(1) Outcome Measures Flashcards
Types of measures
focus of outcome measure (disease specific or generic outcome measures–published normative values)
Mode of administration– Performance based and Self Report
How do objective measures enhance clinical practice?
identifying and quantifying limitations
forming evaluation, dx, and prognosis
informs plan of care
helps evaluate success of PT interventions
What are the aspects of objective measure decision making framework?
what to measure, purpose of measure, type of measure, pt and clinic factors, psychometric factors, feasibility
Purposes of outcome measures
quantify performance or health status
intended to track change in performance
can direct plan of care
determine progress/improvement
help with dx
predict future status
Purposes of outcome measures
discriminative (characteristics or predefined categories)
predictive (future status, identify risk, prognosis, discharge)
evaluative (effectiveness of intervention by evaluating change over time)
these factors closely match the pt goals and tx plan—-Motivation, dependent on stage of recovery, pt capability
patient factors
List examples of psychometric factors
reliability, validity, MDC, MCID
List examples of feasibility factor
time, space, equipment, training, cost, cultural and language limiters, proprietary issues
What is PPS?
Prospective payment system:
method used by centers of medicare/medicaid to determine projected pt length of stay and hospital reimbursement for pts
__________ is the medicare reporting instrument used by inpatient rehab facilities
IRF PAI: inpatient rehab facility – patient assessment instrument
IRF PAI reports standardized quality measures and pt assessment data in what 4 post acute settings?
inpatient rehab, skilled nursing, long-term acute care, home health
IRF PAI replaces FIM as means for determining level of function for what 2 things?
length of stay and reimbursement
IRF PAI must be scored within ______ days of admission and at discharge
3
Inpatient rehab facilities are reimbursed by taking these things into consideration (4)
- admitting dx
- tiered co-morbidities (unrelated to dx)
- admission functional and bowel/bladder scores
- some cases, pt age
What does section BB of IRF PAI assess?
hearing, speech, vision, ability to express ideas and wants as well as to understand verbal content
What does section C of IRF PAI assess?
cognitive patterns
What does section H of IRF PAI assess?
bowel and bladder continence
What does section GG of IRF PAI assess?
Functional abilities and goals
admission - pt’s baseline functional status conducted prior to the benefit of services
PLOF “every day activities”:
self-care, indoor mobility (ambulation), stairs, functional cognition
Prior level of assistance Scoring
3-
2-
1-
8-
9-
3- independent
2- needed some help
*1- dependent (helper does all the effort or assistance of 2 or more helpers is required for pt to complete activity even if it is stand by assist only and does not end up needed hands on assistance!)
8- unknown
9-N/A (pt did not perform immediately prior to current illness, exacerbation, or injury)
The list of devices and aids include: (6 items)
manual WC, motorized WC/scooter, mechanical lift, walker, orthotics/prosthetics, none of the above (no device or other device)
What items are on Mobility for ONLY PTs not OTs
car transfers, walking, steps, picking up object, wheelchair mobility
(OT and PT: roll L to R, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, toilet transfer)
Quality indicator grading
06
05
04
03
02
01
if activity not attempted
07
09
10
88
- independent
- set up/clean up
- supervision or touching assistance (cueing/CGA)
- Partial/Mod assist (helper does less than half the effort)
- substantial/maximal assist (helper does more than half the effort)
- dependent
if activity not attempted
07. pt refused
09. N/A (not attempted and pt did not perform before current illness…)
10. not attempted due to environmental issue (equipment, weather)
88. not attempted due to medical condition or safety concerns
Quality indicator grading:
not attempted due to medical condition or safety concerns
88
Quality indicator grade:
not attempted due to environmental issue (equipment, weather)
10
Quality indicator grade:
N/A (not attempted and pt did not perform before current illness…)
9
Quality indicator grade:
pt refused
07
Quality indicator grade:
dependent
01
Quality Indicator grade:
substantial/max assist
02
Quality Indicator Grade:
Partial/mod assist
03
Quality Indicator Grade:
supervision or touching assist
04
Quality Indicator Grade:
set up or clean up
05
Quality Indicator Grade:
independent
06
Only select “activity not attempted” if…
activity not completed or cant be determined by pt/caregiver, collaboration with other faculty staff, assessment of similar activities
How would you score this bed mobility:
pt was able to perform task, but required PT to put rails up and down
set up: 05
List some examples for a score of 88
pain, doctor orders restrict mobility, inability to lower head of bed due to medical condition
How would you score this for toilet transfer?
stand lift was used to help pt stand
1
How would you score this toilet transfer?
hoyer lift used due to medical/safety issues
88
How would you score this toilet trasnfer?
pt was unable to complete this task before current illness/injury
09
T/F: Pt must complete walking task to receive a score
T
T/F: pt may take a brief sitting rest break
(walking)
FALSE: they can take a standing break
T/F getting to a standing position is not considered when scoring walking
True
T/F: a pt can get a different score for each walking activity
true
How would you score this pt for walking?
pt begins activity, but cannot complete and a helper does not complete activity for pt
88
how would you score this for walking?
2 helpers with one helper providing trunk support or WC follow
1
T/F: You can score walking with exoskeleton
false
T/F: steps have a specific height in stairs scoring
false
T/F: Stair scoring – if a pt cannot perform one of the activities, you move on to the next one
false, you cannot score subsequent activities if you cant do it
T/F: rest breaks between activities are allow for stair scoring
true
T/F stair scoring for curb cannot include parallel bars
true
T/F: stair scoring for curb can include railings
true
Considerations for picking up object from floor
must be standing to perform activity
t/f: a reacher may not be used for assistance in retrieving item if they need assistance to use the device
true
they can use it if they can do so independently
wheelchair scoring consists of
wheeling at least 50 feet and make 2 turns – 90 degrees same or different directions
What is the only condition that you would code “0” no
(wheelchair scoring)
pt does not have wc or scooter at time
(core outcome measures)
establish the minimum measures needed to quantify function in the constructs of: (4)
balance, walking speed, walking endurance/distance, transfer ability
What are the 6 core outcome measures?
Berg balance, functional gait assessment, ABC activities specific balance confidence scale, 10m wt, 6MWT, 5TSTS
Can you use AD in balance tests for Berg?
NO
Berg: item 8 use ______ to reach forward
both arms
Berg: If you have unilateral involvement, which side do you test for items 13/14?
involved limb
FGA: Under what conditions can you use 4 steps?
BILAT railings and step height 7 3/4 - 9 inches
FGA: Are AD permitted?
yes, where scoring indicates a score for completion with device, it is a 0 for other items
FGA: where should you stand in comparison to pt?
at least a half step behind pt (not directly in front or beside)
ABC scale: how do you score a test that is incomplete?
sum the ratings and divide by the number of items completed
ABC Scale: how many items must be completed to get a score?
12/16
How do you score assistance for 10m walk test?
7 point ordinal scale
1= total assist
2= max assist
3= mod
4= min
5= supervision
6= mod independent – AD, extra time, mild safety issues
7- independent
A score of 0 is indicated for 10m test if…
pt requires total assistance, unable to ambulate, requires assistance for limb swing or forward propulsion
Where should the PT stand for 10m walk test
at least half a step behind pt (avoid “pacing” by walking in front or next to)
10mWT cut off scores
Household ambulator
Limited community ambulator
community ambulator
< 0.4 m/s
0.4 - 0.8 m/s
> 0.8 m/s
