Pt Rated Outcome Tools

clinician-rated outcome measures

things a clinician measures, generally impairments, performance measures (ex: Functional Hop Tests)

pt-rated outcome measures

things the pt rates, ex: pain, ability to lift their child, DASH (self-administered test)

what is an outcome measure used for?

used to discriminate among pts at a single point in time

used to predict an event or outcome, to predict prognosis of a pt

used to evaluate a change in a pt

why should we use outcome measurements?

to comprehensively evaluate and rx relationships between impairments, function, and disability

tracking pt outcomes for clinic and clinician effectiveness

to improve communication with pt, 3rd party reimbursement, healthcare providers

to direct care and goals toward function/activity and disability/participation

intra-class correlation coefficient

relationship between measures

test-retest reliability

measurement error

error in the measurement technique

sources of error

design: repeated measures and internal consistency measure

statistic: SEM, MDC

application: error in a single days score

error in the change score: how much change is truly change and not error?

SEM

and index of the error or the precision of the measure for a single day’s score (single point in time)

expressed in units of the measure

how much certainty does a SEM and MDC carry? How to express SEM/MDC > than that amount?

68% certainty

SEM/MDC x z score for CB of interest

MDC

error associated with change scores (2 points in time)

MCID

the amount of change important to the pt; anchor-related

MCD vs MCID

MCD: statistical change for an instrument

MCID: statistical change that is significant to a pt

patient-rated questionnaires

generic, disease or condition-specific, pt specific, single questions (global rating, pt satisfaction)

generic questionnaire

used to make comparisons between groups with different health problems

disease/condition specific

used to make comparisons between different pts or groups with the same disease or condition

ex: comparisons between pts with shoulder pathologies - Penn Shoulder Scale, DASH, Lysholm Knee Score, Harris Hip Score, Roland-Morris, Revised Oswestry, Neck Disability Index

pt-specific questionnaire

used to make comparison about a single pt over time

ex: asking pts what it is they have difficulty with, and then have them rate the difficulty level - Pt Specific Functional Scale (PSFS), Pt-Specific Index

Pain

Generic question

types: Numeric Pain Rating Scale (NPRS) and Visual Analog Scale (VAS)

When to use PSFS

to track pt’s progress, it is a pt-specific question where the results are compared only to the pt.

What type of questionnaire is the Neck Disability Index?

condition-specific questionnaire

for neck pain pts

what type of questionnaire is Revised Oswestry

condition-specific questionnaire

for pts with LBP

What type of questionnaire is DASH? (Disabilities of Arm, Shoulder, Hand)

region-specific questionnaire for UE

30 questions

Quick DASH

region-specific questionnaire

11 questions

what type of questionnaire is LEFS

region-specific questionnaire for LE

20 questions

what type of questionnaire is FABQ?

predictive test

the higher the score, the greater the fear/avoidant tendencies with correlates with worse prognosis

what is the significance of MDC?

If the change in 2 values is greater or equal to the MDC, the change is significant. If the change in values is less than the MDC, it is not significant

statistics can only be applied to patients with _______ characteristics of those patients in the study of measurement properties

the same

what are practical issues when choosing a pt-rated scale

for pt: ease of use, time to complete

for PT: scoring ease, time to complete, interpretation

ultimately, does it help with pt care?

when do you give pt-rated forms?

every 4 weeks or after 10 visits whichever comes first- use in the waiting room

after completion of pt-rated form?

review with pt

writing goals for pt

use of single questions - ex: pt will ambulate > 2 blocks without aggravation of symptoms in 2 weeks

utilizing the MDC, MCID - ex: pt will have improved tolerance for ADL’s as evidenced by ≥10 change in LEFS score in 4 weeks

decision making for pt treatment

determine activities and participation that are difficult, using pt-rated and or clinician-rated performance measures then assess impairments hypothesized to relate to these restrictions to develop treatment plan

ex: ACL surgery pt - difficulty in walking, observe gait, measure knee ROM, knee strength, etc

assessing the effect of treatment - is pt getting better

you must determine this by measuring activities/participation

pt-rated must be used

clinician-rated performance measures can be used but there is a limited number of these and limited evidence for this