L1 Outcome Measures

Question 1

Why do PTs need to use clinical measures?

Answer 1

Track pt progress over time
to justify more PT visits
screen for possible medical or psychosocial problems
discriminate among impairments
predict future events
show the value of what we do as PTs
research, to measure change

Question 2

How do we select outcome measures?

Answer 2

Meets the needs of your patient
Must be valid
Must be reliable
Needs to be responsive to change

fits the three psychometric properties: reliability, validity, clinical meaningfulness

Question 3

Patient reported outcome measures PROS

Answer 3

efficient, describes patient perspective of problem

Question 4

Patient reported outcome measures CONS

Answer 4

rely on pt self assessment ability, accurate recall of past events

Question 5

Patient reported outcome measures

Answer 5

questionnaires that the patient answers on their own about the impairment

Question 6

Performance-based outcome measures PROS

Answer 6

with high reliability can be very accurate way to document change

Question 7

Performance-based outcome measures CONS

Answer 7

equipment, time

Question 8

Performance-based outcome measures

Answer 8

actual activity that the pt completes, like the 6 minute walk test

Question 9

Content Validity

Answer 9

outcome measure includes all the characteristics that it purports to measure
established by expert panel

Question 10

Criterion Validity

Answer 10

establishes the validity of an outcome measure by comparing it to a more established gold standard measure

can be divided into concurrent and predictive

Question 11

Construct Validity

Answer 11

ability of a measure to assess an abstract characteristic or concept

theoretical model, comparing various populations in order to create a new outcome measure

Question 12

Sources of measurement error

Answer 12

Instrument
Patient
Clinician
Environment

Question 13

Measurement error

Answer 13

there is error to every measurement that we do
we try to eliminate as much as possible
error contributes to reliability
usually instrument error is the most common

Question 14

Relative Reliability

Answer 14

degree to which individual measurements maintain their position over repeated measurements/consistency

types: inter-rater, intra-rater, test-retest

Question 15

Strength of correlation

Answer 15

measured by intraclass correlation or Kappa (k)

values range from 0-1, higher value indicates greater reliability.

Less than .5 is poor reliability. You should use .9 or above within the clinic

Question 16

Standardization

Answer 16

ensuring administration and scoring of a test is done in the same way, should be within the clinic, yourself, as well as standardized to the measure instructions

Question 17

Internal Consistency

Answer 17

the extent to which multiple items within an outcome measure reflect the same construct

assessed using Cronbach alpha, should be between .7 to .9

score below .70 = suggests items are not measuring same construct

score above .90 = suggest repetition between items

Question 18

Absolute reliability

Answer 18

degree to which scores vary across repeated measurements

measured using the standard error measurement (SEM)

Question 19

Standard Error of Measurement

Answer 19

estimate of the extent to which observed scores vary around the true score.

SEM = SD (sq 1-r)

Question 20

Minimal detectable change

Answer 20

the minimum amount of change required on an outcome measure to exceed anticipated measurement error and variability. your patient has to change MORE than this for it to be a significant change/not due to error or chance

must be determined for different populations

Question 21

Measures of responsiveness

Answer 21

Change over time = responsiveness

MDC
MCID
Floor/ceiling effect

Question 22

Minimal Clinical Important DIfference

Answer 22

specific to a particular patient population, should consider diagnosis, age, severity of condition

should be larger than MDC to be valuable
MCID is helpful when interpreting study results

Question 23

Floor and Ceiling Effects

Answer 23

lack of a sufficient range of a measurement to accurately characterize a group of patients

floor effects can happen early on in treatment

Question 24

How do you appraise outcome measure studies?

Answer 24

determine the applicability
determine the quality
interpret the results
summarize the clinical bottom line

Question 25

How do you apply outcome measures to clinical decisions?

Answer 25

to write goals
to track pt progress
to make decisions about plan of care
to critically appraise an intervention study that you want to apply to clinical practice
to screen for problems

Question 26

Concurrent Validity

Answer 26

established when researchers demonstrate that an outcome measure has a high correlation with a criterion measure taken at the same point in time

Question 27

Predictive validity

Answer 27

established when researchers demonstrate that an outcome measure has a high correlation with a cirterion measured in the future

Question 28

Validity

Answer 28

outcome measure’s ability to measure the characteristic or feature that is intended to measure

Question 29

Reliability

Answer 29

outcome measure’s consistency in score production

Question 30

Test-retest reliability

Answer 30

extent to which an outcome measure produces the same result when repeatedly applied to a patient who has not experienced change in the characteristic being measured

Question 31

Intra-rater reliability

Answer 31

consistency that an outcome measure has the same score when used by the same PT on the same pt

establishes the variability of raters when pt has not changed

specifically addresses the skills of the raters conducting the test

Question 32

How do you apply outcome measures to clinical decisions?

Answer 32

writing goals
track patient progress
make clinical decisions about POC
critically appraise an intervention study
screen for a problem

Question 33

Learning health system

Answer 33

system in which routinely collected information is used for continuous improvement and innovation

health systems become learning systems when they can continuously and routinely study/improve themselves

Question 34

What is the goal of a learning health system?

Answer 34

to identify and promote the best care practices at the lowest cost, improve patient experience, better health outcomes, improved staff experience

choosing the correct outcome measures to collect helpful and effective patient data

Question 35

How can PTs play a role in learning health system processes?

Answer 35

-select the right outcome measures
-connect practice to research
-practice research concepts, new role of a PT
-common data models (organizing in a set way)
-clinical documentation practices
-connection between who designs EMRs and who uses them

Question 36

health informatics

Answer 36

the practice of acquiring, studying and managing health data and applying medical concepts in conjunction with health information technology systems to help clinicians provide better healthcare