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EBCP > Chapter 10 > Flashcards

Chapter 10 Flashcards

1
Q

Why is it important for the Dr. to monitor patient progress accurately?

A

Facilitates making the best possible clinical decisions

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2
Q

What are the benefits of using outcome measures for the patient, Dr., and 3rd party payers?

A

Patients = more likely to receive appropriate care

Dr = use the information to formulate diagnoses and plan care

3rd Party = be more likely to receive legitimate services in return for monetary expenditures

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3
Q

T/F An outcome measure should be insensitive to change

A

FALSE

-Needs to be sensitive to allow a change in direct association with actual changes that occur in the patient characteristic being measured.

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4
Q

Systematically developed statements to assist practioner and patient decisions about appropriate health care for specific circumstances

A

Clinical practice guidelines

  • Developed by experts in a field using an organized process
  • Evidence is assembled on the management ok the kinds of conditions handled by practitioners
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5
Q

Steps in clinical practice guidelines development

A

1) The subject area of the guideline is identified
2) Guideline development groups are assembled
3) Evidence is obtained and assessed
4) Evidence is shaped into a clinical guideline
5) The guideline is reviewed externally

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6
Q

Expert opinions that are sought when there is little or no scientific evidence available. Merely the opinions of a panel of experts.

A

Consensus opinions

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7
Q

Method used in guidelines development to establish a group position. Involves serial input from a group of panel members via questionnaires

A

Delphi method

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8
Q

What are disadvantages of guidelines?

A

1) Evidence for a treatment may be low quality or unavailable
2) Guidelines only address one condition at a time (most patient have multiple symptoms)
3) Recommended treatment options may not always be appropriate (unique patients)
4) Guidelines should never be treated as a “cook book”
5) Need to be updated periodically (depends how rapid change occurs in a topic/field)

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9
Q

Activities, disciplines, and methods that are available to identify, implement, and monitor the available evidence in health care.

A

Best practices

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10
Q

What does the choise of outcome methods depend on?

A

The objective for the patient or requirements of the party or stake holder who will receive the information

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11
Q

Questionnaires that are designed to assess the physical, psychological, emotional, and social well-being of patients. Reported from the patients perspective.

A

Healthy related quality of life (HRQL) measures

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12
Q

What is a major critcism of HRQLs?

A

Being subjective and unreliable

-However, measures are typically more reliable then “objective” outcome measures

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13
Q

What are some benefits of HRQLs?

A
  • Findings are meaningful to the patient
  • HRQL measures are helpful in the assessment of patients’ functional limitations
  • They are appropriate and useful in monitoring the effects of treatment
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14
Q

T/F

The Neck Disability Index is an example of a generic HRQL instrument

A

FALSE

  • SF-36 is a generic instrument HRQL
  • Neck Disability Index is a specific instrument HRQL
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15
Q

What are some benefits of condition specific HRQLs over generic instrument HRQL?

A
  • They evaluate elements of function that are relevant to the specific condition under consideration
  • As a result, they are generally more responsive to changes in patients’ primary conditions
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16
Q

Most commonly used outcome measures in chiropractic

A

Pain and function

  • Can’t measure pain directly however, so it must be estimated from replies to oral or written queries.
  • Process is influenced by patient culture, conditioning, education, etc.
  • Pain replies then need to be interpreted by the clinician.
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17
Q

A.k.a. 11 point pain scale. Very common. Patient estimates the severity of their pain on a 0-10 scale.

A

Numeruc Rating Scale

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18
Q

How does the Dr. interpret the NRS?

A

1-4 = mild pain

5-6 = moderate pain

7+ = severe pain

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19
Q

Occasionally encountered in the literature. Provides little more evidence then the 11-point scale

A

101-point NRS (NRS-101)

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20
Q

A 10 cm line with descriptive phrases at each end that depict the extremes of pain

A

Visual Analog Scale (VAS)

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21
Q

A scale that averages the patients pain levels right now, typical, or on average and when it is at its worst. Uses 3 VAS ratings that represent different points in time.

A

Characteristic Pain Intensity (CPI)

22
Q

T/F

In research, the CPI correlated better with measures of pain-related disability, pain medication use, and standard pain measures then individual ratings

A

True

23
Q

A scale that depicts pain intensity using a series of adjectives that reflect the extremes of pain (ex: from no pain to intense pain). Patients are asked to choose the adjective that best describes their pain level by selecting from a list of possibilities.

A

Verbal Rating Scales (VRS)

24
Q

T/F

The NPS is preferred by patients because of its simplicity

A

FALSE

The VRS is preferred by patients

-VRS however is not as sensitive or reliable as other pain scales and can easily be misinterpreted because the word descriptions may not have the same meaning for different persons

25
Q

Used to quantify the degree of discomfort associated with the palpation, typically of myofascial tissues. Patient interpretation is correlated with examiners observation of their reaction to a pain stimulus which can help objectify information gained from palpation.

A

Tenderness Rating Scale

26
Q

Patients simply shade or mark the regions of a blank body image where they are experiencing pain. Can be used independently or incorporated into questionnaires. Their utility can be enhanced with used along with other outcome measures.

A

Pain drawings

27
Q

Patient makes areas of pain on a blank body image and then transparent grid depicting 45 regions of the body is superimposed over the completed image. Completed drawings can be scored as to the percentage of body surface in the shaded regions by referring to a list of weighted values.

A

Margolis system

28
Q

One of the most widely tested pain measures of all time. Gold standard against which newly developed pain instruments are tested. Developed by Melzak in 1975 to quantitatively measure pain.

A

McGill Pain Questionnaire (MPQ)

29
Q

3 major classes of word descriptors found in MPQ

A
  • Sensory qualities
  • Affective, in terms of tension, fear, and autonomic responses to pain
  • Evaluative words that describe the intensity of the pain
30
Q

4 parts of the MPQ

A

1) Pain drawing
2) 78 pain descriptors (sharp, intense, pinching, etc.) that span 20 categories
3) Questions that assess how the pain changes over time and what relieves or increases it
4) A pain intensity section

31
Q

Questionnaires that deal with patients’ emotional and psychological state. Chronic pain can bring about anxiety, depression, and hopelessness.

A

Psychometric measures

  • It can aggravate existing depression
  • Some cases, depression can cause chronic pain
32
Q

Most commonly used self-administered scale for measuring depression world wide. Can be integrated into a busy clinical practice without difficulty. 21 items dealing with statements about how patients perceive themselves.

A

Beck Depression Index

33
Q

If a question on the BDI is rated as a 3, what does that correlate to?

A

0 = no disappointment in myself

1 = disappointment in myself

2 = disgusted with myself

3 = i hate myself

Score 10-18 = mild depression

19-21 = borderline clinical depression

34
Q

Which of the following is not a benefit of the BDI?

a) Test’s validity and reliability has been established
b) Has high internal consistency and high content validity
c) Is unable to distinguish depressed from non-depressed subjects
d) is sensitive to change

A

c) Is unable to distinguish depressed from non-depressed subjects

BDI has a good discriminate validity making it able to distinguish between depressed and non-depressed subjects

35
Q

Psychometric questionnaire that can be used to assess pain in musculoskeletal patients. Contains 90 items. Each is graded 0-4 scale of distress from “ot at all” to “extremely”

A

Sympton Checklist-90-Revised (SCL-90-R)

36
Q

Questionnaires that evaluate activity limitations associated with a variety of conditions (back pain, knee pain, asthma). Many physical tests and general health care questionnaires fall into this category.

A

Measures of function.

37
Q

One of the most commonly used outcome measures in the management of spinal disorders. Validity and reliability has been well established. Appropriate for both research and clinical practice.

A

Oswestry Disability Index (ODI)

a.k,a, Oswestry Low back pain disability questionnaire

38
Q

Which is not a benefit of the ODI?

a) Is self-administered
b) Typically completed in less than 5 minutes
c) Scoring is straightforward and can be done by a staff member
d) Only hard copy forms are available to be used.

A

d) Only hard copy forms are available to be used.

Electronic versions are available. The rest are all true benefits of the ODI

39
Q

How does the scoring for the ODI work?

A

10 statements with 6 options per statement. Each option has a value ranging from 0 to 5 (first is 0, last is 5)

40
Q

What ODI score would be interpreted as severe disability?

A

0-20% = minimal disability

20-40% = moderate disability

40-60% = severe disability

60-80% = crippled

80-100% = bed-bound or exaggerating

41
Q

When is an ODI considered clinically important?

A

Minimum clinical important difference is 6 ODI points

-Other researchers have calculated as high as 15 points.

42
Q

Questionnaire has been shown to be a valid and reliable instrument for the assessment of low back disability. Sensitive to change over time for low back pain patients. Its popularity is comparable with ODI

A

Roland-Morris Questionnaire (RMQ)

43
Q

What does a score of 24 on the RMQ imply?

A

Maximum pain and diminished function

-0 = no pain and normal function

44
Q

T/F Head to head, the ODI was found to be simpler, faster, and more acceptable to patients then the RMQ.

A

FALSE.

RMQ was found to be simpler, faster, and more acceptable to patients

45
Q

T/F The RMQ is a more sensitive measure of activity intolerance in acute and subacute patients while the ODI is more sensitive for indentifying activity intolerances in chronic patients.

A

True

46
Q

According to Von Korff and Saunders, a score of ___ or more on the RMQ or ODI denotes significant disability and an unfavorable outcome.

A

13

47
Q

Minimum clinically important difference for RMQ evaluations.

A

At least 4 RMQ improvement to consider their condition as improved.

48
Q

Modification of the Oswestry Low Back Pain Disability Index. Developed in 1989 by Howard Vernon, D.C. Scored the same as the ODI. Minimum clinical important difference is 5 point change.

A

Neck Disability Index.

49
Q

Uses the same basic components of the NDI in addition to questions on emotional health, social activity, and fatigue. Minimum clinically important difference is 15 points.

A

Whiplash Disability Questionnaire (WDQ)

50
Q

25 question survery designed for patients with cervicogenic headaches. Usefull in assessing the impact of headache on daily living.

A

Headache Disability Inventory (HDI)

51
Q

T/F

The HDI is made up of 25 questions with 12 emotional questions and 13 funtional questions

A

True

52
Q

The maximum score of HDI is _____ and a change of at least _____ points must occur from test to retest before the changes can be attributed to patients treatments

A

100 points (2-32 = mild, 33-59 = moderate, 60 or more = severe)

-Need at least 29 points for a significant change

EBCP (3 decks)

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