Test 2: Neuro Acute Care Outcome Measures

Question 1

Uses of outcome measures

Answer 1

identify baseline

predict prognosis

categorize pt

communicate status

determine appropriate intervention

identify pt improvement

Question 2

3 main CLINICAL purposes of outcome measures

Answer 2

discriminate (pts into groups)

predict (make prognosis)

evaluate (effect of intervention)

Question 3

categories of outcome measures

Answer 3

diagnosis
performance based
self report
clinician reported

Question 4

examples of age specific tests

Answer 4

pediatrics = peabody developmental motor scales

geriatrics = functional reach; normative by age

Question 5

examples of task specific tests

Answer 5

berg = postural stability

dynamic gait index = gait

Question 6

describe performance based measure

Answer 6

actual performance of an item or task at specific time and environment

variables used

results are timed, level of assistance, distance

fatiugue and practice effects may skew results

Question 7

describe self report measures and things to keep in mind about using them

Answer 7

can use proxy if cognitive barriers

useful when function cant be observed directly

therapist may use questionnaire to interview pt

pt may falsely report what they think the clinician wants to hear

OFTEN USED FOR QUALITY OF LIFE/PARTICIPATION MEASURES

Question 8

characteristics of outcome measures

Answer 8

reliability
validity
sensitivity
sensibility (bonus)

Question 9

what is reliability

Answer 9

reproducibility of a measure when repeated at random with the same subject

Question 10

interrater vs itrarater vst test retest reliability

Answer 10

interrater = 2 examiners achieve similar results

intrarater = achieve similar results for the same examiner

test-retest = repeated use of the measure yields similar results; Standard error of measurement (SEM)

Question 11

what is the intraclass correlation coefficient (ICC)

Answer 11

reliability index in test retest, intrarater, and interrater reliability analysis

With 95% confidence interval:

<0.5 = poor reliability
0.5-0.75= moderate
<0.75 - 0.9 = good
< 0.90 = excellent

Question 12

what is standard error of measurement

Answer 12

estimates how repeated measures of a person on the same instrument tend to be distributed around his or her “true” score

large SEM = negative impact on reliability

SEM is the amount of error considered as measurement of error

Question 13

what is validity

Answer 13

ability of a tool to measure what it is intended to measure

Question 14

criterion validity

Answer 14

comparison of results to gold standard

Question 15

predictive validity

Answer 15

ability to predict future outcomes

Question 16

face validity

Answer 16

assumption that an instrument is valid based on its appearance

i.e. a reasonable measure of the variable being assessed

Question 17

content validity

Answer 17

items that make up an instrument adequately sample the possible items that compose what needs to be measured

typically assessed by subject matter experts (SME)

Question 18

contruct validity

Answer 18

does the measure measure what it is supposed to? degree to which the instrument reflects the theoretical components of the measure

Question 19

how is validity measured

Answer 19

by correlation coefficient

clinical bottom line

excellent = CC >0.6

adequate = CC 0.31-0.59

poor = CC <0.30

Question 20

what is sensitivity

Answer 20

ability of an instrument to measure change in state of pt whether it is relevant or meaningful

Question 21

what is sensitivitu measured by

Answer 21

minimal detectable change and responsiveness

Question 22

what is the floor and ceiling effect of sensitivity

Answer 22

floor = decreased sensitivity to change with pts at lower level

ceiling = decreased sensitivity to higher level pts, all pts get a max score

Question 23

what is responsiveness

Answer 23

ability of an instrument to measure a meaningful or clinically important change in clinical state

implies a change that is noticeably, appreciably different and that is of value to a pt

Question 24

what is minimal detectable change

Answer 24

measure of sensitivity of a test/measure

statistical estimate of smallest amount of change that can be detected by a measure which corresponds to a noticeable change in ability

reflects a score that suggests change in ability that is not a result of the measurement errir

Question 25

what is sensibility

Answer 25

logistics and practicality to administer outcome

setting appropriateness
pt appropriateness
easy to administer vs training required
timely administration
cost of measure

Question 26

what domains might outcome measures fall into

Answer 26

body functions (impairments)

activity (functional limits)

participation (disability)

Question 27

examples of measures that fall into the body structures and function category

Answer 27

for cognition: mini-mental (MMSE), Montreal Cognitive (MoCA)

Balance- CTSIB, push and release, 30 sec STS

Question 28

examples of outcome measures that fall into the activity domain

Answer 28

performance based measures

dynamic gait index (gait)

functional independence measure (FIM)

box and blocks (reach and grasp)

Question 29

describe the measures you would find in the participation domain

Answer 29

limitations in performance of socially defined roles

often self report/observation report

can be generic or disease specific

quality of life measures - pt perception

can be subjective

self efficacy plays a role

Question 30

examples of outcome measures that fall into the participation ICF domain

Answer 30

activities specific balance confidence scale (ABC)

fall efficacy scale

rankin scale

SF36

stroke impact scale

Question 31

describe the stroke impact scale

Answer 31

self report

59 items, 8 subgroups

participation domain

pt rates perceived recovery

Question 32

domain often used to inform LTG for pts

Answer 32

participation domain

Question 33

what is EDGE

Answer 33

evaluation database to guide effectiveness

provide recommendations for measures by level of ICF, pt, practice setting, utility in research, and entry level PT edu