1 - Types of OMs

Question 1

What are the 5 ways to categorize OMs?

Answer 1

Purpose
Collection Method
Domain/Dimension
Directness
Functional Classification

Question 2

What are the 3 types of purpose?

Answer 2

1. To evaluate change
2. To discriminate groups
3. To predict outcomes

Question 3

How do we evaluate change?

Answer 3

Clinically important changes must be GREATER than the error of the measure (e.g. MCID)

Question 4

How do we discriminate btwn groups?

Answer 4

Use dx criteria to separate pts into groups (e.g. fallers vs non-fallers)

Question 5

How do we predict outcomes?

Answer 5

Classify pts into groups that inform prognosis (e.g. high, medium, or low falls-risk)

Question 6

What are the 3 collection methods?

Answer 6

1. Patient reported outcomes (PRO)
2. Performance-based outcomes
3. Administrative outcomes

Question 7

PROs can sometimes be…

Answer 7

Observer-reported - if pt cannot answer themselves (e.g. cognitive impairment, parent answering for infant)

Question 8

What are some examples of administrative outcomes?

Answer 8

Number of visits, length of care, health system utilization

Question 9

What are the 7 types of domain?

Answer 9

1. Disease/injury specific
2. Site/body region specific
3. Construct specific
4. Generic/general
5. Summary
6. Individualized
7. Utility

Question 10

Disease/injury specific assesses…

Answer 10

Multiple dimensions of a specific disease (e.g. Unified Parkinson’s Disease Rating Scale - specific to Parkinson’s, but measures many different aspects of Parkinson’s)

Question 11

Disease/injury specific advantages

Answer 11

Highly specific to a particular disease.
May be more likely to detect clinically relevant changes.
High internal consistency.
High acceptability to patients, items identify their concerns.

Question 12

Disease/injury specific disadvantages

Answer 12

May not identify QOL or changes that are not a specific aspect of the disease.
Broad health studies: Can’t compare those with & without disease. Can’t compare different treatments for those with different health problems.

Question 13

Site/body region specific advantages

Answer 13

Highly relevant to pts receiving treatment for that body part or condition.
Highly valid and responsive for that specific population.

Question 14

Site/body region specific disadvantages

Answer 14

Narrow/specific focus may not identify broader health changes or identify other health concerns.

Question 15

Dimension/construct specific assesses…

Answer 15

One specific aspect of health status (e.g. Dizziness Handicap Index, Dynamic Gait Index)

Question 16

Dimension/construct specific advantages

Answer 16

Provide detailed understanding of the dimension.

Can be used as a screening tool by a variety of healthcare personnel.

Question 17

Dimension/construct specific disadvantages

Answer 17

Usually designed to identify group differences or make dx.

Not usually intended to measure changes.

Question 18

Generic/general assesses…

Answer 18

Contain multiple dimensions of health (i.e. social, physical, mental health, pain)
Example: Short Form Health Survey 36 (SF-36), QOL Questionnaire, PROMIS

Question 19

Generic/general advantages

Answer 19

Can be used if no specific measure exists.
May detect unexpected results from treatment.
May reduce the need for a large number of questionnaires.
Policy: if a small number of generic outcomes are used, it may allow for more consistency in research.

Question 20

Generic/general disadvantages

Answer 20

Doesn’t provide much detail of a specific problem.
May be less sensitive to change for a PT intervention.
Time-consuming.

Question 21

Summary assesses…

Answer 21

Capture broad picture in minimal items, often only one item/question.
Example: “How do you feel compared to one year ago?”

Question 22

Summary advantages

Answer 22

Brief, short, to the point!

Question 23

Summary disadvantages

Answer 23

Measurement precision.
Recall bias (may not accurately remember health a year ago).
Response shift bias (current health state may shift response).
Cannot detect differences in different aspects of health.

Question 24

Individualized assesses…

Answer 24

Patient identifies items of personal concern

Question 25

Individualized advantages

Answer 25

Address patient’s own concerns.
No Floor and ceiling effects.
Goal-setting.

Question 26

Individualized disadvantages

Answer 26

Clinician and patient may not agree on desired construct (e.g. pain versus function).
Feasibility - time requirements.
Difficult to compare patients.

Question 27

Patient-Specific Functional Scale is an example of an individualized measure. How does it work?

Answer 27

Pt lists out activities they want to return to (e.g. stand for 1 hour).
Pt ranks each item from 0 (unable to perform) to 10 (able to perform at the same level as before injury/problem).
Average score is calculated.
MDC = average +2 and/or individual item +3

Question 28

What are the 2 types of directness?

Answer 28

1. Primary Outcome Measure - assess changes from PT intervention, something you’d write a PT goal about.
2. Secondary Outcome Measure - other factors that may impact outcome, indirectly relates to PT goals (e.g. Depression Scale).

Question 29

What factors are considered in functional classification (hint: ICF Model)

Answer 29

Body Structure/Function: pain, ROM, strength, endurance.
Activity: walking speed/distance, balance control.
Participation: work, recreation, community engagement.
Environmental, Personal, and Contextual Factors

Question 30

What are the 4 levels of perspective as to why OMs are important?

Answer 30

1. Individual - screen for problems, make clinical decisions, monitor progress.
2. System - evaluate quality of care, compare clinics/regions, determine cost-effectiveness of care.
3. Policy - insurance, pay.
4. Society - monitor changes over time, public health.