thoughts Questionnaire (NPTQ-4) | 1 month after enrollment | A shortened version (4 items) of the Negative Pain Thoughts Questionnaire will be used to assess maladaptive cognitive coping strategies related to pain. Each item is rated on a 5-point Likert scale (0 = never to 4 = always), with total scores ranging from 0 to 16. Higher scores indicate more frequent negative pain-related thoughts, representing a worse outcome. |
| PROMIS Depression CAT | 1 month after enrollment | Patient-perceived feelings of depression will be assessed using the PROMIS Depression Computer Adaptive Test (CAT) v1.2. This instrument selects items from a validated item bank to measure negative mood, loss of interest, and feelings of hopelessness. Scores are reported as T-scores, standardized with a mean of 50 and a standard deviation of 10 in the general U.S. population. Higher scores indicate greater depressive symptoms, representing a worse outcome. |
| Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPE) | 1 month after enrollment | The Jefferson Scale of Patient's Perceptions of Physician Empathy includes five items rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree), with total scores ranging from 5 to 35. Higher scores indicate greater perceived physician empathy, representing a better outcome. |
| Communication effectiveness | 1 month after enrollment | Two questions will be used to assess patient-perceived communication effectiveness, focusing on clarity, understanding, and responsiveness during the clinical interaction. Each item was rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with higher scores indicating more effective communication. |
Countries
United States
Outcome results
None listed