Lecture 4- Outcome Measures

kms013's version from 2016-01-31 22:39


Question Answer
What is an outcome measure?the result of a test that is used to objectively determine the baseline fx of the pt at the beginning of tx. Once tx has commenced, the same instrument can be used to determine progress and tx
What are the outcome measures we report?p!, strength, ROM
What are the things the pt self-reports?Ability to perform ADLs/work activities (fxl scales), depression (depression index) Fear of returning to work (Fear avoidance Questionaire) General Health (SF-36) Mortality (Death Statistics)
Impairment vs. Self-report...what are the past assumptions vs what evidence now suggests?Past: Impairment measures are "better" tahn self-report measures for measuring fx/disability; Now-- many self-report outcome measures for each body region have demonstrated acceptable reliability and validity
CP: Pt self report on OM should = improvements of impairments/fx per your re-assessment (in other words, if the pt reports a 50% improvmenet in their OM, you should also feel liek the pt has imporved 50% based on their obj. improvements w impairmnets/fxl limitations
Self-report questionnaire outcome tools are primarily used to: (3)1. determine pts belief of their level of fxl loss/disability (health related QOL), 2. Evaluate change within an individual pt or a group of pts 3. Predict a future event or prognosis w a given tx or lack thereof
Self-Report Questionnaire Uses:Comprehensively evaluate a pt by measuring all aspects of the disability process, develop fxl goals, track fxl progress, and pt outcomes in clinical setting, improve decision making abilites regarding the assessment of tx effectiveness, assess clinical effectiveness of tx, research
Self-Report questionnaires should have estabilished measurement properities for the following:1. The pt is improvig (deteriorating) and the self-report questionnaire is capturing that change 2. Minimal Detectable Change (MDC)--> Clinical bottom line: MDC is the minimum amount of change in a pts score that ensures the change isn't the result of measurement error 3. Minimally Clinically Important Difference (MCID): --> Clinical Bottom Line-- smallest amt of change in an outcome that might be considered important by the pt or clinican
What are the 4 types of self-report outcom Measures (fxl scales)1. Generic 2. Disease or Condition specific 3. Pt. specific 4. Single questions: Global rating & pt satisfaction
Generic QuestionnaireSelf report of Helath related QOL, used to make comparison b/w groups w different health problems (comparison b/w pts w total knee arthroplasties and pts who have sustained a CVA), Questionnaires in this category include: (Short Form 36 (SF-36)) & Sickness Impact Profile (SIPo)
Pt specific Questionnaire is used to make ___comparisons about a single pt over time (it also involves asking the pt what it is that they are having difficulty w that activity) (Used if pt does not have many fxl limitations or if commonly used outcome measures "don't fit") (Questionnaires in this category include Patient-specific fxl scale PSFS, patient-specific index PSI)
Global Rating of fxl or pt satisfactionGlobal rating scale, percent improvment, patient satisfaction scale
Choosing a self-report Questionnaire: What is your purpose?Assess fx or disability via fxl scales (higher score is better) Disability scales (lower score is better) tx effectiveness, single vs group of pts outcomes, meet documentation or regulatory requirments
What are the 2 types of questionnaire issues/considerations?Methodogical, practical
what is methodological questionnaire issues/considerations?Reliability, validity, error, responsiveness, types of pts used to calculate statistics, types of study used to calculate statistics
what is practical questionnaire issues/considerations?pt ease of use and time to complete, clinican ease of scoring, time to complete, and interpretation--- ultimately, will it "help" with or improve pt care?
Implementation and Clinical useswhen do you give the forms to the pt? After completion, when do you review w the pt?, interpretation of the questionnaire's score, writing goals (incorporate specific questions taken from the questionnaire, utilize the MDC and MCID if using the questionnaire score

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