Choosing Outcome Measures

subjective outcome measures

-patient reports or therapist observations that depend on perceptions, feelings, opinions, or judgements -ratings, observations, scales based on opinion

-be generic -have date on 2 or more neuro populations -able to tract pt change over time -free, <20 min to administer, no special equipment -published data on reliability and ability to assess change

to be considered for the core set, outcome measures must:

outcome measures

tools and methods used to measure the functional outcomes

Functional Independence Measure (FIM)

-18 item measure of physical, psychological, social function; used at rehab facilities; grades level of assist needed -6 self-care items, 3 transfer items, gait, WC stairs, communication, social cognition -not sensitive and focuses on measure of assist required

objective outcome measures

-actual instrumental readings or counts that are more likely to be free of bias and based on facts -timed measures, distance measures

performance based measures

-assess pt performance on specific actives in test environment; may not reflect ACTUAL performance at home -direct observation of pt performing an activity -what can pt do under specific set of circumstances -ex. 6 min walk test, functional reach test, get up and go test

EDGE Documents

-batteries of tests for specific health conditions -consistent use allows comparisons across facilities, clinicians, and pt characteristics -data will contribute to better clinical evidence

Continuity Assessment Record and Evaluation (CARE)

-developed as part of medicare post-acute care payment reform -measures health and functional status of medicare beneficiaries at acute discharge and measures change in severity and other outcomes for medicare post-acute care pts -designed to standardize assessment of pt's medical, functional, cognitive, and social support status across acute and post acute settings

disease specific measures

-for patients with specific diagnosis -ex. parkinson's disease questionairre-39, Stroke Impact Scale

generic measures

-for use across all pt populations -may have normative values -ex. 36 item short form health survey, Functional Independence Measure

self-report measures

-info on pt's opinions/perceptions of effects of health condition -good way to get info on home performance but may or may not be accurate -pt asked directly by PT or self-administered report -valid if done correctly -timeframe you ask about is impotant -ex. modified fatigue impact scale, motor activity log

validity

-is test appropriate to examine the desired constructs -if an instrument measures what it was designed to measure

barthel index

-measures degree of assist required on 10 items of mobility and self care ADL; complete independence or need assist; ordinal; weighted item scores; 100 is best score -functional changes in inpatient rehab (CVA) -strong interrater reliability and test-retest reliability

Katz Index of Activities of Daily Living

-pt performance and degree of assistance required in 6 categories of basic ADL -observation and pt report over 2 wk period; 1 point for each activity without help; 0 if assist or can't dol given sum letter score -no gait component

Sickness Impact Profile (SIP)

-sensitve to changes in perceived function (designed to detect small impact of illness) -self-administered or interview; 20-30 min -higher scores = greater dysfunction

SF-36

-short form of MOS; 36 questions -8 scales: physical function, social function, role function, mental health, energy/fatigue, pain, general health perceptions -nominal and ordinal scales -100% is optimal health -good validly and reliability

minimal clinical important difference

-smallest difference in a measure considered worthwhile or important -external criterion for change score that would have clinical meaning -affected by initial score

Outcome and Assessment Information Set (OASIS)

-to ID needs upon admission, follow-up every 60 days and discharge to homeware services; mandatory for Medicare providers -prior and current level of function -discipline neutral

specificty

a measure of validity of a screening procedure, based on the probability that someone who does not have a disease will test negative

sensitivity

a measure of validity of a screening procedure, based on the probability that someone with a disease will test positive

functional outcomes

actual changes in functional limitations that result from intervention and other outcomes

balance, transfers, gait

core set should be administered to adult pt's with neuro conditions who have goals and the capacity to improve in the constructs of ---, ---, and/or ---

reliability

measures a phenomenon dependably, time after time, accurately, predictability, and without variation -includes: test-retest, intrarater, interrater

minimal detectable change

minimal amount of change on the outcome measure that is necessary to exceed error and variability in that measure -does NOT tell you if change was clinically meaningful

floor effects

no room to demonstrate decline

ceiling effects

no room to demonstrate progression

-current functional status -current cognitive status -clinical setting in which pt will be treated -pt's chief concerns -pt's goals -reasonable expectations for recovery -living situation

patient factors to consider when choosing outcome measures