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PHTY3140 > L32: Outcome Measures > Flashcards

L32: Outcome Measures Flashcards

1
Q

What are 7 purposes of outcome measures to physiotherapists?

A
  1. Provide a baseline for treatment plans - help establish short & long term goals
  2. Monitor treatment effects & adjust treatment goals appropriately
  3. Evaluate effectiveness of interventions
  4. Motivate patient, family & staff
  5. Maintain standards of care
  6. Predict outcome
  7. Facilitate research in clinical setting
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2
Q

What are 5 purpose of outcome measures to health care teams?

A
  1. Provide an objective measure of disability/dependence
  2. Predict outcome
  3. Establish effectiveness of services, enable comparison (benchmarking) of services (AROC)
  4. Used to calculate funds to service providers
  5. Provide accountability to funding sources re quality service & cost effectiveness
  6. Choice of outcome measure depends on
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3
Q

What are 3 features that the choice of outcome measure depends on?

A
  1. Time required
  2. Validity/reliability
  3. Equipment required
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4
Q

What are 3 characteristics of outcome measures should be integrated with usual assessment?

A
  1. Functional task should be measured with an objective outcome measure appropriate for that patient (e.g. MAS for stroke)
  2. Impairments are best measured objectively (e.g. Tardieu scale for spasticity)
  3. Overtime, you can integrate objective assessment with functional assessment
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5
Q

What is minimal detectable change (MDC)?

A

The minimal amount of change outside of error that reflects true change by a patient between two time points.

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6
Q

What is minimally clinically important difference (MCID)?

A

Smallest change that is important to either the patient or clinician

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7
Q

What are 4 characteristics of minimally clinically important difference (MCID)?

A
  1. Determined statistically, anchor-based (patient or clinician perspective) or Delphi panel
  2. Patient needs less change to find it important
  3. Clinician needs more change to find it important
  4. MCID also depends on severity/stage of disease
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8
Q

What are 2 ouctome measures of overall severity?

A
  1. National Institutes of Health Stroke Scale (NIHSS)
  2. Modified Rankin Scale (MRS)
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9
Q

What does the NIHSS measure?

A

NIHSS measures the severity of symptoms after cerebral infarct

  • Should be done as early as possible
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10
Q

What are 15 items tto assess the severity of impairment in the National Institutes of Health Stroke Scale (NIHSS) as outcome measures of overall severity? How are they graded and what are ths scores?

A
  1. Level of consciousness (LOC)
  2. Ability to respond to questions and obey simple commands
  3. Papillary response
  4. Deviation of gaze
  5. Extent of hemianopsia
  6. Facial palsy
  7. Resistance to gravity in the weaker limb
  8. Plantar reflexes
  9. Limb ataxia
  10. Sensory loss
  11. Visual neglect
  12. Dysarthria and aphasia severity
  • Items are graded on a 3 or 4 point ordinal scale
  • Scores range from 0-42. High = greater severity.
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11
Q

What are the NIHSS scores?

A
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12
Q

What does the Modified Rankin Scale (MRS) measure?

A

Single-item global outcome rating scale for stroke severity

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13
Q

What are the MRS scores?

A
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14
Q

What are 5 outcome measures of impairments?

A
  1. Fugl Meyer
  2. Chedoke-McMaster Stroke Assessment
  3. Clock Drawing Test
  4. Mini Mental State Examination (MMSE)
  5. Geriatric Depression Scale (GDS)
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15
Q

What are 2 outcome measures for motor and sensory impairment?

A
  1. Fugl Meyer
  2. Chedoke-McMaster Stroke Assx
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16
Q

What is an outcome measures for visuospatial & praxisimpairment?

A

Clock drawing test

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17
Q

What is an outcome measures for cognitive function impairment?

A

MMSE, GDS

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18
Q

What are 3 characteristics of the Fugl Mever for motor and sensory impairment?

A

Overall assessment of motor and sensory impairment 155-item assessment

  • Upper extremity, lower extremity, balance, sensation, passive joint motion, pain
  • Used in Singapore, USA. Not common in Australia.
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19
Q

What are 10 characteristics of Chedoke-McMaster Stroke Assessment?

A

Measures impairment & activity in stroke and other neurological disorders

  1. 2 sections: Impairment & activity inventory
  2. Impairment: Recovery of the arm, hand, leg, foot, postural control, shoulder pain
  3. Activity: Similar to MAS - 10-items
  4. Each is measured on a 7-point scale
  5. Takes ~1 hour to complete
  6. Max score = 100
  7. Validity: Content, concurrent
  8. Test-retest & inter-rater reliability is high (ICC = 0.96-0.98)
  9. Purchase manual/CD and training
  10. Used in Canada
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20
Q

What are 3 characteristics of Clock Drawing Test?

A
  1. Ask patient to draw a clock, place numbers, hands at 10 past 11.
  2. Evaluate qualitative or quantitative score
  3. This test may be influenced by other deficits
    1. Multi-infarct dementia ○ Increasing age
    2. Level of education
    3. Presence of depression ○ Visual neglect
    4. Hemiparesis
    5. Motor dyscoordination
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21
Q

What are 5 other deficits that the Clock Drawing Test may be influenced by?

A
  1. Multi-infarct dementia ○ Increasing age
  2. Level of education
  3. Presence of depression
  4. Visual neglect
  5. Hemiparesis
  6. Motor dyscoordination
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22
Q

What does the Mini Mental State Examination (MMSE) measure?

A

<23 is generally accepted as cognitive impairment and was associated with the diagnosis of dementia in ≥79% of cases

  • Measures general cognitive functions.
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23
Q

What are the MMSE scores?

A
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24
Q

What are scores of Geriatric Depression Scale (GDS)?

A
  1. Score /30
  2. Non-depressed 10-11/30
  3. Minor depression 11-12/30
25
Q

What are 3 outcome measures of activities?

A
  1. Functional mobility tests
  2. Upper limb
  3. Functional motor tasks
26
Q

What are 2 functional mobility tests?

A
  1. Dynamic Gait Index
  2. BOOMER
27
Q

What are 4 upper limb tests?

A
  1. Patient-specific functional scale
  2. REACH test
  3. Box and block test
  4. Wolf motor function test
28
Q

What are 5 functional motor tasks?

A
  1. COVS
  2. Berg Balance Scale
  3. FIM
  4. FAM
  5. Modified Barthel Index
29
Q

What does the dynamic gait index measure?

A

Measures community ambulation

30
Q

What are 8 gait tasks for the ability to walk 6 m (25 cm wide) (score)?

A
  1. Walking at a comfortable pace
  2. Walking at a faster rate , then slower
  3. Walking with horizontal head turns
  4. Walking with vertical head movement
  5. Walking, pivot turn and stop
  6. Walking and stepping over an obstacle
  7. Walking and stepping around an obstacle
  8. Walking up and down stairs
31
Q

What are the DGI scores?

A
32
Q

What are 3 norms of DGI?

A
  1. Healthy elders
    • 60 years: 22-24
    • 70 years:21-24 ○ 80 years: 13-24 ○ Falls risk: <19
  2. Stroke
    • 1 week: 13
    • 2 months: 14
    • 5 months: 14
  3. MS: <12 indicates fall-risk
33
Q

What are 5 characteristics of Dynamic Gait Index?

A
  1. Used in stroke, BI, PD, MS, vestibular, geriatric patients
  2. Scores on a 4-point scale
  3. Highest possible score is 24 points
  4. MDC varies by population A real change is >4.
  5. MCID is not established for most but for older adults (1-2)
34
Q

What are 4 (combination) tests in the Balance Outcome Measure for Elder Rehabilitation (BOOMER)?

A
  1. Step test: Average of 2 trials - R & L
  2. TUG comfy pace
  3. Functional reach: 2 practice, then 1 recorded
  4. Quiet stance feet together EC: 3x 30 sec trials
  • Scored /16
  • MCID 3/16
35
Q

What are 4 characteristics of Patient-Specific Functional Scale (PSFS)?

A
  1. Patients rate their ability to complete an activity on a 11-point scale at a level experienced prior to injury or change in functional status
  2. 0 = 0 unable to perform
  3. 10 = 10 able to perform at prior level
    • For severe patients: 10 = 10 same as other arm, or as well as I would like
  4. Patients rates their current level of ability on each activity assessed
  • High inter-rater reliability (ICC = 0.97)
  • Concurrent validity (0.64-0.94)
36
Q

What is the Rating of Everyday Arm use in the Community and Home (REACH)?

A

Separate scales for dominant & non-dominant UL

37
Q

What are 6 categories (each arm) in the Rating of Everyday Arm use in the Community and Home (REACH)?

A
  1. No use
  2. Stabilize
  3. Assist or easy reach
  4. Some reach & grasp with hand manipulation
  5. Everyday use unless potential negative consequences ○ Full use
38
Q

What are 9 characteristics of the Box & Block Test?

A
  1. Move max number of 2.5 cm blocks in 60 sec from one side to another over a 30 cm barrier
  2. Measures unilateral gross motor dexterity
  3. Used in stroke, SCI, MS, TBI
  4. Equipment: Box, 150 2.5cm blocks
  5. Score: Number of blocks transferred
  6. Not measuring quality of movement
  7. Normative data tables by age (e.g. 68 blocks for 70 yo females)
  8. MDC 6 blocks/minute
  9. MCID not established
39
Q

What are 8 characteristics of Wolf Motor Function Test?

A
  1. Assessing UL performance in stroke or TBI
  2. High level function: Start with shoulder F 90°
  3. 17 items: 15 function-based tasks and 2 strength based tasks
    • Items 1-6 involve timed functional tasks
    • Items 7-14 are measures of strength
    • The rest of 9 items consist of analyzing movement quality when completing various tasks
  4. Allow 2 minutes/task
  5. Excellent reliability & validity in stroke
  6. Rate on a 6-point scale
    • 0 = does not attempt with the involved arm
    • 5 = arm does participate, movement appears to be normal
    • Maximum score is 75
  7. Lower scores indicate lower functioning levels
  8. MCD 1-2 points, 19 sec
40
Q

What are of the Clinical Outcome Variable Scale (COVS)?

A
  1. Lower level, lower limb function - wheelchair skills
  2. Used with elderly, neurological & orthogeriatric clients
  3. Monitors independence & performance of functional motor tasks
  4. Useful for setting targets & monitoring progress
  5. Assess 13 functional tasks
    1. Rolling
    2. Supine to sit
    3. Sitting balance
    4. Horizontal transfer (between two surfaces of similar height)
    5. Vertical transfer (getting up off the ground)
    6. Gait performance, use of aids, endurance & velocity
    7. Wheelchair mobility
    8. Upper limb function
  6. Rate each task on a 7-point scale
    • 1 = dependent
    • 7 = independent
    • Max score 91
  7. MDC and MCID not established
  8. Test-retest reliability is high (ICC >0.97)
41
Q

What are the 13 functional tasks in the Clinical Outcome Variable Scale (COVS)?

A
  1. Rolling
  2. Supine to sit
  3. Sitting balance
  4. Horizontal transfer (between two surfaces of similar height)
  5. Vertical transfer (getting up off the ground)
  6. Gait performance, use of aids, endurance & velocity
  7. Wheelchair mobility
  8. Upper limb function
42
Q

What are 3 characteristics of Berg Balance Scale?

A
  1. Balance assessment incorporating common individual tests
  2. 14 items
  3. Scored from 0-4
    1. Max score 56
    2. Increased falls risk scores <45
    3. High falls risk scores <23
43
Q

What are 6 characteristics of Functional Independence Measure (FIM)?

A
  1. 18 items
  2. 7 -point scale of observed performance
  3. Different components of the measure are scored by different team members
    • FIM motor
    • FIM cognitive
    • Physios test dressing & mobility
  4. FIM is tied to benchmarking across public and private sectors - must do on admission and discharge (AROC)
  5. Accreditation training is required
  6. Used throughout the world including Australia
44
Q

What are scores of FIM?

A
45
Q

What are the FIM norms for aciute stroke?

A
46
Q

What are 3 characteristics of Functional Assessment Measure (FAM)?

A
  1. An extra 12 items with a cognitive, behavioural, communication and community function measures
  2. More psychosocial components
  3. FIM + FAM
47
Q

What are 4 characteristics of the Modified Barthel Index?

A
  1. 10-item battery
  2. Independence in the items is rated /100
    • High score is better
  3. Rated by several disciplines (OT do this)
  4. Scores linked to funding in some sectors
48
Q

What is an ouctome measure of participation?

A

Stroke Impact Scale

  • Stroke-specific, self-report
49
Q

What are mutidimensional outcomes assessed in teh Stroke Impact Scale?

A
  1. Strength
  2. Hand function
  3. ADL
  4. Mobility
  5. Communication
  6. Emotion
  7. Memory & thinking ○ Participation

Good reliability. Validity variable.

50
Q

What are 8 types of things that outcome measures can be used on?

A
  1. Active movement: Isolated movement
  2. Power, if have selective isolated movement
  3. Joint range, muscle length, neural length
  4. Somatosensation
  5. Vision
  6. Gait: TUG, timed 10m walk, 6MWT, HiMAT
  7. Spasticity: Tardieu, modified Ashworth scale
  8. Function: MAS
51
Q

What are 6 characteristics of the Timed 10-Meter Walk?

A
  1. Patient walks 14 m at regular gait speed +/- walking aid
  2. Standardise instruction: Walk past the far line at a comfortable/fast speed without stopping or talking
  3. Time & count number of steps in the middle 10 m of the total 14 m
  4. Measures
    1. Gait velocity (m/s)
    2. Step length (m) = 10/number steps
    3. Stride length (m) = 2x step length
    4. Cadence = steps/minute
  5. Validated & reliable in
    • Older adults
    • Patients with SCI, stroke
  6. Responsive to change in patients with acute stroke
  7. MCID acute stroke = 0.16m/s
52
Q

What are 4 measures in the Timed 10-Meter Walk?

A
  1. Gait velocity (m/s)
  2. Step length (m) = 10/number steps
  3. Stride length (m) = 2x step length
  4. Cadence = steps/minute
53
Q

What are norms of the Timed 10-Meter Walk in health males (60 and 70 yrs old)?

A

Healthy males (comfy/fast)

  • 60 years: 1.36/1.93
  • 70 years: 1.33/2.08
54
Q

What are norms of the Timed 10-Meter Walk in healthy females (60 and 70 yrs old)?

A
  1. 60 years: 1.30/1.77
  2. 70 years: 1.27/1.74
55
Q

What are norms of the Timed 10-Meter Walk of stroke patients?

A
  1. <0.4 m/s household ambulators
  2. 0.4-0.8 m/s limited community ambulators
  3. >0.8 m/s community ambulators
56
Q

What are 10 characteristics of High level Mobility Assessment Tool (HiMAT)?

A
  1. Designed for higher functioning brain injured adults (e.g. 91/91 on COVS but not fully functioning/c-ordinated)
  2. 11 items: Walking, running, hopping, skipping, jumping and stair items.
  3. Patients perform each task at their maximum safe speed (except for bounding and stair items)
  4. Measure with a stopwatch or tape measure
  5. Rate each item on a 5-point scale
  6. Items are then summed for a total score.
  7. Inter-rater reliability 0.99
  8. Test-retest reliability 0.99
  9. MDC and MCID not established
  10. Norms: Chronic TBI 32.6
57
Q

What are 5 characteristics of the Modified Elderly Mobility Scale?

A
  1. Used with elderly, neurological disorders & orthogeriatric clients
  2. Measure of independence in functional tasks
  3. Combines several motor tasks
    1. Lying to sitting
    2. Sit to stand
    3. Standing balance
    4. Gait
    5. Timed 10m walk
    6. Functional reach
    7. Ability to negotiate stairs
  4. Score /23
  5. Equipment
    1. Stopwatch, tape measure
    2. Bed
    3. 10m walkway
58
Q

What are 5 motor tasks of the Modified Elderly Mobility Scale?

A
  1. Lying to sitting
  2. Sit to stand
  3. Standing balance
  4. Gait
  5. Timed 10m walk
  6. Functional reach
  7. Ability to negotiate stairs
59
Q

What are 3 equipments of the Modified Elderly Mobility Scale?

A
  1. Stopwatch, tape measure
  2. Bed
  3. 10m walkway

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