Article

Evidence suggests that psychosocial factors have an influence on the outcome of
physical therapy treatment and that the extent of their influence differs
considerably among patients. As a consequence, substantial research efforts are
focused on developing new clinical tools designed to identify and highlight when
psychosocial factors are present at a level relevant to decision making. The
conceptual differences in the ways that psychosocial factors influence outcome
are described, structured around 3 common research terms: (1) prognostic factors,
(2) treatment effect modifiers or moderators, and (3) treatment mediators.
Prognostic factors are those characteristics that help estimate a patient's
likely outcome irrespective of the chosen management. Treatment effect modifiers
or moderators are factors measured at baseline that influence the relationship
between a specific intervention and outcome. Treatment mediators are factors that
have an intermediary role in the link between treatment and outcome. How these
different influences on outcome can be translated into useful and complementary
tools that aim to reduce treatment variability in clinical practice is described.
One approach is to use prognostic factors to develop screening tools that
identify an individual's risk status, typically based on predictive psychosocial
factors such as catastophizing and depression. Another approach is to identify
specific treatment effect modifiers to derive treatment decision aids or
prediction rules to help match a patient's characteristics to the interventions
available. A third approach is to use treatment mediators (eg, self-efficacy) to
develop monitoring tools to inform the clinician about which aspects of treatment
to strengthen.

Langue : ANGLAIS