Personalized treatment goals in hand and wrist care: understanding the influence of baseline and target score on goal achievement.

Abstract

To investigate the independent association between the initial baseline and target scores and the probability of achieving personal treatment goals in patients with various hand and wrist conditions. Prospective cohort study. Data were collected as part of usual care at a specialized clinic for hand surgery and therapy. Adult patients who received surgical or nonsurgical treatment for thumb base osteoarthritis, carpal tunnel syndrome, trigger finger, Morbus de Quervain, Dupuytren disease, or triangular fibrocartilaginous complex injury and completed the Patient Specific Needs evaluation (PSN) before their first consultation and three months after treatment initiation. NA MAIN OUTCOME MEASURES: The primary outcome was whether patients achieved their Personal Meaningful Gain (PMG) three months after treatment. The PMG represents the improvement in individual aims to achieve in a domain relevant to them, given their baseline score. A total of 2,445 patients (39%) achieved their PMG. A higher baseline score, reflecting less severe symptoms or functional limitations, was associated with increased odds of reaching the PMG (OR 1.39[95%-CI 1.09-1.76], p=0.007). A higher target score was associated with lower odds of reaching the PMG (OR 0.67[0.60-0.73], p<0.001). There was a significant interaction between the baseline and target scores (OR 0.96[0.94-0.99], p=0.01), indicating that the effect of one score on achieving the PMG depends on the level of the other score. Patients with a more favorable baseline score, indicating better health in the self-chosen domain, are more likely to achieve their personal treatment goals. A higher target score, reflecting a more ambitious treatment goal, was associated with lower odds of achieving the goal. The positive influence of a higher baseline score on goal attainment diminished as the target score increased. Clinicians should assist patients in setting achievable goals tailored to each individual's baseline condition, helping to manage expectations and support meaningful progress throughout the rehabilitation process.