Todd Ginkel, DC, Laurie Applebee, PT and Jennifer Missling, PT at the 2017 HealthPartners Innovation Awards

Innovation is the heart of PDR Clinics’ vision of being the best non-surgical solution for neck and low back pain management.

As part of our continued investment in innovation PDR took part in the 2017 HealthPartners Innovation Awards.

As a Innovations in HealthCare Recognition Participant, PDR submitted an innovation on using predictive indicators to improve outcomes.

The poster content is provided below.


In contrast to a biomedical model that emphasizes treatments based on physiologic structure of the spine (i.e., joint, disc, or muscle injury), the biopsychosocial model addresses a broader spectrum. Cognitive Functional Therapy (CFT) is a behaviorally targeted intervention that combines normalization of movement while discoursing pain behaviors by reconstructing maladaptive thoughts about pain.


We studied patient activation and its relationship to neck and low back pain therapy outcomes and program adherence and its relationship to other routine inventories performed in our office. We also wanted to determine if there is any opportunity to better triage patients for improved completion rate and outcomes.



  • Using predictive indicators for poor outcome may allow providers to triage care earlier in the process, offering a more targeted approach to obtain higher outcomes.
  • PAM-13 measure for patient activation and Keele STart Back measure for psychosocial risks factors allow providers to understand patient psychology and employ coaching for activation and motivational interviewing skills appropriately with care


The results demonstrate that regardless of the level of activation or severity of disability, patients get similar outcomes. This validates that patients completing a CFT-based rehabilitation program achieve outstanding results in function, pain, and psychosocial outcomes.


Understanding the relationship of patient activation and psychosocial barriers to recovery and adherence helps provide some preliminary knowledge moving forward into health care payment reform.