MSK1 – Patients Suffering From a Neck Injury who Improve Physical Function

Measure Title: Patients Suffering From a Neck Injury who Improve Physical Function

Measure Description Percentage of patients 18 years or older suffering from a neck injury who achieve the Minimal Clinically Important Difference (MCID) in the NDI or PROMIS Pain Interference, or like mapped measure during the performance year.

Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.

This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in NDI/PROMIS Pain Interference/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a neck injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with neck injuries to achieve an MCID in their NDI change score (> or = to -7.5) or ( > or = -2) in PROMIS Pain Interference change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.

Numerator Exclusions: None

Published Specialty: Physical Therapy/Occupational Therapy

High Priority Measure: Yes

Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)

Include Telehealth: Yes

Inverse Measure: No

Proportional Measure: Yes

Continuous Variable Measure: No

Ratio Measure: No

Score Range: N/A

Number of Performance Rates: 1

Performance Rate Description: This measure will include the combined rate of;
Rate 1) Total number of patients aged 18 years or older with a neck injury who achieve an overall score change of > or = the MCID in the NDI, PROMIS Pain Interference or like mapped measure.

Risk Adjusted Status: Yes

MIPS Reporting Options: Traditional MIPS

Care Setting: Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care

Clinical Recommendation Statement: Patients regularly enter the clinic with compromised neck function, measurable via the NDI. Through effective rehabilitation there are marked, measurable improvements. This gap for improvement will always exist in these neck pain/injury patients, as this is a true “”pre- vs. post-“” measurement.

Patients (n=225) whose average age was 75.0 (6.7) had an average baseline score of 33.8 (15.0) on the NDI. 61.5% of patients achieved a MCID (10 points improvement).

Fritz, J. M., Hunter, S. J., Tracy, D. M., & Brennan, G. P. (2011). Utilization and clinical outcomes of outpatient physical therapy for Medicare beneficiaries with musculoskeletal conditions. Physical Therapy, 91(3), 330–345. https://doi.org/10.2522/ptj.20090290

Patients suffering from cervical spine pain generally enter the clinic looking to improve physical function and return to what they want to do efficiently. Physical Function can be measured and tailored to that specific patient by using PROMIS CAT measures. The PROMIS Physical Function measures the outcome of patients with musculoskeletal disorders by assessing physical function through a grading scale of activities of daily living.

A T score is a standard score with a mean of 50 and a standard deviation of 10. Centering scores in this way allows quick interpretation of where an individual is on a symptom or outcome compared to others in the reference population. T scores are not percentiles and generally range from 20-80 (not 0-100).

Using the PROMIS Physical Function Computer Adaptive Test (CAT) to assess neck function in physical therapy patients is highly recommended. Backed by strong evidence, including studies by [Purvis et al., 2017][1] and [Johnson et al., 2019][2], the PROMIS Physical Function CAT offers efficient and accurate evaluation. Its adaptive testing adapts questions to patient responses, minimizing burden while enhancing precision. Decreased floor and ceiling effects make it a comprehensive tool for assessing neck function. Incorporating the PROMIS CAT empowers therapists to tailor interventions and monitor progress, ensuring more effective patient care.

[1] Purvis TE, Andreou E, Neuman BJ, Riley LH 3rd, Skolasky RL. Concurrent Validity and Responsiveness of PROMIS Health Domains Among Patients Presenting for Anterior Cervical Spine Surgery. Spine (Phila Pa 1976). 2017 Dec 1;42(23):E1357-E1365. doi: 10.1097/BRS.0000000000002347. PMID: 28742757.
[2] Johnson, Bradley & Stekas, Nicholas & Ayres, Ethan & Moses, Michael & Jevotovsky, David & Fischer, Charla & Buckland, Aaron & Errico, Thomas & Protopsaltis, Themistocles. (2019). PROMIS Correlates with Legacy Outcome Measures in Patients with Neck Pain and Improves Upon NDI When Assessing Disability in Cervical Deformity. Spine. Publish Ahead of Print. 10.1097/BRS.0000000000002994.

Measure Rationale: Musculoskeletal and connective tissue disorders, as highlighted by the World Health Organization (2022), are pervasive, affecting 1.71 billion individuals globally and serving as the leading cause of disability on a global scale. The substantial economic burden of these conditions, totaling approximately $980.1 billion and accounting for 5.7% of the global GDP and 30% of national health expenditures [1][2]. Neck pain and dysfunction, a prevalent issue, led to 11.4 missed work days or 290.8 million missed days in the United States alone in 2012 [3]. This burden has not only health implications but also economic repercussions, impacting overall quality of life. While the burden of musculoskeletal dysfunction is well-documented, it’s likely underestimated in terms of prevalence and severity [4].

In addressing this issue, physical therapists (PTs) and occupational therapists (OTs) play a crucial role in pain management and functional maintenance, with the goal of reducing opioid prescriptions [5]. The Neck Disability Index (NDI) patient-reported outcome measure (PROM) has consistently proven to be a reliable and cost-effective tool for tracking outcomes [6][7][8]. Studies by Fritz et al. (2011), Brennan et al. (2017), Lutz et al. (2020), Hung et al. (2019), and Young et al. (2019) have demonstrated the NDI’s reliability, responsiveness, and construct validity [9][10][11][12][13]. Notably, the NDI is endorsed for clinical use and has been translated into multiple languages [14][15][16]. The NDI’s robust psychometric characteristics make it a crucial tool for clinicians to showcase the quality of care, enabling effective treatment comparisons and value-driven healthcare [17].

The use of the PROMIS Physical Function Computer Adaptive Test (CAT) is strongly recommended for physical therapists, orthopedic therapists, and musculoskeletal doctors for assessing neck function in clinical practice. Supported by robust psychometric evidence, including studies by Brodke et al. (2016) and Cheung et al. (2019) [18][19], the PROMIS Physical Function CAT demonstrates excellent reliability, validity, and efficiency. Its adaptive testing algorithm tailors questions to individual responses, enhancing measurement precision and minimizing patient burden. This tool’s clinical applicability is underscored by its ability to capture subtle changes, as highlighted by Horn et al. (2020) [20], making it an indispensable resource for tracking progress and facilitating informed treatment decisions, ultimately improving patient outcomes.

References:

Wright, M. W., et al. (2014). Journal of Orthopaedic & Sports Physical Therapy, 44(2), 67-70.
Blyth, F. M., et al. (2019). The Lancet, 393(10182), 1119-1132.
Fritz, J. M., et al. (2011). Physical Therapy, 91(5), 755-765.
Brennan, G. P., et al. (2017). Spine, 42(24), E1445-E1451.
Lutz, G. K., et al. (2020). JAMA Network Open, 3(1), e1919633.
Hung, M., et al. (2019). Spine, 44(24), E1447-E1456.
Young, B. A., et al. (2019). Archives of Physical Medicine and Rehabilitation, 100(11), 2082-2088.
MacDermid, J. C., et al. (2009). Journal of Orthopaedic & Sports Physical Therapy, 39(5), 400-417.
Vernon, H. (2008). Spine, 33(4 Suppl), S38-44.
Brodke DJ, Saltzman CL, Brodke DS. (2016) PROMIS for Orthopaedic Outcomes Measurement. J Am Acad Orthop Surg. 2016 Nov;24(11):744-749.
Cheung EC, Moore LK, Flores SE, Lansdown DA, Feeley BT, Zhang AL. (2019) Correlation of PROMIS with Orthopaedic Patient-Reported Outcome Measures. JBJS Rev. 2019 Aug;7(8):e9. doi: 10.2106
Horn ME, Reinke EK, Couce LJ, Reeve BB, Ledbetter L, George SZ. Reporting and utilization of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures in orthopedic research and practice: a systematic review. J Orthop Surg Res. 2020 Nov 23;15(1):553. doi: 10.1186″”