Measurement in Neurological Physio

Question 1

Why do we need to measure outcomes?

Answer 1

• To quantify problems
• To identify change in performance over time
• To evaluate cost effectiveness of intervention

Question 2

What does purposeful measurement involve?

Answer 2

• Needs to be performed for a predetermined purpose
• May need to be altered at different stages of rehab
• Asking what am I trying to change
• Taking into account floor & ceiling effects

Question 3

What is the difference between reliability & validity?

Answer 3

• Reliability: Extent to which a measurement is consistent & free from error (intra-rater, inter-rater, retest)
• Validity: Extent to which a tool measures what it is intended to measure & to which a measure is responsive to change

Question 4

What are the global measures of activity?

Answer 4

• Motor Assessment Scale (MAS) for Stroke
• Functional independence measure (FIM)
• Barthel index

Question 5

What does the MAS consist of?

Answer 5

• Evaluates commonly performed functional activities
• 8 items rated on scale of 1-6
• Highly reliable & valid
• Good tool for physios

Question 6

What does the FIM consist of?

Answer 6

• Measurement of impact of disease on a person’s ability to perform normal activities
• 6 categories
• Much broader measure than MAS
• Doesn’t measure quality of movement performed (not very helpful for physios)

Question 7

What does the Barthel index consist of?

Answer 7

• Measures performance across a range of common activities
• 11 categories
• Doesn’t look at quality of movement

Question 8

What are specific performance tests used for?

Answer 8

Measuring one specific movement/task

Question 9

What specific performance test is used for sitting?

Answer 9

Item 3 of MAS or sitting balance test

Question 10

What specific performance tests are used for standing up?

Answer 10

• Item 4 of MAS (sitting to standing)

- Time taken to stand up 5 times

Question 11

What specific performance tests are used for standing balance?

Answer 11

• Functional reach
• Step test
• Berg balance scale

Question 12

What specific performance tests are used for mobility & gait?

Answer 12

• 10MWT: Measures gait speed, step length, cadence
• Timed up & go: Measures gait speed during standing & turning
• 6MWT: Measures gait endurance

Question 13

What are some of the higher-level mobility/gait measurement tools?

Answer 13

• High-level mobility assessment tool (HiMAT): Evaluates high level balance problems
• Functional ambulation classification (FAC): Mobility over a variety of terrains, slopes & curbs

Question 14

What is the main specific performance test used for upper limb function?

Answer 14

• Nine hole peg test
• Evaluates arm & hand dexterity
• High inter-rater but low test-retest reliability

Question 15

What are some of the other tests used for upper limb function?

Answer 15

• Action research arm test (ARAT): Grasp, grip, pinch & gross movement
• Spiral test: Coordination

Question 16

What is involved in interpreting change in measurement?

Answer 16

• Minimal detectable change (MDC): Score that reflects change by exceeding measurement error
• Minimal important clinical different (ICD): Minimal score associated with important change