L1 Outcome Measures Flashcards
Why do PTs need to use clinical measures?
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
How do we select outcome measures?
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
Patient reported outcome measures PROS
efficient, describes patient perspective of problem
Patient reported outcome measures CONS
rely on pt self assessment ability, accurate recall of past events
Patient reported outcome measures
questionnaires that the patient answers on their own about the impairment
Performance-based outcome measures PROS
with high reliability can be very accurate way to document change
Performance-based outcome measures CONS
equipment, time
Performance-based outcome measures
actual activity that the pt completes, like the 6 minute walk test
Content Validity
outcome measure includes all the characteristics that it purports to measure
established by expert panel
Criterion Validity
establishes the validity of an outcome measure by comparing it to a more established gold standard measure
can be divided into concurrent and predictive
Construct Validity
ability of a measure to assess an abstract characteristic or concept
theoretical model, comparing various populations in order to create a new outcome measure
Sources of measurement error
Instrument
Patient
Clinician
Environment
Measurement error
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
Relative Reliability
degree to which individual measurements maintain their position over repeated measurements/consistency
types: inter-rater, intra-rater, test-retest
Strength of correlation
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
Standardization
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
Internal Consistency
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
Absolute reliability
degree to which scores vary across repeated measurements
measured using the standard error measurement (SEM)
Standard Error of Measurement
estimate of the extent to which observed scores vary around the true score.
SEM = SD (sq 1-r)
Minimal detectable change
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
Measures of responsiveness
Change over time = responsiveness
MDC
MCID
Floor/ceiling effect
Minimal Clinical Important DIfference
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
Floor and Ceiling Effects
lack of a sufficient range of a measurement to accurately characterize a group of patients
floor effects can happen early on in treatment
How do you appraise outcome measure studies?
determine the applicability
determine the quality
interpret the results
summarize the clinical bottom line
How do you apply outcome measures to clinical decisions?
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
Concurrent Validity
established when researchers demonstrate that an outcome measure has a high correlation with a criterion measure taken at the same point in time
Predictive validity
established when researchers demonstrate that an outcome measure has a high correlation with a cirterion measured in the future
Validity
outcome measure’s ability to measure the characteristic or feature that is intended to measure
Reliability
outcome measure’s consistency in score production
Test-retest reliability
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
Intra-rater reliability
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
How do you apply outcome measures to clinical decisions?
writing goals
track patient progress
make clinical decisions about POC
critically appraise an intervention study
screen for a problem
Learning health system
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
What is the goal of a learning health system?
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
How can PTs play a role in learning health system processes?
-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
health informatics
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
