Outcome Measures Flashcards
Outcome Measures
The proportion of true positives tests out of all patients with a condition, or the ability of a test or instrument to yield a positive result for a subject that has that disease = ?
- Sensitivity is the proportion of true positives tests out of all patients with a condition, or the ability of a test or instrument to yield a positive result for a subject that has that disease.
- A test that is often used is the “Thompson Test” for Achilles tendon rupture. Sensitivity refers to a test’s ability to correctly identify individuals who have a particular condition (true positives).
- The ability to correctly classify a test is essential, and the equation for sensitivity is the following:
Sensitivity = (True Positives (A))/(True Positives (A) + False Negatives (C))
- Sensitivity does not allow providers to understand individuals who tested positive but did not have the disease (False Positives)
- False positives are a consideration through measurements of specificity.
Outcome Measures
The percentage of true negatives out of all subjects who do not have a disease or condition, or the ability of the test or instrument to obtain normal range or negative results for a person who does not have a disease = ?
- Specificity is the percentage of true negatives out of all subjects who do not have a disease or condition, or the ability of the test or instrument to obtain normal range or negative results for a person who does not have a disease.
- A common test in physical therapy with high specificity is the “Lachman Test” used to diagnose anterior cruciate ligament (ACL) injuries in the knee. Specificity refers to the test’s ability to correctly identify individuals without the condition (true negatives)
- The formula to determine specificity is the following:
Specificity = (True Negatives (D)) / (True Negatives(D) + False Positives(B))
Outcome Measures
How consistently a method measures something = ?
- Reliability refers to how consistently a method measures something.
- If the same result can be consistently achieved by using the same methods under the same circumstances, the measurement is considered reliable.
Outcome Measures
How accurately a method measures what it is intended to measure = ?
- Validity refers to how accurately a method measures what it is intended to measure. If research has high validity, that means it produces results that correspond to real properties, characteristics, and variations in the physical or social world.
- High reliability is one indicator that a measurement is valid.
- If a method is not reliable, it probably isn’t valid.
Outcome Measures
defined as the smallest amount of change that is greater than measurement error = ?
VS.
defined as the smallest amount of change in a domain (e.g., balance, gait, quality of life, pain) that is considered relevant or important to patients, clinicians, or significant others = ?
- The minimal detectable change (MDC) has been defined as the smallest amount of change that is greater than measurement error
- The Minimally clinically important difference (MCID) has been defined as the smallest amount of change in a domain (e.g., balance, gait, quality of life, pain) that is considered relevant or important to patients, clinicians, or significant others
Outcome Measures
CTSIB = ?
Clinical Test of Sensory Interaction on Balance
Clinical Test of Sensory Interaction on Balance (CTSIB): Patient is being evaluated based off of their performance in maintaining their balance throughout each of the six conditions while being timed for 30 seconds each.
- If during the first attempt throughout any of the six conditions, patient is unable to maintain the correct position for the standard 30 seconds, patient will be provided with 2 additional attempts and the average time of the 3 trails will be calculated.
Modified-CTSIB: eliminates the use of the visual conflict dome
- Each trial is terminated when a change in position is noted in either the patient’s arms or feet.
- Emphasis on safety throughout CTSIB
- A score of <260 seconds (summing all 3, 30 sec trials for each of 6 conditions) has 90% specificity and 44% sensitivity for identifying fallers.
- The CTSIB test was correlated with the gold standard SOT (Sensory Organization Test) for vestibular disorders. When the two tests were compared, the CTSIB had a specificity of 87% and sensitivity of 60%, but was less sensitive than the SOT when identifying subtle patterns of balance dysfunction.
Six CTSIB Conditions:
1. Stand on Firm Surface, Eyes Open: Stand on floor / Arms across chest & feet together / Eyes Open / Hold for 30 seconds
- Stand on Firm Surface, Eyes Closed: Stand on floor / Arms across chest & feet together / Eyes Closed / Hold for 30 seconds
- Stand on Firm Surface, Visual Conflict Dome: Stand on floor / Arms across chest & feet together / Visual conflict dome donned with eyes open / Hold for 30 seconds
- Stand on Foam Surface, Eyes Open: Stand on 3 inch high density foam cushion / Arms across chest & feet together / Eyes Open / Hold for 30 seconds
- Stand on Foam Surface, Eyes Closed: Stand on 3 inch high density foam cushion / Arms across chest & feet together / Eyes Closed / Hold for 30 seconds
- Stand on Foam Surface, Visual Conflict Dome: Stand on 3 inch high density foam cushion / Arms across chest & feet together / Visual conflict dome donned with eyes open / Hold for 30 seconds
- Excellent test-retest reliability for community dwelling adults
- Excellent interrater reliability for stroke/hemiplegic patients
- Criterion validity: predicted 75% of community dwelling elderly fallers and 60% of non fallers.
Outcome Measures
BERG Balance Scale
- When performing the BERG balance test, it consists of 14 items that assess static and dynamic sitting balance and standing balance.
- Item level scores are ranged from 0-4, depending on how much assistance needed and time to complete
- Scores are then summed and maximum score one can receive is 56.
Interpretation of results are as followed:
- 0–20, wheelchair bound
- 21–40, walking with assistance
- 41–56, independent
Items required when performing:
- Stop-watch, standard height chair with and without armrest (18-20 inch), stool (7.75-9 inch), shoe or object, ruler.
BERG balance scale tested twice on all residents in 7-14 day span.
- < 47 indicating patient is at risk of falls
- Sensitivity = 94.4%
- Specificity = 54.8%
- Test-Retest Reliability = Excellent .886
- Interrater/Intrarater Reliability = Excellent .993
- Validity = Excellent .762
Outcome Measures
DGI = ?
Dynamic Gait Index (DGI): It assesses an individual’s ability to modify balance while walking in the presence of external demands.
Can be performed WITH or WITHOUT an assistive device.
Marked distance of 20 feet is needed
Items needed:
- Shoe box
- Stairs
- Two obstacles of same size
Interpretation:
- <19/24 = predictive of falls in the elderly
- > 22/24 = safe ambulators
Outcome Measures
TUG = ?
Timed Up and GO (TUG): To determine fall risk and measure the progress of balance, sit to stand and walking.
- In general,>13.5sec is fall risk
Test performance:
- Pt sits in a standard height chair with back support and arm rest
- Pt is allowed to use AD and UE during the test, but need to be documented
- Pt is instructed to walk 3-meters (10ft), turn around, walk back and sit down
- The timer starts once you say “Go” and stops once the patient buttocks touch the chair
- Instruct the patient to use comfortable and safe walking speed
Outcome Measures
FSST = ?
Four Square Step Test (FSST): “A test of dynamic balance and coordination that clinically assesses a participant’s ability to step over objects forward, sideways, and backwards”
Assesses the following:
- Activities of Daily Living
- Balance (vestibular & non-vestibular)
- Coordination
General Rules:
- One practice trial allowed to ensure understanding
- Two performance trials are completed and the better time in seconds is recorded as the score
- Participant steps over 4 canes that are placed in a plus sign arrangement
- Participant begins by standing in Square 1, facing Square 2
- Stopwatch should start when the first foot makes contact with square 2 and stops when the last foot makes contact with square 1
Stepping sequence (with both feet touching each square):
- Clockwise → Counter-clockwise
- Square 1 → Square 2 → Square 3 → Square 4 → Square 1 → Square 4 → Square 3 → Square 2 → Square 1
Outcome Measures
FIST = ?
Function in Sitting Test (FIST): To evaluate sitting balance and assess sensory, motor, proactive, reactive, and steady state balance factors.
14 test items, scored on a scale of 0-4:
- 4 - complete independence
- 3 - independent with task but needs verbal or tactile cues
- 2 - needs UE support to complete task
- 1 - needs assistance to complete task, note min-max assistance needed
- 0 - total dependence
Testing instructions:
- One trial allowed for each item
- Individual seated at EOB with half of upper leg supported, hips and knees at 90 degrees and feet flat on floor
- Hands are placed in lap unless needed for support
Intended Populations:
- Primarily intended for patients post stroke, brain injury, MS, or patients with a vestibular disorder, but is appropriate for all patients with the following:
- Sitting balance deficits
- Patients who are unable to stand
- Patients who cannot tolerate more complex balance assessments
- The FIST is NOT appropriate for patients who are able to stand, ambulate, and complete complex ADLs.
Outcome Measures
30 Second Sit to Stand
Procedure:
Administered using a folding chair without arms
- seat height of 17 inches (43.2 cm)
- rubber tips on the legs
- place against a wall to prevent it from moving
Patient is seated in the middle of the chair
- back straight
- feet approximately a shoulder width apart and placed on the floor at an angle slightly back from the knees
- one foot slightly in front of the other to help maintain balance
- Arms are crossed at the wrists and held against the chest.
- Demonstrate the task both slowly and quickly.Have the patient practice a repetition or two before completing the test. Goal is to complete as many full stands as possible within 30 seconds, with patient fully seated between each stand. While monitoring the participant’s performance to ensure proper form, the tester silently counts the completion of each correct stand while timing 30 seconds on a stopwatch.
- The score is the total number of stands within 30 secondsmore than halfway up at the end of 30 seconds counts as a full stand. Incorrectly executed stands are not counted.
- The 30-second chair stand involves recording the number of stands a person can complete in 30 seconds rather than the amount of time it takes to complete a pre-determined number of repetitions.
0 for those who cannot complete 1 stand
greater then 20 for more fit individuals.
Outcome Measures
5XSST = ?
No Exceptions:
- No modifications are allowed for this test.
- If the patient requires the use of upper extremities during examination, they will be scored 0.
- Incorrectly executed stands are not counted.
- Chair heights vary within the literature but make sure to use the same height of chair for serial assessment.
- Recommended a seat height of 17 inches.
Outcome Measures
Mini BEST
Shortened version of BESTest (Balance Evaluation Systems Test)= Improves clinical utilization
14-item test used to assess:
* Balance – Vestibular
* Balance – Non-VestibularEquipment:
* Foam Pad
* Incline ramp of 10 deg slope (2x2 foot is recommended)
* Standard chair without arm rests or wheels
* Firm chair with arms
* Box (9 inches in height or about 2 shoeboxes stacked)
* Stopwatch
Masking tape marked on floor at 3 meters from front of chair
- Functional Mobility
- Gait
- Vestibular
Outcome Measures
6 minute walk test
Outcome Measures
Timed 10 meter walk test
