Outcome Measures Flashcards
World Health Organization QoL- BREF
WHOQOL-BREF
Populations: PD, dementia, SCI, stroke, geriatrics, w/c users
Measures: QoL based on culture, values, and goals
PARTICIPATION RESTRICTION
Domains: physical and psychological health, social relationships, and environment
Scores: each domain has a max of 100; higher scores = increased QoL
MDC for SCI: 5.37
Dynamic gait index
DGI
Populations: brain injury, MS, PD, vestibular dysfunction, geriatrics, stroke
ACTIVITY LIMITATION
Measures dynamic balance with various walking tasks
Cut-off: =/>19pts indicates falls risk
Community-dwelling elderly
MDC: 2.9 pts
MCID: 1.9 pts
Gross Motor Function Measure
GMFM
-Criterion-referenced
-Used to monitor change over time
-Validated with CP ages 5 mos to 16 yrs
Bruininks-Oseretsky Test of Motor Proficiency
BOTMP
-valid for 4.5-14.5 years
- Norm-referenced and best used to compare a patient to age-matched peers.
Barthel Index
Population: stroke, TBI, geriatrics
Measures: performance of 10 ADL/mobility tasks
ACTIVITY LIMITATION
Scores: 0-100 higher scores indicate greater IND
Stroke: <62.90 moderate disability
<21.30 severe disability
Functional Independence Measure
FIM
Populations: stroke, TBI, SCI, MS and geriatrics
Measures: level of disability and amount of assist required for ADL’s with performance of 18 tasks
ACTIVITY LIMITATION
Scores: 18-126 higher scores indicate higher level of function
MCID stroke: 22 pts
FIM total score of 37-72 at admission showed higher gains than >73 or <36
National Institutes of Health Stroke Scale
NIHSS
Population: stroke
Measures: severity of symptoms and impairments following stroke
BODY STRUCTURE/FUNCTION
Score: 0-42 (lower indicates less severity)
Stroke severity:
-Mild: 1-5
-Mild to moderate: 5-14
-Severe: 15-24
-Very severe: >25
Outcomes related to scores at admission
- <5: 80% discharged home
- 6-13: typically require acute inpatient rehab
- >14: frequently require long-term skilled care
Expanded Disability Status Scale
System for quantifying disability d/t MS
-0-4.5: able walk IND
-6.0: intermittent or constant unilateral assist (cane, crutch, brace) required to walk about 100 meters with/without resting
-6.5: constant bilat UE assist required to walk about 20 meters
-7: essentially in a w/c, IND with propulsion/transfers
-8.5: essentially restricted to bed for much of day; some effective use of arm, retains some self care
Mini Mental State Exam
MMSE
Populations: stroke, TBI, geriatrics, PD, alzheimer’s/dementia
Screening tool uses several questions and tasks to assess cognitive impairment
BODY STRUCTURE/FUNCTION
Score: 0-30 (higher scores indicate better cognition)
=/<24 indicates presence of cognitive impairment
None: 24-30
Mild: 18-23
Severe: 0-17
Montreal Cognitive Assessment
MoCA
Populations: geriatrics, PD, stroke, dementia
Screening tool used to detect mild cognitive dysfunction
BODY STRUCTURE/FUNCTION
Scores: 0-30 (higher scores indicate greater cognition)
<23 suggests cognitive dysfunction
Mini BESTest
Populations: acquired/TBI, geriatrics, movement disorders, MS, PD, stroke, vestibular dysfunction
BODY STRUCTURE and FUNCTION
Scores: 0-28 (higher scores indicates less impairment)
14 items rated 0-2 that address anticipatory/reactionary postural adjustments, sensory orientation and dynamic gait
Falls risk
Stroke: =/<17.5
PD: <23
MDC/MCID
Vestibular: 4 pts
PD: 5.5 pts
Scale for the Assessment and Rating of Ataxia
SARA
Populations: cerebellar dysfunction, stroke
Provides quantitative assessment of impairments related to ataxia
BODY STRUCTURE/FUNCTION, ACTIVITY LIMITATIONS
0-40 (lower score indicates less ataxia)
Gait: =/<8: IND
=/<11.5 quad cane
=/<12.25: walker
ADL’s:
=/<5.5 IND
=/<10 min DEP
=/<14.25 mod DEP
=/< 23 max DEP
Rancho Level I
No response
Complete absence of observable behavior when presented with visual, auditory, tactile, proprioceptive, vestibular or painful stimuli
Rancho Level II
Generalized Response
Reaction to external stimuli is non-specific, inconsistent, and non-purposeful manner with stereotypical and limited responses
Rancho Level III
Localized Response
Responds specifically and inconsistently to stimuli with delays
-Turn toward or away from auditory stimuli
-Following moving object within visual field
-May follow simple commands (squeeze my hand)
Rancho Level IV
Confused/agitated
-Alert and in heightened state of activity
-May be restless aggressive or abusive d/t confusion
-Absent short-term memory
-Performance of motor activities without purpose
-Lack of deficit awareness (SAFETY CONCERN)
Rancho Level V
Confused/inappropriate/non-agitated
-Alert and non-agitated
-Not oriented
-Gross attention to environment but highly distractible
-Severely impaired recent memory
-Unable to learn new info
-Absence of goal-directed, problem solving, self-monitoring behavior
-Appropriate responses to simple commands with external cues
Rancho Level VI
Confused/appropriate
-Inconsistently oriented to person, place, and time
-Emerging awareness of appropriate response to self, family, and basic needs
-Goal-directed behavior but dependent on external cues
-Remote memory better than recent memory
-Demonstrates carry-over for some re-learned familiar tasks (self- care)
-Consistently follows simple directions
Rancho Level VII
Automatic/appropriate (Robotic)
-Appropriate behavior in familiar settings
-Performs daily routines automatically
-Demonstrates carry-over of new learning
-Unrealistic planning for the future and overestimates abilities
-Initiates social interactions, but judgement remains impaired
-Imitates others
Rancho Level VIII
Purposeful/appropriate (SBA)
-Consistently oriented
-IND for familiar tasks in distracting environments
-Aware of impairments, difficulty taking corrective action when completing tasks
-Difficulty with abstract reasoning, stress tolerance, and judgement
Rancho Level IX
Purposeful/appropriate (SBA on request)
-IND shifts between tasks for two hours
-Requires some assistance to adjust to life demands
-Emotional and behavioral issues possible
Rancho Level X
Purposeful/appropriate (mod-I)
-Goal-directed and able to handle multiple tasks IND with strategies
-May continue to have decreased attention and require additional time to compete tasks or need an AD
Walking Index for SCI II
WISCI
Population: SCI
Determines amount of physical assistance and/or aids for walking
ACTIVITY LIMITATION
Scores: 0-20pts (higher score indicates less impairment)
RANK ORDER
0= unable to stand/participate in assisted walking
0-5 in // bars
6-19 various AD’s, braces and lvl of assist
20= ambulates 10m without AD, braces of physical assist
No normative/cut-off data
Postural Assessment of Stroke
PASS
Population: stroke
ACTIVITY LIMITATION
Assesses and monitors postural ability in lying, sitting and standing while maintaining or changing position in 12 tasks
Scoring: 0-36 (higher score indicates more able); 0-3 on 12 tasks
MDC: 2-3 points depending on chronicity
Predicting IND ambulation at d/c 12.5pts
6MWT
Populations; ALL
ACTIVITY LIMITATION
Measures the distant walked in 6 minutes- ambulatory endurance
Normative values for community-dwelling elderly:
-60-69y: 538-572m (1,764-1,876ft)
-70-79y: 471-527m (1,544-1,764ft)
-80-89y: 392-417m (1,286-1,544ft)
MCID:
- Geriatrics: 50m (164ft)
- Stroke: 34.4m (113ft)
MDC’s across multiple populations between 110ft to 269(PD) is outlier
10MWT
ACTIVIT LIMITATION
-<0.1m/s d/c to SNF
->0.1m/s d/c more likely home
-<0.6m/s DEP with ADL’s and increased risk of hospitalization
-1.0m/s IND with ADL’s and less likely to fall
-<1.0m/s needs intervention to reduce fall risk
-Household ambulator: <0.4m/s
-Limited community ambulator: 0.4-0.8m/s
-Community ambulator: >0.8m/s
MDC:
- PD: 0.18m/s comfortable, 0.25m/s fastest
MCID:
- Geriatrics: 0.10m/s
- SCI: 0.13m/s
- TBI: 0.15m/s comfortable, 0.25m/s fastest
Berg Balance Scale
BBS
Populations: stroke, MS, PD, core set
BODY STRUCTURE/FUNCTION
Scores: 0-56pts, higher indicates better balance, 0-4 scores
=/<45/56pts increased risk of falls
MDC: 5-7pts across multiple diagnoses
SCI Acute
(Highly Recommended)
(0-3 months)
-ISNSCI/ASIA Impairment Scale
-6MWT
-10MWT
-Hand held myometry
-TUG
-Walking Index for SCI II
SCI Acute
(Recommended)
-BBS
-FIM
-MMT
-Needs Assessment Checklist
-NPRS
-SC Independence Measure III
-SCI Functional Ambulation Inventory
SCI Sub-Acute
(Highly Recommended)
3-6 months
-6MWT
-10MWT
-ISNSCI/ASIA Impairment Scale
-Hand Held Myometry
-TUG
SCI Sub-Acute
(Recommended)
3-6 months
-BBS
-FIM
-MMT
-Needs Assessment Checklist
-NPRS
-Sickness Impact Profile 68
-SCI Functional Ambulation Inventory
-SCI Independence Measures III
-WISCI II
SCI Chronic
(Highly Recommended)
> 6 months
-6MWT
-10MWT
-ISNSCI/ASIA Impairment Scale
-Hand Held Myometry
- NPRS
-World Health Organization QoL BREF
SCI Chronic
(Recommended)
-BBS
-Capabilities of UE Functioning Instrument
-Craig Handicap Assessment and Reporting
-Craig Hospital Inventory of Environmental Factors
-FIM
-Graded and Redefined Assessment of Sensibility Strength and Prehension
-Life Satisfaction Questionnaire 9
-MMT
-Multidimensional Pain Inventory, SCI Version
-Reintegration to Normal Living Index
-Satisfaction with Life Scale
-Short Form 36
-Sickness Impact Profile 68
-SCI Functional Ambulation Inventory
-SCI Functional Ambulation Profile
-SCI FIM III
-TUG
-WISCI II
-W/c Skills Test
-W/C Users Shoulder Pain Test
Motion Sensitivity Quotient
MSQ
0-10%: mild motion sensitivity
11-30%: moderate motion sensitivity
31-100%: severe motion sensitivity
Those with Meniere’s and Vestibular Migraines had significantly higher scores than controls.
Freezing of Gait Questionnaire
Only validated tool to subjectively test freezing of gait
6-item questionnaire to be completed during “on” times
Scoring: 0 (absence of sx’s) to 4 (most severe)
Total score of 0-24
Answered based on last week or overall presence of freezing during the entire day
Agitated Behavior Scale
Populations: TBI, dementia, Alzheimer’s disease
Scoring: 14-56pts (high indicates more agitation)
WNL: =/<21
Mild agitation: 22-28pts
Moderate: 29-35
Severe: >35
Modified Falls Efficacy Scale
Population: geriatrics
Assesses perception of balance and fear of falling during ADL’s
ACTIVITY LIMITATION/PARTICIPATION RESTRICTION
0-10 (higher score indicate more confidence)
<5 predictive of falls and longer hospital stay
Modified Rankin Scale
- No symptoms
- No significant disability despite symptoms; able to carry out all usual duties and activities
- Slight disability: unable to carry out all previous activities but able to look after own affairs without assistance
- Moderate disability: requiring some help, but able to walk without assistance
- Moderately severe disability: unable to walk without assistance, and unable to attend to own bodily needs without assistance
- Severe disability: bedridden, incontinent, and requiring constant nursing care and attention
- Death
Push and Release Test
Populations: cerebellar dysfunction, PD, vestibular dysfunction, general balance patients
Assesses instability by ability to regain balance. Tested with patient leaning backwards.
BODY STRUCTURE/FUNCTION, ACTIVITY LIMITATIONS
Scores 0-4 (lower scores indicate better ability)
0: recovers with 1 step IND
1: 2-3 steps required but IND
2: 4+ steps required by IND
3: Able to step but requires assistance
4: Falls without attempting a step or unable to stand without assistance
9-hole peg test
Populations: acquired brain injury, stroke, PD, MS
Timed test to measure finger dexterity
BODY STRUCTURE FUNCTION/ACTIVITY LIMITATION
90th percentile
Female 20-24: 12.5 secs R, 11.5 secs L
Male 20-24: 10.5 secs R, 11 secs L
Female 60-64: 17.5 secs R, 18.5 secs L
Male 60-64: 18.5 secs R, 20 secs L
Female 80-84: 20 secs R, 22 secs L
Male 80-84: 22.5 secs R, 24.5 secs L
> 33.3 secs indicates severe hand dysfunction in MS
Modified Fatigue Impact Scale
Populations: MS and TBI
BODY STRUCTURE AND FUNCTION/ACTIVITY LIMITATIONS
0-84 (lower number indicates less impact of fatigue)
24 items rated 0- never to 4-almost always
MCID for MS: 16.2pts
Conversions
3.28 feet = 1 meter
1 inch = 2.54 cm
Functional Reach Test
Populations: MS, stroke, PD, community dwelling elderly, PD, SCI, vestibular disorders
ACTIVITY LIMITATION
<18.5cm indicates falls risk in geriatrics
<31.75 cm indicates falls risk in PD
Medical Outcomes Study SF-36
Populations: stroke, TBI, MS, Cancer, PD, SCI
The 8 subscales are:
1) Physical Functioning
2) Role Limitations due to Physical Problems
3) General Health Perceptions
4) Vitality
5) Social Functioning
6) Role Limitations due to Emotional Problems
7) General Mental Health
8) Health Transition
Each sub scale is scored 0 (negative health)-100 (positive health)
Trunk Impairment Scale
Populations: stroke, PD, MS
BODY STRUCTURE FUNCTION/ACTIVITY LIMITATION
Scores range from a minimum of 0 to a maximum of 23.
If patient scores 0 on the first item, the total score on the TIS is 0.
Each item can be performed three times.
The highest score counts; otherwise, no practice sessions are allowed.
The patient can be corrected between attempts.
Three subscales: static sitting, balance, dynamic sitting balance and coordination. Each subscale has between three and 10 items.
Rivermead Mobility Index
Populations: TBI, SCI, stroke, MS
ACTIVITY LIMITATION
Scores: 0-15pts (higher scores indicate better mobility), 0= No or cannot perform task, 1= YES or can perform task
Tasks include: turning over in bed, sit<>stand, walking, running
SCI Functional Ambulation Profile
SCI-FAP
Recommended in chronic stages
ACTIVITY LIMITATION
Scores: total is 2100
Tasks include obstacles, carry, stairs, walking through a door
SCI Functional Ambulation Inventory
SCI-FAI
Recommended in acute, sub-acute and chronic stages
Gait parameter (qualitative characteristics), AD parameter, temporal distance parameter
ACTIVITY LIMITATION
Scores: 0-39pts, higher scores indicate better function
MDC: 1.9pts for gait
