Outcome Measures Flashcards
Why do we Use Outcome Measures?
Collect and record information
Use that information to enhance patient care
Outcomes in clinical practice use the following to assess the end results of care and the effect upon health of the patient and society:
Health Care Provider
Patient
Public
Payer
Providers:
Accountability
Clinically Efficient and Economical Documentation
Health Care Customer =
Payers/Purchasers
Regulators
Administrators
Clinical Researchers
Outcome Experts
Health Care Providers
Meaning of Outcomes =
Cost Containment
HCP Compliance
Efficiency-Low Utilization
Proof of a Premise
Patient’s Benefits
Clinical Health Status
What Makes a Useable Outcome Measure?
Utility = Is it useful?
Reliability = Is it dependable and reproducible?
Validity = Does it do what it is supposed to do?
> Sensitivity = Can it identify patients with a condition?
> Specificity = Can it identify those without the condition?
Responsiveness = Can it measure differences over time?
Subjective = (Patient Driven)
General Health
Pain Perception
Condition or Disease Specific
Psychometric
Disability Prediction
Patient Satisfaction
Objective = (HCP Driven)
Range of Motion
Strength-Endurance
Non-Organic
Proprioception/Balance
Gait
Cardiopulmonary
Development
Conduction
Also, remember to utilize the same ___ the course of care with each patient.
outcome tool throughout
The Neuro Core Set =
6 Outcome Measures that are (generally) applicable to most Neurological diagnoses
6 Outcome Measures that are (generally) applicable to most Neurological diagnoses:
Berg Balance Scale
Functional Gait Assessment
10 Meter Walk Test
6 Minute Walk Test
Five Times Sit to Stand
Activities-Specific Confidence Scale
Berg Balance Scale (BBS)
Ordinal measurement tool assessing dynamic balance
Predicts “fallers” and “non-fallers”
Requires subjects to perform 14 balance & mobility tasks
Takes ~20-30 minutes
Valid & reliable tool to predict falls in elderly
Excellent intra-rater (0.98) and inter-rater (0.99) reliability
MDC = 8 points
Berg Balance Scale
Equipment:
Stopwatch, ruler, 2 chairs w/ and w/out armrests, & step stool (of avg ht)
Berg Balance Scale
Rated:
14 sub-tasks to be performed in standardized order
Each task is graded on 5-pt ordinal scale = range from 0 - 4
Scores based on speed, stability, or degree of assistance required
Berg Balance Scale - 4
pt performs tasks independently & meets time & distance requirement
Berg Balance Scale - 0
pt unable to perform or needs moderate max assistance
Berg Balance =
Task scores summed w/ max of 56
Scores higher than 45 = “non-fallers”
Scores lower than 45 = impaired & at increased risk of falls = “fallers”
Functional Gait Assessment =
10 items
7 of the 8 original DGI items
> Variations in speed, head turning, turning, stepping over & around obstacles, and stairclimbing
3 new items
> Gait with narrow base of support
> Backwards ambulation
> Gait with eyes closed
Functional Gait Assessment
Points =
4 point scale (0-3), 30 total points
MDC = 4.2 points (originally for Stroke)
≤ 22/30 predicted falls (Sensitivity 85%, Specificity 86%)
≤ 20/30 predicted unexplained falls for community dwelling adult (Sensitivity 100%, Specificity 76%)
Interrater reliability = .93
5 Time Sit to Stand =
Individual is seated in chair and told to stand and sit 5 times in a row without touching the back of the chair
Original instructions did not allow the use of arms:
> Documented as unable to complete without the use of assistance
> However, you can still time and use this for goals
Walking Speed as a 6th Vital Sign = Walking speed can tell us a variety of things:
Individual’s functional capacity
General health status
Response to rehabilitation
Functional dependence
Frailty
Mobility disability
Cognitive decline
Falls
Institutionalization
Hospitalization
Cardiovascular-related events and mortality
All-cause mortality
Walking Speed - clinical pearls
administer tests with a timed central straight path 5 to 10 meters in length
stopwatch and premeasured length of rope provide a portable option
included an acceleration phase
> self-selected ~2.5m
> maximal tets: 3 t0 3.25m
include real-life example or demonstration to instructions for maximal tests
maintain consistency at all subsequent testing sessions
10 Meter Walk Test
1st procedure =
10 meter walk way
First 2 meters and last 2 meters are acceleration and deceleration zones, untimed
Middle 6 meters is timed (So really, 6 meter walk test)
Calculate
6/seconds = m/s
X 2.24 = mph
10 Meter Walk Test
2nd procedure =
20 meter walk way
First 5 meters and last 5 meters are acceleration and deceleration zones, untimed
Middle 10 meters is timed
Calculate
10/seconds = m/s
X 2.24 = mph
10 Meter Walk Test - When compared with the 4 meter walk test =
Reliability of both walking tests is excellent
The 4-Meter Walk Test does not exhibit a high enough degree of concurrent validity with the 10-Meter Walk Test to be used interchangeably for gait assessments in healthy, older adults
We therefore recommend using the 10-Meter Walk Test to obtain the most valid clinical assessment of walking speed when using it as a 1-time indicator of health status.”
6 Minute Walk Test (6MWT) =
Measure of exercise tolerance and endurance
Has recently been standardized as 6 minute, used to be 12 minutes
6 Minute Walk Test (6MWT)
Equipment:
Stopwatch, rolling tape measure, six-minute walk cues, sphygmomanometer, stethoscope, clipboard, and masking tape
6 Minute Walk Test (6MWT)
Reliability and MDC:
Good test-retest reliability (.95 for geriatrics, Harada et al. 1999)
MDC = 58.21 Meters for Geriatrics
MDIC = 50 Meters for Geriatrics
Good construct and concurrent validity for patients with cardiorespiratory diagnoses
6 Minute Walk Test (6MWT)
Able to:
Locate differences between healthy adults and those with heart failure
Predict hospitalization and mortality for those with lung disease
Predict 6MWT values:
Men:
(7.57 x height[cm]) – (5.02 x age) – (1.76 x weight[kg]) – 309 meters
Women:
(2.11 x height[cm]) – (5.78 x age) – (2.29 x weight[kg]) + 667 meters
Activity-specific Balance Confidence Scale (ABC) =
16 item questionnaire
Scale from 0-100
0 = no confidence
100 = full confidence
Overall Score
> (Sum/16) /100 = % overall confident
Activity-specific Balance Confidence Scale (ABC)
Scale:
Below 50% = low level of physical functioning
50-80% = moderate level of physical functioning
Above 80% = highly functioning
Activity-specific Balance Confidence Scale (ABC)
Good reliability for:
Elderly (.92) (Powell & Myers, 1995)
Stroke (.85) (Botner et al. 2005)
Parkinson’s (.94) (Steffen & Seney et al. 2008)
Other Common Outcome Measures =
MiniBESTest
Timed Up and Go
4 Square Step Test
Walking While Talking Test
Montreal Cognitive Exam
Geriatric Depression Scale
Functional Reach Test
AMPAC – Boston 6 Click
