Understanding and predicting which patient will have the best outcomes or responses to a particular treatment has been a priority in physical rehabilitation. Although diagnostic findings have been the cornerstone of clinical decision-making for disease management by health care professionals, the literature now supports that targeting prognostic-related findings is a promising way for rehabilitation clinicians to improve treatment decision-making processes, personalize rehabilitation approaches, and ultimately enhance patient outcomes [1]. The biopsychosocial characteristics of the patient and clinical findings are prognosis-related when they influence the course of the disease. Considering that individuals with the same diagnostic label will have different clinical phenotypes [2], and might have different responses to the same treatment, the prognosis-related findings advise clinicians on the risk of poor/good outcomes for a patient, which is useful to guide management options [3]. For a given health condition, patients at greater risk of poor outcomes will benefit from treatment strategies that are not needed by patients that will recover promptly [4]. In the context of rehabilitation, this means giving the right treatment to the right patient at the right time. Hence, integrating prognostic-related information to improve management of musculoskeletal disorders is a promising way to improve patient outcomes and personalize care.

Specific learning objectives:
1. Understand the added value of prognostic-related information to diagnosis for musculoskeletal rehabilitation practice and how prognosis can serve to reduce overmedicalization and overutilization of health care.
2. Appraise the relevance of externally validated prognostic models to predict a patient’s health outcomes and direct treatment in the context of physical rehabilitation of musculoskeletal conditions.
3. Integrate prognostic-related information into clinical practice to different case study, in order to establish the “prognostic profile” of a patient.

CONTENT
Section #1: The marriage of Diagnosis and Prognosis (25 min)
To understand the added value of diagnostic versus prognostic-related information for musculoskeletal rehabilitation practice, we will address the distinctions between diagnosis and prognosis [5]. We will discuss the potential benefits of prognostic-based decision-making and ways to apply prognosis in clinical practice, along with their benefits and limitations [6, 7]. The different types of prognostic models will be presented [3]. Their clinical contributions will be discussed and illustrated (Dr Cook).

Section #2: The scientific and clinical value of Prognostic models (25 min).
To allow the participants to evaluate the relevance of externally validated prognostic models, we will present results from our most recent systematic review regarding externally validated prognostic models with potential clinical value [8]. We will take this opportunity to explain how prognostic evidence is best integrated into prognostic tools and provide the audience with criteria to highlight key elements to consider when selecting a prognostic tool for clinical practice (Florian NAYE).

Section #3: Establishment of a “prognostic profile” (25 min).
Numerous prognostic factors need to be taken into consideration in order to establish the “prognostic profile” of a patient with a musculoskeletal condition. We will present our most recent study where we develop and assess the acceptability and feasibility of a set of questionnaires to establish the “prognostic profile” of patients with work-related musculoskeletal disorders. Participants will be presented with different case study in order to facilitate the integration of prognostic-related information into practice (Dr Tousignant-Laflamme).

Panel Discussion (20 minutes): Each presenter will have 2 minutes to answer questions from the audience in a final interactive discussion. We will engage the audience and stimulate the interaction with the audience through web-based interactive Q&A (Kahoot®).

IMPLICATIONS
This focused symposium will provide rehabilitation professionals with a better understanding of prognosis, prognosis-related findings, and their contributions to their clinical practice. This new knowledge is essential to enhance the quality of care for people with musculoskeletal conditions. From the exposed prognostic models with potential clinical value, the participants will be able to apply their new knowledge as early as their first patient on Monday.

Through their interactive presentations, the panelists will address an expertise area that should be a core competency of physiotherapists, namely the integration of prognostic-related information to improve the management of musculoskeletal disorders, helping to provide the right treatment to the right patient at the right time. Finally, it will help identify patients who may need more intensive care, from those who are likely to improve with marginal engagement and discusses current evidence supporting this assumption.

References:
[1] https://doi.org/10.1093/ptj/pzz171
[2] https://doi.org/10.1002/ejp.1541
[3] https://doi.org/10.1093/ptj/pzac023
[4] https://doi.org/10.1136/bmj.e5793
[5] https://doi.org/10.1186/s12916-014-0265-4
[6] https://doi.org/10.1371/journal.pmed.1001380
[7] https://doi.org/10.1371/journal.pmed.1001381
[8] https://doi.org/10.1093/ptj/pzad021