Test 2: Neuro Acute Care Outcome Measures Flashcards
Uses of outcome measures
identify baseline
predict prognosis
categorize pt
communicate status
determine appropriate intervention
identify pt improvement
3 main CLINICAL purposes of outcome measures
discriminate (pts into groups)
predict (make prognosis)
evaluate (effect of intervention)
categories of outcome measures
diagnosis
performance based
self report
clinician reported
examples of age specific tests
pediatrics = peabody developmental motor scales
geriatrics = functional reach; normative by age
examples of task specific tests
berg = postural stability
dynamic gait index = gait
describe performance based measure
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
describe self report measures and things to keep in mind about using them
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
characteristics of outcome measures
reliability
validity
sensitivity
sensibility (bonus)
what is reliability
reproducibility of a measure when repeated at random with the same subject
interrater vs itrarater vst test retest reliability
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)
what is the intraclass correlation coefficient (ICC)
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
what is standard error of measurement
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
what is validity
ability of a tool to measure what it is intended to measure
criterion validity
comparison of results to gold standard
predictive validity
ability to predict future outcomes
face validity
assumption that an instrument is valid based on its appearance
i.e. a reasonable measure of the variable being assessed
content validity
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)
contruct validity
does the measure measure what it is supposed to? degree to which the instrument reflects the theoretical components of the measure
how is validity measured
by correlation coefficient
clinical bottom line
excellent = CC >0.6
adequate = CC 0.31-0.59
poor = CC <0.30
what is sensitivity
ability of an instrument to measure change in state of pt whether it is relevant or meaningful
what is sensitivitu measured by
minimal detectable change and responsiveness
what is the floor and ceiling effect of sensitivity
floor = decreased sensitivity to change with pts at lower level
ceiling = decreased sensitivity to higher level pts, all pts get a max score
what is responsiveness
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
what is minimal detectable change
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
what is sensibility
logistics and practicality to administer outcome
setting appropriateness
pt appropriateness
easy to administer vs training required
timely administration
cost of measure
what domains might outcome measures fall into
body functions (impairments)
activity (functional limits)
participation (disability)
examples of measures that fall into the body structures and function category
for cognition: mini-mental (MMSE), Montreal Cognitive (MoCA)
Balance- CTSIB, push and release, 30 sec STS
examples of outcome measures that fall into the activity domain
performance based measures
dynamic gait index (gait)
functional independence measure (FIM)
box and blocks (reach and grasp)
describe the measures you would find in the participation domain
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
examples of outcome measures that fall into the participation ICF domain
activities specific balance confidence scale (ABC)
fall efficacy scale
rankin scale
SF36
stroke impact scale
describe the stroke impact scale
self report
59 items, 8 subgroups
participation domain
pt rates perceived recovery
domain often used to inform LTG for pts
participation domain
what is EDGE
evaluation database to guide effectiveness
provide recommendations for measures by level of ICF, pt, practice setting, utility in research, and entry level PT edu
