Outcome Measures

Question 1

Why do we Use Outcome Measures?

Answer 1

Collect and record information

Use that information to enhance patient care

Question 2

Outcomes in clinical practice use the following to assess the end results of care and the effect upon health of the patient and society:

Answer 2

Health Care Provider
Patient
Public
Payer

Question 3

Providers:

Answer 3

Accountability

Clinically Efficient and Economical Documentation

Question 4

Health Care Customer =

Answer 4

Payers/Purchasers
Regulators
Administrators
Clinical Researchers
Outcome Experts
Health Care Providers

Question 5

Meaning of Outcomes =

Answer 5

Cost Containment
HCP Compliance
Efficiency-Low Utilization
Proof of a Premise
Patient’s Benefits
Clinical Health Status

Question 6

What Makes a Useable Outcome Measure?

Answer 6

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?

Question 7

Subjective = (Patient Driven)

Answer 7

General Health
Pain Perception
Condition or Disease Specific
Psychometric
Disability Prediction
Patient Satisfaction

Question 8

Objective = (HCP Driven)

Answer 8

Range of Motion
Strength-Endurance
Non-Organic
Proprioception/Balance
Gait
Cardiopulmonary
Development
Conduction

Question 9

Also, remember to utilize the same ___ the course of care with each patient.

Answer 9

outcome tool throughout

Question 10

The Neuro Core Set =

Answer 10

6 Outcome Measures that are (generally) applicable to most Neurological diagnoses

Question 11

6 Outcome Measures that are (generally) applicable to most Neurological diagnoses:

Answer 11

Berg Balance Scale

Functional Gait Assessment

10 Meter Walk Test

6 Minute Walk Test

Five Times Sit to Stand

Activities-Specific Confidence Scale

Question 12

Berg Balance Scale (BBS)

Answer 12

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

Question 13

Berg Balance Scale
Equipment:

Answer 13

Stopwatch, ruler, 2 chairs w/ and w/out armrests, & step stool (of avg ht)

Question 14

Berg Balance Scale
Rated:

Answer 14

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

Question 15

Berg Balance Scale - 4

Answer 15

pt performs tasks independently & meets time & distance requirement

Question 16

Berg Balance Scale - 0

Answer 16

pt unable to perform or needs moderate  max assistance

Question 17

Berg Balance =
Task scores summed w/ max of 56

Answer 17

Scores higher than 45 = “non-fallers”

Scores lower than 45 = impaired & at increased risk of falls = “fallers”

Question 18

Functional Gait Assessment =

Answer 18

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

Question 19

Functional Gait Assessment
Points =

Answer 19

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

Question 20

5 Time Sit to Stand =

Answer 20

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

Question 21

Walking Speed as a 6th Vital Sign = Walking speed can tell us a variety of things:

Answer 21

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

Question 22

Walking Speed - clinical pearls

Answer 22

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

Question 23

10 Meter Walk Test
1st procedure =

Answer 23

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

Question 24

10 Meter Walk Test
2nd procedure =

Answer 24

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

Question 25

10 Meter Walk Test - When compared with the 4 meter walk test =

Answer 25

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.”

Question 26

6 Minute Walk Test (6MWT) =

Answer 26

Measure of exercise tolerance and endurance

Has recently been standardized as 6 minute, used to be 12 minutes

Question 27

6 Minute Walk Test (6MWT)
Equipment:

Answer 27

Stopwatch, rolling tape measure, six-minute walk cues, sphygmomanometer, stethoscope, clipboard, and masking tape

Question 28

6 Minute Walk Test (6MWT)
Reliability and MDC:

Answer 28

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

Question 29

6 Minute Walk Test (6MWT)
Able to:

Answer 29

Locate differences between healthy adults and those with heart failure

Predict hospitalization and mortality for those with lung disease

Question 30

Predict 6MWT values:

Answer 30

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

Question 31

Activity-specific Balance Confidence Scale (ABC) =

Answer 31

16 item questionnaire

Scale from 0-100
0 = no confidence
100 = full confidence

Overall Score
> (Sum/16) /100 = % overall confident

Question 32

Activity-specific Balance Confidence Scale (ABC)
Scale:

Answer 32

Below 50% = low level of physical functioning

50-80% = moderate level of physical functioning

Above 80% = highly functioning

Question 33

Activity-specific Balance Confidence Scale (ABC)
Good reliability for:

Answer 33

Elderly (.92) (Powell & Myers, 1995)

Stroke (.85) (Botner et al. 2005)

Parkinson’s (.94) (Steffen & Seney et al. 2008)

Question 34

Other Common Outcome Measures =

Answer 34

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