NPTE Review: Outcomes Measures

Berg Balance Scale

"BBS"

Assess: Fall Risk

< 45 Increased risk of falls

Max Score of 56

14 Everyday Activities = Sitting & Standing Balance, STS, SLB, Pivot Transfer, FR, Turn 360, Pick up object, Look behind shoulder, Tandem stance

CTSIB

"Clinical Test of Sensory Interaction for Balance"

Assess: Each component of the balance system

Ranking System: 1 = Min, 2 = Mold, 3 = Mod, 4 = Falls Over (Sway)

Issues with:

- 2, 3, 5, 6 = Visually Dependent

- 5 & 6 = Vestibular Issue

- 4, 5, 6 = Somatosensory Issue

- 3, 4, 5, 6 = Sensory Selection Issue

6 Conditions - EOSS, ECSS, DomeSS, EOMS, ECMS, DomeMS

Functional Reach

"FR"

Assess: Fall Risk and Standing Balance (static)

< 10 inches = Increased fall risk

Norms:

70 - 87 yrs 10.5 - 13.5 inches

69 - 41 yrs 13.5 - 15 inches

40 - 20 yrs 14.5 - 17 inches

mFR = Done in sitting

MDRT = Done in multiple directions

Timed Up and Go

"TUG"

Assess: Fall risk, balance, and gait

/= 13.5 secs Increased Fall Risk

mTUG >15secs Increased Fall Risk (add cogn portion)

Get Up and Go

"GUG"

> 30 sec is an increase in fall risk

(< 20 sec for 3 meter walk and turn is a LOW risk)

Five Times Sit to Stand

"FTST"

Assess: Fall Risk & Endurance

> 13 secs Balance Disorder/Fall Risk

Tinetti POMA

"Performance Oriented Mobility Assessment"

Assess: Fall Risk (Balance) & GAIT

*Great for PD!

< 19 HIGH Fall Risk

19 - 24 MODERATE Fall Risk

>24 LOW Fall Risk

Max Score 28 ...

Assesses Balance - sitting balance, sit to stand, stand balance, nudging response, EC, turn 360*, sitting down

Assesses Gait - initiation, step length & height, step symmetry, step continuity, path (12 in for at least 10 ft), trunk, walking stance ... over 15 feet distance first at usual, then back at rapid pace

Activity Specific Balance Confidence Scale

"ABC" Scale

Assess: Fall risk associated with confidence level with ADL's

< 50% Homebound

< 67% Fall Risk

< 85% Balance Disorder

Max 100% (Completely Confident)

Balance Error Scoring System

"BESS"

Assess: Static Balance

*Great for Concussions/Mild TBI

HIGH SCORE = Poor Static Postural Control/balance

Max of 60

DLS, SLS, and Tandem (w/ and W/out foam)

Gait Speed

Assess: Fall Risk and Predicts level of community reintegration

Normal Ambulator = 1 - 1.4 m/s (80 m/min)

Community Ambulator = 0.4 - 0.8 m/s (48 m/min)

Household Ambulator = < 0.4 m/s (25 m/min)

10 MWT

"10 Meter Walk Test"

Assess: Gait Speed (Predicts level of community reintegration)

Distance / Time = Gait Speed (m/s)

Assesses walking speed in meters per second over a short duration

*Same as Gait Speed

Normal Ambulator = 1 - 1.4 m/s (80 m/min)

Community Ambulator = 0.4 - 0.8 m/s (48 m/min)

Household Ambulator = < 0.4 m/s (25 m/min)

6 Minute Walk Test

Assess: Endurance and Predicts level of community reintegration & D/c Motor FIM

Measure distance in meters

60 - 90 yo = btw 580 - 390 meters average

Younger 5 - 20 yo = 500 - 720 meters

Slower if fat or older

Dynamic Gait Index

"DGI"

Assess: Gait with Fall Risk

< 19 Increased Fall Risk (MCID of 4 pts)

Max of 24

Walking at steady state (20 ft), Change in speed slow and fast, head turn hor, head turn vert, walk pivot, step over obstacle, stepping around obstacles, stair climbing

Functional Gait Assessment

"FGA"

Assess: Fall Risk

* Great for Cerebellar Dysfunction & Ataxia

< 23 Increased Fall Risk

Max Score of 30

Same as DGI but adds gait with narrow BOS and arms crossed, heel toe walk, gait with EC, gait backwards

Community Balance and Mobility Scale

"CBM"

Assess: Return to community

*Great for Concussion, TBI, CVA, CP (Brain Injury)

*May also use Hi-Mat (high level functioning)

HIGHER score = Better Performance

Max of 96

Functional Independence Measure

"FIM"

*Assessment & Portion Division

Assess: Amount of burden of care & severity of condition

- Used to determine d/c location and length of stay

18 Total Items = 13 Motor & 5 Communication/Cogn.

PT's conduct the Motor Portion 126 points MAX

* > 100 = D/c to Home

Transfers = Bed, Chair Wheelchair, Toilet, Shower/Tub

- Mat table does not count as a bed

- Bed mobility is graded as apart of transfer score (not the individual components of the transfer itself)

- Head elevated/electric bed is considered an AD

- Mechanical lift graded as a 1

- Has to be on a WET surface

Locomotion = Walking or Wheelchair

- A grade 5 includes set up of WC (locking brakes)

FIM Grading Scale (General)

Scale from 0 - 7

7 = Complete Independence

6 = Modified Independence (Use of AD)

- Or 3x's the expected amount of time

5 = Supervision or Set up/Clean up

4 = Min Assist (>/= 75%) at least 75%

- Help with 1 leg

- Help lifting or lowering

- Contact guard or guiding

3 = Mod Assist (74 - 50%) at least 50%

- Help with BOTH legs

- Help lifting or lowering

2 = Max Assist (50 - 25%) at least 25%

- Help lifting AND lowering

1 = Total Assist (< 25%) Less than 25%

- Or with 2 or More People

0 = Activity did NOT occur

FIM Grading Scale (Stairs)

7 = 12 - 14 Stairs Independently

6 = 12 - 14 Stairs with use of AD

5 = 12 - 14 Stairs with Helper

*4 - 6 Independently w/ or w/out AD = Household Ambulator

4 = 12 - 14 Stairs with Helper (>/= 75%)

3 = 12 - 14 Stairs with Helper (74 - 50%)

2 = 4 - 6 Stairs with Helper (50 - 25%)

1 = > or equal 2 - 4 Stairs with Helper (< 25%), 2 helpers or stair lift

0 = Activity did NOT occur

*Up AND Down Stairs

FIM Grading Scale (Locomotion - Distance Walked & Distance Travelled in Wheelchair)

Level 3: >/= 150 ft

Level 2: 50 - 149 ft

Level 1: < 50 ft

Code 0: Did not occur

FIM Grading Scale (Locomotion - Walk & Wheelchair)

7 = 150 ft Independently

6 = 150 ft with use of AD

5 = 150 ft with Supervision/Cueing

*50 ft Independently w/ or w/out AD

4 = 150 ft with Helper (>/= 75%)

3 = 150 ft with Helper (74 - 50%)

2 = 50 ft with Helper (50 - 25%)

1 = < 50 ft with Helper (< 25%) Or with 2 People

0 = Activity did NOT occur

Functional Assessment Measure

"FAM"

Assess: Community Return/Integration (Employment)

*Great for TBI

* Meant to be added as an addition to the FIM (same scoring system)

< 65 At Risk for LONG term unemployment

Assesses Swallowing/Speech, Car transfer, Community access, Reading/Writing, Emotional status, Adjustability to limitations, Employability, Orientation, Attention, & Safety judgement

OASIS

"Outcome Assessment Information Set"

Assess: Functional Status for Home Care

*Mandated for MC pts (Done within 24 hrs return to home)

Cutoff 16 points = Depression

SF 36

"Short Form 36"

Assess: Perception of wellness (Indicates future need for healthcare services)

100% = Optimal Health (High Score, Less Services Needed)

NIHSS

"National Institute for Health Stroke Scale"

Assess: Level of disability & location of care

*Used for Stroke Pts

Higher score = higher level of impairment

0 = no impairment

1 - 5 = mild impairment (80% d/c home)

5 - 14 = Mild to mod imp (acute inpt rehab)

15 - 24 = severe (long term care or subacute, home after)

> 25 = very severe (location varies)

Max Score of 42

MME

"Mini Mental Health Exam"

Assess: Cognitive Function & Memory

*Great for Stroke

< 24 = Cognitive Impairment

Max Score of 30 (Higher score is better)

Includes orientation to time, place, 3 words, attention & calculation, recall 3 words, language: reading and writing, visual construction (drawing)

American Shoulder and Elbow Surgeons (ASES)

Standardized Shoulder Assessment Form

Assess: functional limitations and pain of the shoulder

100 point scale that consists of two dimensions: pain and activities of daily living

100 = Good, No Pain/ No difficulty with ADLs

0 = Max disability and high pain

Shoulder Pain And Disability Index (SPADI)

Assess: Pain and disability related to shoulder problems

It is divided into 2 subscales: pain and disability

OPS

"Orpington Prognostic Score"

Assess: Stroke Severity & Prognosis

* Great for Acute or Subacute Stroke (< 6 Months)

Rage from 1.6 to 6.8 (higher ID's greater impairment)

< 3.2 = mild to mod (high chance of d/c to home)

3.2 - 5.2 = mod to severe (responds to rehab)

> 5.2 = severe to major (dependent increased risk for institutionalization)

FMA

"Fugl-Meyer Assessment of Physical Performance"

Assess: Early recovery in post stroke

*Used with Stroke pts

Max TOTAL Score = 226 (100 for motor fn)

< 50 = severe (level of motor impairment)

50 - 84 = marked

85 - 90 = moderate

91 - 99 = slight

100 = no impairment

SIS

"Stroke Impact Scale"

Assess: Level of Recovery from Stroke (Impact on ADL's)

* Used with Stroke

0 = No Recovery

100 = Full Recovery

Roland-Morris Disability Questionnaire

Roland-Morris Disability Questionnaire is most sensitive for patients with mild to moderate disability due to acute, sub-acute or chronic low back pain

24 yes/no questions

Max = 24 (most limited, severe disability)

Arterial Blood Gases - pH Norms for Adults

7.35 - 7.45

(7.4)

Arterial Blood Gases - PaCO2 Norms for Adults

35 - 45 mm Hg

(40)

Arterial Blood Gases - PaO2 Norms for Adults

80 - 100 mm Hg

(97)

Arterial Blood Gases - HCO3 Norms for Adults

22 - 26 mEq/L

(24)

Arterial Blood Gases - Order of Values

pH, PaCO2, PaO2, HCO3

Cardiac Biomarkers

Creatine Phosphokinase (CK-MB) & Troponin (I or T) specific for MI

CK-MB (Norm 3 - 5% or 5 - 25 IU/L "international units")

Appears = 4 hours after infarct

Peaks = 12 - 24 hours

Declines = 48 - 72 hours (2 - 3 days)

Troponin-I (Norm < 0.1 ng/mL)

Remains elevated for 5 - 7 days

Lipid Panel - Total Cholesterol

< 200 mg/dL Desirable*

> 240 mg/dL HIGH

Lipid Panel - Triglycerides

< 150 mg/dL Desirable*

200 - 499 mg/dL High

>/= 500 mg/dL Very High

*Body converts any unused calories to triglycerides, stored in adipose tissue (high levels of triglycerides in obese, alcoholics, candy addicts, high blood sugars diabetics)

Lipid Panel - LDL

< 100 mg/dL Desirable*

160 - 189 mg/dL High

>/= 190 mg/dL Very High

Lipid Panel - HDL

40 - 60 mg/dL Desirable*

< 40 mg/dL LOW

> 60 mg/dL HIGH

Complete Blood Count - Hematocrit

37 - 52 %

Males higher

Females lower

Increased with burns, dehydration, hypovolemia and polycythemia

Decreased with anemia, nutrition deficiency, leukemia

Don't exercise with HCT of ...

< 25%

Complete Blood Count - Hemoglobin

12 - 18

Males higher

Females lower

Low = anemia or blood loss

High = polycythemia or dehydration (vomit, sweat, diarrhea, burns, diuretics)

Don't exercise with Hgb of ...

< 8 x 10^6/mL

Complete Blood Count - RBC

4.0 - 6.0 x 10^6/ml

Males 4.3 - 5.6 x 10^6/ml

Females 4.0 - 5.2 x 10^6/ml *LESS

*Number of RBC throughout the body

Complete Blood Count - WBC (total)

4,000 - 10,000 cells/mm3

< 5,000 and Febrile NO EXERCISE

< 1,000 USE MASK WITH PATIENT

Complete Blood Count - Platelet

Platelet = 150,000 - 450,000 cell/mm3

Low = risk of bleeding and bruising

High = risk for thrombi

Exercise Based on Platelets

50,000 - 30,000 = Mod Exercise

30,000 - 20,000 = Light exercise

< 20,000 = ADL only, AROM

ESR

< 15 mm/hr = Males

< 20 mm/hr = Females

C-reactive protein (CRP)

Normal < 10 mg/L

If > 100 = Infection

Protein found in blood plasma, whose levels rise in response to inflammation, high if have arteriosclerosis

Prothrombin Time (PT)

11 - 15 secs

Partial Thromboplastin Time (PTT)

PTT = 25 - 40 seconds

*a blood test that measures how long it takes blood to clot

*Used to monitor anticoagulation therapy or bleeding disorders, not affected by hydration levels

INR

0.9 - 1.1 Normal

2 - 3 For Anti-coagulation therapy

3.5 Genetic clotting disorders

The higher the INR, the higher the risk for bleeding

Bleeding Time

2 - 10 mins

SpO2

Normal = btw 95 - 98%

*Not effect by blood loss

Hypoxemia

< 80 mm Hg

Mild 79 - 60 mm Hg

Moderate 59 - 40 mm Hg

Severe < 40 mm Hg

When is use of Supplemental O2 needed...

With acute or chronic hypoxemia (low O2 in the arterial blood)

PaO2

Angina Pain Scale

Assess: Severity of Sx's from Angina Pectoris

Scale from 1 - 4

1 = Mild, barely noticeable

2 = Moderate, bothersome

3 = Moderately Severe, very uncomfortable

4 = Severe, most intense pain ever

Ankle Brachial Index Interpretation

Assess: The amount of blockage within the arteries

Formula: ABI = Highest Ankle Systolic BP on One Side / Highest Brachial Systolic BP Taken (which ever is higher)

>/= 1.30 Rigid arteries (Need US to check for PAD)

*1.0- 1.30 NORMAL, no blockage

0.9 - 0.8 Mild Blockage, beginning of PAD

0.7 - 0.4 Moderate Blockage, claudication pain during exercise

< 0.4 Severe Blockage, claudication pain during rest

Blood Pressure in Children

Classified by SBP & DBP percentiles for age, sex, height

Normal = SBP/DBP < 90 %

PreHTN = Btw the 90 % and 94 %

Stage 1 HTN = Btw 95 % and 99 % (plus 5 mm Hg)

Stage 2 HTN = > 99 % (plus 5 mm Hg)

Lower than Adults: Range 80 - 120/55-75 mm Hg

Blood Pressure in Adults

Normal = < 120 / < 80 mm Hg (or 110 / 70 mm Hg)

PreHTN = 120 - 139 / 80 - 89

Stage 1 HTN = 140 - 159 / 90 - 99

Stage 2 HTN = >/= 160 / >/= 100

BMI "Body Mass Index"

Formula = weight (kg) / height (m2)

Your weight (in pounds) ÷ 2.2 = your weight (in kilograms)

Your height (in inches) ÷ 39.37 = your height (in meters)

< 18.5 Underweight

18.5 - 24.9 NORMAL*

25 - 29.9 Overweight

30 - 34.9 Obese Class 1

35 - 39.9 Obese Class 2

>/= 40 Obese (Extreme) Class 3

Waist Circumference

Increased risk for HTN, CAD, Diabetes Type 2, High Cholesterol...

> 102 cm (40 inches) Male

> 88 cm (35 inches) Female

Capillary Refill Time

< 2 seconds Normal

> 2 seconds Flow Compromised (arterial occlusion, hypovolemic shock, hypothermia)

Limb Edema & Classification for Lymphedema

Seven measurements on UE or LE (starting at boney prominence, going 5 or 10 cm)

Compared sides > 2 - 3 cm difference on 4 regions or lines = Lymphedema present

Classification for Lymphedema... Mild, Mod, Severe

btw affected & unaffected

Mild < 3 cm

Mod 3 - 5 cm

Severe > 5 cm

Claudication Test

Assess: PAD with intermittent claudication

Procedure: Treadmill at 2.0 mph, grade low

Two time measures - Initial claudication distance (pain free) and absolute (max distance walked)

Grading for Claudication Pain: Grades 1 - 4

Grade 1 = Initial, modest start of pain

Grade 2 = Moderate discomfort, attention can be diverted

Grade 3 = Intense pain, attention cannot be diverted

Grade 4 = Unbearable pain

Borg's Dyspnea Scale

Scale = 0 - 10

0 = Normal, no SOB

0.5 = Very, very slight

... Slight

3 = Moderate

... mod towards

5 = Severe

... severe towards

7 = Very Severe

... towards

10 = Max

Indications to stop a Exercise Stress Test

Assess: Presence of CAD

Drop in SBP > 10 mm Hg, ST segment depression, any signs of claudication or ischemia, angina (Moderate 3 or more on the angina pain scale), HTN response > 250/ >115 mm Hg

Reading an ECG

Rhythm, HR, P wave, Q wave, QRS, T wave

HR

5 big boxes = 1 sec

30 big boxes = 6 sec

1 small box = 0.04 sec (QRS)

1 big box = 0.2 sec (PR interval)

Regular Rhythm:

300 / # large boxes btw R to R = bpm

Counting = 300, 150, 100, 75, 60, 50, 43, 37

Irregular:

# of QRS in 6 sec x 10 = bpm

Normal Infant HR

130 - 100 bpm

Normal Child HR

100 - 80 bpm

Normal Adult HR

100 - 60 bpm

Grading Volume or Amplitude of Pulse

Scale 0 - 3+ (similar to reflex grading)

0 = Absent

1 + = Diminished, Small

2+ = Normal

3+ = Bounding, Large

Pulmonary Function Testing (PFT)

Measures volume of air during exhalation or inhalation

Measures can be:

Forced vital capacity (FVC) - the amount of air which can be forcibly exhaled from the lungs after a max inhale (exhale for at least 6 seconds hard & fast, 3x's) *reduced in both Restrictive and Obstructive (~ 80 - 120% or btw 3.7 - 4.8 L)

Peak expiratory flow (PEF) - person's maximum speed of expiration using a peak flow meter (Male > 100 L/min, Female > 85 L/min is WNL)

Forced expiratory volume in 1 sec (FEV1) - the volume of air that can forcibly be blown out in one second, after full inspiration; measures flow (and volume) during the first second of an FVC maneuver *reduced in Obstructive and normal or increased in Restrictive (~ 80 - 120%)

Mid-expiratory flow (FEF) - the peak of expiratory flow as taken from the flow-volume curve using a peak flow meter (25 - 75%)

FEV1/FVC Ratio

< 70 % indicates obstructive condition in Adults

(less than 80% in children)

Airway narrowing during exhalation causes a reduction in max air flow = asthma, emphysema, chronic bronchitis

FEV1/FVC Ratio Classifications

> 100 % = Normal

100 - 70 % = Mild Obstruction

70 - 60 % = Moderate

60 - 50 % = Mod/Severe

< 50 % = Severe

SpO2 Readings

Normal > 95%

Readings on pulse ox are +/- 4%

Stop activity and call doc if...

< 90% acutely ill

< 85% chronic lung disease

Rate Pressure Pulse

Myocardial oxygen consumption and coronary blood flow, onset of angina

- Exercise and gain values with onset of angina

rpp (# x 10^3) = HR x SBP

Barthel Index

Assesses: Ability to preform a variety of ADL's (level of ability - independent vs dependent)

*Very Valid and reliable

Used in: Rehab, LTC, Home Care

Test: 10 ADL's

Scoring: 0 - 100 (100 means patient is independent)

Waist-Hip Ratio

The ratio of the circumference of the waist to that of the hips

Ratio > 0.9 indicates central obesity and risk of CAD

BUN or Blood Urea Nitrogen Level

Used to assess kidney function

Norms = 10 - 20 mg/dL

Amount of nitrogen in the blood that comes from the waste product urea (waste accumulate into ammonia and then changed into the protein urea to be excreted)

High = dehydration, kidney failure, or heart failure

Dehydration - reduced blood volume, causing concentration of the solutes

Kidney Fail - usually excrete urea, but if failing will not causing the increase

Proprioception Loss

Insenate with monofilament testing

10 gm = proprioception loss (5.07)

75 gm = insenate (6.10)

Wagner Ulcer Grade Scale

Used for Vascular Wounds - Not pressure Ulcers (Staging)

Scale = 0 - 5

0 - Pre-ulcer; intact skin; healed ulcer; bony deformity

1 - Superficial ulcer (not involving subcutaneous tissue)

2 - Deep ulcer involving subcutaneous tissue (potentially underlying tissues as well)

3 - Deep Ulcer with Infection (osteitis, osteomyelitis, abscess)

4 - Gangrene of digit

5 - Gangrene of foot

Staging for Pressure/Neuropathic Ulcers - Stage I

intact skin, nonblanchable, over bony prominence, painful, boggy or firm, cooler/warmer

(May be discoloration on black individuals)

Staging for Pressure/Neuropathic Ulcers - Stage II

Partial thickness, involving epidermis and dermis (no further), blister or open shallow ulcer, pink, painful, no slough or bruising

*NOT USED to describe skin tears, maceration, etc

Staging for Pressure/Neuropathic Ulcers - Stage III

Full thickness, involving epidermis, dermis, and subcutaneous tissue (no further), painful, slough may be present but does not obscure wound, undermining and tunneling may be present

Staging for Pressure/Neuropathic Ulcers - Stage IV

Full thickness, involving epidermis, dermis, subcutaneous tissue and underlying tissues (muscle, bone), painful, slough or eschar may be present, undermining and tunneling may be present

Staging for Pressure/Neuropathic Ulcers - Unstageable

Full thickness, covered by slough or eschar that obscures the wound depth

Stable, dry, no red - normal on heels (biological cover)

Staging for Pressure/Neuropathic Ulcers - Deep Tissue Injury

Purple or maroon discoloration or blood blister due to underlying damage of tissue form pressure or shear forces

Painful, firm/boggy, warmer/cooler

Skin pH

Normal = 4.0

Below 3 or greater 5 cause acidosis or alkalosis reactions

*Negative electrode - prone to chemical burns (pH of 9 erodes epidermis)

BMD Bone Mineral Density

Women

T score < -1 SD and > -2.5 SD = Osteopenia

T score < -2.5 SD Osteoporosis

*Severe if with one or more fractures

Baden Walker System

Uterine Prolapse

Grades from 0 - 4

0 = Normal

1 = Halfway to hymen

2 = At the hymen

3 = Halfway pass hymen

4 = Max descent - need pessary

BUN

Normal = 7 - 20 mg/dL

Bilirubin

Normal = 0.3 - 1.9 mg/dL

Albumin

Normal < 150 mg in urine

Stages of Kidney Disease

Stages 1 - 5 Based on GFR

1 = Damage with normal GFR >/= 90

2 = Mild 60 - 89

3 = Mod 30 - 59

4 = Severe 15 - 49

5 = Failure < 15

GOLD for COPD

"Global Initiative for Chronic Obstructive Lung Disease"

Stages 1 - 4 (all FEV1/FVC < 70%)

FEV1 Values

I = Mild >/= 80%

II = Mod >/= 50%

III = Severe >/= 30%

IV = Very Severe < 30%

Pitting Edema

Scale = 1+ to 4+

1+ = <0.25 inches, not very visible

2+ = 0.25 - 0.5 more visible < 15 seconds

3+ = 0.5 - 1.0 rebounds in 15 - 30 seconds

4+ = > 1.0 rebounds in > 30 seconds

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