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outcome measures Flashcards

1
Q

what are outcome measures?

A
  • tool to measure the result of interventions over time
  • demonstrate if the interventions are effective and efficient
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2
Q

what are the outcome measure tools?

A
  • test
  • measurement
  • scale
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3
Q

what are the measures?

A
  • variety of outcome measures
  • individualised, generic and condition specific
  • measure a particular attribute of interest to patients or clinicians
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4
Q

what are the measures influenced by? when do they change?

A
  • influenced by an intervention
  • changes as patient is treated
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5
Q

what are the examples of outcome measures?

A
  • strength
  • range of movement
  • pain
  • psychological measures such as BP, HR, RR, SP02
  • distance mobilised
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6
Q

what do we quantify and monitor from outcome measures?

A
  • quantify a patient’s ability
  • monitor treatment progress
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7
Q

what do outcome measures facilitate and acquire?

A
  • facilitate clinical decision- making
  • acquire baseline data
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8
Q

what do outcome measures determine?

A
  • clinical efficacy
  • cost- effectiveness of treatment
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9
Q

what are patient reported outcome measures? give an example

A
  • used to assess outcomes which are important to the patient
  • questionnaires
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10
Q

what are patient reported outcome measures used to assess?

A
  • assess outcomes which are important to the patient
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11
Q

what can patient reported outcome measures assess and support?

A
  • assess if treatment plan is working
  • support clinical decision making
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12
Q

what does patient reported outcome measures involve and drive?

A
  • involves research and evidence- based practice
  • drive quality improvement
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13
Q

what does patient reported outcome measures empower?

A
  • empowers the patient
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14
Q

what can patient reported outcome measures help with ?

A
  • service provision and policy making
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15
Q

how is patient reported outcome measures multidimensional?

A
  • physical, mental and social factors
  • known as health- related quality of life tools
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16
Q

what is the advantages of patient reported measures?

A

+ measures attributes most important to them e.g., QOL so more interesting

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17
Q

what are clinician- reported measures? give an example

A
  • passive clinical tests or performance based measures
  • limb girth, isokinetic strength testing
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18
Q

what is the advantage of clinician reported measures ?

A
  • assess what a patient can do, not what they think they can do
  • more objective
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19
Q

what are individualised patient reported outcome measures? give an example

A
  • looks at patients’ own definitions of health and the outcomes that are important to them
    e.g., patient specific function scale
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20
Q

what are the ten desirable properties of an outcome measure?

A
  • appropriateness
  • acceptability
  • feasibility
  • interpretability
  • reliability
  • validity
  • responsiveness
  • low floor and ceiling effects
  • internal consistency and dimensionality
  • tested with patients of interest
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21
Q

what should you consider when you select an appropriate outcome measure?

A
  • consider the condition you are treating
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22
Q

what are the four things you should think about to select an appropriate outcome measure?

A
  • appropriate
  • valid
  • reliable
  • responsive
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23
Q

what does appropriateness refer to in outcome measures? what are the two types?

A
  • is the measure appropriate for the intended use
  • generic or specific
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24
Q

what are the two big factors taken into consideration for appropriateness?

A
  • who is being measured
  • what is being measured
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25
Q

how should measures be designed to aid appropriateness?

A
  • measures should be purposely designed for types of patients with whom they will be using
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26
Q

what is a generic patient reported outcome measure? give an example

A
  • measures the response of patients regardless of illness or disorder
  • used with most patients as addresses all aspects of QOL
    e.g., SF-36
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27
Q

what are specific patient reported outcome measure? give an example

A
  • focuses on specific disease/ disorder and outcomes relevant to condition
  • intended for patients who share a particular feature
    e.g., neck disability index
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28
Q

what are the three types of specific measures?

A
  • condition- specific
  • site- specific
  • dimension- specific
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29
Q

what is condition specific?

A
  • same injury/ condition
30
Q

what is site- specific?

A
  • injury to the same body part
31
Q

what is dimension specific ?

A
  • same signs and symptoms
32
Q

what is the advantage and disadvantage of more condition specific measures?

A

+ more likely to measure outcomes relevant to that condition
- less likely to measure overall health and quality of life

33
Q

how is what being measured separated into 4 categories?

A
  • body structure impairment
  • body function impairment
  • activity limitation
  • participation limitation
34
Q

what does body structure impairment refer to?- give an example

A
  • injury itself
  • ACL injury> MRI scan
35
Q

what does body function impairment refer to?- give an example

A
  • signs and symptoms of injury
  • muscle weakness> isokinetic strength test
36
Q

what is activity limitations?- give an example

A
  • inability to perform specific functional activities
  • reduced hop distance> hop test
37
Q

what is participation restrictions?- give an example

A
  • inability to participate in life situations
  • can’t play sport: battery of functional fitness test
38
Q

what does validity refer to in outcome measures?

A
  • outcome measure is testing what it says it is testing
39
Q

what are the four types of validity?

A
  • face
  • content
  • criterion
  • construct
40
Q

what is face validity?

A
  • does the measure appear to be valid?
    not as important as the others but patients more likely to cooperate in assessments that they perceive to be more relevant
41
Q

what is content validity?

A
  • is the measure comprehensive?
  • extent to which a measure covers all important aspects of constructs being measured
42
Q

what is content validity applicable to?

A
  • measures comprising more than 1 component
    e.g., questionnaire
43
Q

what is criterion validity?

A
  • do scores on measure correlate with gold standard?
44
Q

what is construct validity?

A
  • degree to which a measure relates to other measures and variables in accordance with theoretically- derived hypotheses
  • convergent, divergent and known- groups validity
45
Q

what should you look for when evaluating content validity?

A
  • look for evidence that creators were thorough and systematic in selecting components
46
Q

what are the three components for inclusion?

A
  • literature reviews
  • expert panel discussions
  • views of patients (focus groups and interview)
47
Q

what should a measure correlate highly with?

A
  • other measures that assess the same construct and are already known to have excellent validity
48
Q

what is the limitation of construct validity?

A
  • few gold standards exist so need to assess construct validity instead
49
Q

what are the three types of construct validity?

A
  • convergent validity
  • divergent validity
  • known groups validity
50
Q

what does convergent validity mean?

A
  • does the measure correlate well with related measures
  • no comparison with gold standards means high correlations are not expected
  • you decide what is acceptable e.g., 0.5
51
Q

what is divergent validity? what should the correlation be below?

A
  • does the measure correlate poorly with unrelated measures
  • measure shouldn’t correlate too strongly with unrelate measures
  • below 0.3
52
Q

what is known- groups validity? what does it discriminate between?

A
  • can the measure detect differences between sub- groups of patients
  • measures should discriminate between sub groups who differ in some respect e.g., injury severity or disability level
53
Q

what does reliability refer to in outcome measures?

A
  • results are reproducible
  • measure should provide similar values on repeated administration in unchanged patients
54
Q

what are the three types of reliability?

A
  • intra- rater
  • inter- rater
  • test- retest
55
Q

what is intra- rater reliability?

A
  • extent to which measurements taken by the same person are consistent overtime
56
Q

what is inter- rater reliability?

A
  • extent to which measurements taken by different people are similar
57
Q

what is test- retest?

A
  • extent to which patients completing a measure without a rater provide consistent results
  • compare results on two different times
58
Q

how do you quantify reliability? what is no reliability vs perfect?

A
  • quantify via a coefficient
    0= no reliability
    1= perfect
59
Q

what does reliability coefficient reflect and tell us?

A
  • reflects extent to which a measure can differentiate between individuals
  • tells us whether we can rely on a measure in certain situations
60
Q

what is a good enough coefficient for groups of patients?

A
  • 0.7
  • research
61
Q

what is a good enough coefficient for individuals ?

A
  • 0.9
  • clinical decision making
62
Q

what are the two types of scales for reliability?

A
  • continuous scale
  • categorical scale
63
Q

give an example of a continuous reliability scale

A
  • hop distance
  • intraclass correlation coefficient
64
Q

give an example of categorical reliability scale

A
  • mild, moderate, severe
  • kappa coefficient
65
Q

other than consistency, what is reliability about?

A
  • population dependent
66
Q

how do you measure reliability?

A

true subject variability/ true subject variability + measurement error

67
Q

what does ratio of measurement error measure?

A
  • how different or not the people you are measuring are
68
Q

what is reliability influenced by?

A
  • variability
  • so no such thing as reliability of a measure
69
Q

what does responsiveness refer to in outcome measures?

A
  • sensitive to change over time
70
Q

what else should be measured?

A
  • activities of daily living
  • HRQL
71
Q

what barriers could there be to completing the outcome measures?

A
  • cognitive
  • psychological
  • socioeconomic status

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