Outcome Measures Flashcards
What are outcome measures
- measurement instruments with a list of items (at the BSF, activity, or participation level)
- they generate scores that are intended to quantify a patient’s performance or health status based on standardized evaluation protocols or close-ended questions
- essential part of EBP (evidence based practice)
- intended to track change in functional status (different from other tests like MMT or ROM)
Why do we need outcome measures
- objective baseline
What happens when you pick the right outcome measure
- helps clinical design making
- assists in formulating the evaluation, diagnosis, & prognosis
- informing/modifying the POC (plan of care)
- help re-evaluate the success of physical therapy interventions
- helps with communication
Describe APTA’s outcome measure section
- includes the ICF figure and lists 26 categories of test/measures based on constructs
- no specific recommendations for use of one outcome measure over another
- no design making guideline
Describe the decision making framework
- Referral: reason, medical diagnosis, nursing notes
- Initial observations: movements, functional abilities, communication
- History: review charts
- Systems review: identify areas that need further exam
- Final selection
Factors to consider when selecting an outcome measure
- What to measure
- Purpose of measure
- Type of measure
- Patient and clinic factors
- Psychometric factors
- Feasibility
How to decide what to measure
- apply the ICF model on the Guide’s PT examination guideline to create decision making process
What 3 purposes are outcome measures designed to fulfill
- Discriminate
- Evaluate
- Predict
Describe discriminate purpose of outcome measures
- distinguish/categorize people in different groups
- helps with screening treatment needs assessment
- allow fewer response choices in order to discriminate
Describe evaluate purpose of outcome measures
- can evaluate change over time
- responsive to change
- determine effectiveness of treatment
- part of evaluation/re-evaluation
Describe predict purpose of outcome measures
- forecast future status
- identify risk
- help with prognosis
- help with D/C planning
What are the different types/focus of outcome measures
- Generic vs Disease specific OM
- Performance based OM
- Self report OM
Describe a generic vs disease specific OM
- Generic: designed to be used across all patient populations regardless of health condition, more likely to have normative data
- Disease specific: for specific disease condition, more meaningful to the patient, but less likely to have normative data
Describe a performance based OM
- measures the actual performance of a predetermined task in a structured environment
- insight into patient’s actual capabilities at a specific point in time
- may not reflect performance in real environment (house/community)
Describe a self-report OM
- provides information on the patient’s opinions/perceptions about the impact of their health condition
- cannot be observed, patient may over or under estimate their abilities or report what the clinician wants to hear
Describe patient factors
- OM should have items that match the pt’s goals, helps to keep the pt motivated by providing relevant feedback about goal attainment
- earlier during recovery process body structure/function OMs are more relevant and in later stages participation OMs are more helpful
- Pt’s capability
- Pt’s language, cultural, and emotional constraints
What would be a clinic factors
- some clinics require certain outcome measures for all patients (ex: FIM)
Describe psychometric factors
- floor and ceiling effects
- need MDC (reports true change but not if the change is clinically important) and MCID (reports patient’s perception of change)
Describe feasibility factors
- Time constraints
- Space constraints
- Heavy training & expertise requirements for sophisticated tests like kinematic gait analysis using m motion analysis systems
- Proprietary issues
ANPT strokEdge II recommendations for entry level Ps to learn to use
- Functional Independence Measure
- Fugl-Meyer Assessment (Motor performance)
- Postural Assessment Scale for Stroke Patients
- Stroke Impact Scale
- Trunk Impairment Scale
Other outcome measures for stroke patients that entry level PTs should be exposed to
- 9 Hole Peg Test
- Action Research Arm Test
- Arm Motor Ability Test
- Assessment of Life Habits
- BESTest
- Box and Blocks Test
- Canadian Occupational Performance Measure
- Chedoke-McMaster Stroke Assessment
- Disabilities of the Arm, Hand, & Shoulder Questionnaire
- Dynamometry
- EuroQOL
- Function in Sitting Test
- Modified Ashworth Scale
- Modified Rankin Scale
- Motricity Index
- Nottingham Assessment of Somatosensation
- NIH Stroke Scale
- Rate of Perceived Exertion (RPE)
- Rivermead Motor Assessment
- Stroke Rehabilitation Assessment of Movement
- Tardieu Spasticity Scale (Modified Tardieu)
What will picking good outcome measures help with
- creating meaningful and realistic goals
- provide motivation
- validate/justify treatment
- indicate effectiveness of POC (plan of care)
What is the commonly accepted gait speed that is said to reduce fall risk
- 0.8 meters per second
What is Berg test scored out of and what is the fall risk cutoff
- Scored out of 56
- Cutoff for fall risk = ≤45
Ceiling versus floor effect
- We want the ceiling effect of an outcome no more than 15%
- Ceiling effect: proportion of respondents scoring the highest/100% on an outcome measure
- Floor effect: proportion of respondents scoring the lowest on an outcome measure
Core measures of gait, balance, and transfers recommended for ALL adults with neurologic disorders are
- 6 Minute Walk Test
- 10 Meter Walk Test
- Berg Balance Scale
- Functional Gait Assessment (FGA)
- Activities Specific Balance Confidence Scale (ABCs)
- 5 Times Sit to Stand Test
