Final-Outcome Measures Flashcards
When do you use outcome measures and why
At baseline and after treatment periodically to assess progress and show treatment is effective, reasonable and necessary
VAS
Visual analog scale
“Vertical like to indicate your level of pain today”
from none-worse pain
NRS
Numeric pain rating scale
“Circle the number that indicates your level of pain”
VAS vertical
Better understood by elderly
Quadruple VAS
- pain now
- typical or average pain
- at its best
- at its worst
Pain diagram
Image of body parts
Disability
Ability of a person to perform common activities
Measure function
ODI
Oswestry diability index
-low back disability
- 10 sections of daily activities with 6 options for each.
- scored 0-5
Add each section. Greatest disability is 50. X2 for %
NDI
Neck disability index
Modified from ODI 10 sections, 6 options. 0-5 scale. Add.
Roland Morris Questionaire (RMQ)
Low back disability
24 disability statements.
Score number of statements marked
Bournemouth low back and Bournemouth neck questionnaires
7 items each 0-10.
Take points and divide by 70 for %
Headache disability index
2 sub scales: emotional/functional
Plus total composite score
UEFI/LEFS
Upper extremity functional index
20 items score 0-4
Total score/80 x 100= % diability
FAOS/ HOOS/KOOS/RAOS
Questions assessing 6 areas
5 options scored 0-4. Out of 168.
Require change of 10% for meaningful improvement
Global-well being scale
Worst-best
**opposite of VAS.
Make vertical line between the two
Yellow flat outcomes
Fear avoidance beliefs question are
Modified work APGAR
Waddell’s signs
Modified work APGAR
Almost always, sometimes, hardly ever
Hardly ever enjoy job tasks were 2.5 X more likely to have back injuries than opposite
Waddell’s signs
- superficial/non-anatomic tenderness
- simulation (LBP with axial loading or standing and rotating UE)
- distraction (40-45 degree difference between supine SLR and sitting)
- regional disturbances (unexplained weakness/sensory findings)
- over-reaction
Simulation-Waddell
- Patient standing and doc rotates patients shoulder and hips
No pain
- Patient stands and doc applied compression down to head
No pain
Analysis of waddell’s signs
3+ = abnormal illness behavior
- psychological overlay to pain
- treat pain and overlay
Pain diagram yellow flags
- pain outside body
- pain in all 4 extremities
- multipl types of pain qualities ex: ache, burn, stab, numb, pins etc.
Decreased trunk and hip strength/endurance has been correlated with?
Back pain-current and future
Yellow flag vs. red
Hits/exam findings that are at risk for developing chronic pain
Vs.
Prompt doc to do more tests
Yellow flag
Risk factor for chronicity
-most work or psychosocial factors
Assess within first 4-12 weeks
Yellow flags for cervical and upper
Severe pain after 1 month (RR 10.5= risk never go away after 3 mo)
- upper extremity co-morbidity
- low job support/stress
- catastophizing pain coping style
- # of pain treatment episodes
- recommendations for surgery
Low back yellow flags
- 4+ weeks of s/s
- sciatica
- previous episodes
- severe pain after 3 weeks
- delaying treatment 1 week
- widespread pain
Yellow flags seen in exam
+ straight leg raise test
+ neurological signs
+ orthopedic tests
+lack of centralization with repetitive ROM
Centralizes is good
Psychosocial yellow flags
3+ Waddell Fear avoidance Anxiety/depression Low expectancy of recovery Blaming others Negative social
Low back yellow flag function aspects
Light work intolerance
Sleep disruption
20/100 + on oswestry disability
Yellow flag questionaire
13 Qs
< 55 = low risk of chronic disability
55-65= moderate
65+ high risk
Are yellow flags patients fault?
No. They are experiencing abnormal illness behavior and additional management strategies are needed
- cognitive-behavioral approach
- co-manage
Higher risk for surgery
Red flags
Fracture/dislocation Neoplasm Infection Rediculopathy General/non-specific
Red flags for fracture
Trauma Osteoporosis Age: F 55+, M: 65+ Hormonal: post menopause, hypogonadism Again/Caucasian Smoker Medication: steroids, heparin, CA to
Red flag neoplasm
50+ Hist of CA Weight loss No relief of s/s with rest/position change Failure of conservative tax
Red flags for infection
Immunosuppression (HIV, DM, steroids) IV drugs Recent UTI Recent dental procedure Penetrating wound
Red flags for general/non-specific
- under 18 or over 45 with precipitating event
- night pain
- bowel/bladder change
- systemic illness
