Outcome measures, Red/yellow flags Flashcards
What are outcome measures?
Used to document progress
– Must demonstrate a departure from wellness
– Must demonstrate progress
What is the importance of having documented progress?
Show that treatment is effective, reasonable, and necessary.
Types of outcome measures:
Visual pain analog scale - no pain to worst pain imaginable
Numeric pain rating scale (NRS - circle the number) no pain to worst pain imaginable
VAS
Quadruple VAS
Pain diagram
Etc
What is VAS and who is it best for?
Vertical analog scale, better understood by the elderly.
What is quadruple VAS?
- Pain Right Now?
- Typical or Average Pain?
- Pain At It’s Best?
- Pain At It’s Worst?
What is ODI?
Oswestry disability index.
• Low back disability • 10 sections of daily activities – Pain Intensity, personal care, walking, social life… • 6 choices for each section • Scored 0-5 • Add each section for over-all disability – Greatest disability = 50 – or multiply by 2 for % score
What is the Roland Morris Questionnaire?
- RMQ
- Low back disability
- 24 disability statements
- Score: total number of statements marked
What is the Bournemouth low back and neck questionnaires?
- 7 Items
- Each is a scale of 0 to 10
- Take total points and divide by 70 for % disability
What is the headache disability Index?
• 2 subscales
– Emotional and Functional
• Plus Total Composite score
What is the upper extremity functionality index?
(UEFI)
– 20 Items scored 0 – 4
– Total score / 80 x 100 = % disability
What is LEFS?
Lower Extremity Functional Scale (LEFS) • Similar to Upper Extremity Functional Index (UEFI) – 20 Items scored 0 – 4 – Total score / 80 x 100 = % disability
What is the general health status questionnaire?
Health Status Questionnaire (HSQ 36, or SF 36)
– 8 Subscales of general health
• Physical Functioning, Role Physical, Bodily Pain,
General Health, Vitality, Social Functioning, Role
Emotional, Mental Health
– 2 Summary Measures
• Physical Health, Emotional Health
– Overall score
– 3 Individual diagnostic questionaires
***What is the global well-being scale?
Laid out opposite of VAS. Worst you could possibly feel is on the left, best you could possibly feel is on the right, unlike VAS.
What are some of the mental status questionnaires?
Beck depression inventory - II (BDI II)
Geriatric depression scale
What are yellow flag outcomes?
Psychosocial outcomes
What are examples of yellow flag outcomes?
• Fear Avoidance Beliefs Questionnaire (better of the 2)
– Measures beliefs about activity and pain in
normal activity and work
• Modified Work APGAR
– Questions about job tasks and interpersonal
relationships on the job.
What are Waddell’s signs (5)?
- Superficial or Non-anatomic Tenderness
- Simulation
– LBP with axial loading or standing rotation of the
shoulders and pelvis - Distraction
– 40o-45o difference Supine SLR to Sitting SLR - Regional disturbances
– Unexplained weakness or sensory findings - Over-reaction
– Exaggerated responses to testing
What does it mean if patient is positive for 3 or more of Waddell’s signs?
Abnormal illness behavior
• Psychological overlay to the pain
T/F
Since the patient tested positive for 3 of Waddell’s signs, their condition has now been identified as out of the scope of your practice as a DC. You should refer out.
False
Treat the pain and the psychological overlay.
What are functional measures?
• Measure patient’s ability to perform physical tasks • Objective measures – ROM, Reflexes, Strength, Endurance • Decreased trunk and hip strength / endurance has been correlated with low back pain (current and future episodes).
What is a yellow flag?
History and examination findings that are risk
factors for developing chronic pain
What is a red flag?
– History and examination findings that prompt
the clinician to conduct further diagnostic
procedures
If a patient has severe pain (with a cervical injury) after 1 month of care what is suggested?
Yellow flag suggesting possible chronicity, less likely to get better.
What is an example of catasrophizing pain coping style?
“I know I’m going to end up in a wheelchair”
Low back should get better in how many weeks?
3
Neck injury should get better in how many weeks?
4
