INTRODUCTION OF OUTCOME MEASURES

Faiza shujaat BSPT (KU), MSPT (DUHS) Physiotherapist DUHS

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Introduction and importance of outcome measures.

Background. Outcome Measure? Types of outcome measures. Structural characteristics of outcome measure. Identifying outcome measure for use in clinical practice Evaluating outcome measure Why to use outcome measure in clinical practice. Common pitfalls and dilemmas.
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Background
Florence nightingale Introduction of health indicators in 19th century Mortality rate Late 60s and early 70s More global health indicators were developed more focused on physical morbidity and mental health In 80s & 90s more positive health indicators were developed Degree of well being, Ability, Comfort & Autonomy.
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Rehabilitation services plan, April 1994

the Department of Health and Community Services, in partnership with Region Hospital Corporations, managers of community-based services and rehabilitation professionals, will develop, or adapt from other sources. outcome measures to evaluate the quality of rehabilitation services. (Rehabilitation Services Plan, page 30)
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 Out come refer to the effects of treatments, programs or policies on individuals or populations

Outcome measure

A gerontologist in Philadelphia, A Powell Lawton said that functional assessment was any systematic attempt to objectively measure the level at which a person is functioning in a variety of domains.

For audiologist, physiotherapist, occupational therapist and speech language pathologist Out come may be thought of as changes in the lives of clients and their environment(s) as a result of rehabilitation 8/7/2012 5

Outcome measures are tools:

Instruments,
Questionnaires, Scales, Rating forms, etc.
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 OC are used to used to uncover or identify the outcome intervention for the client Thus they are used to document the change in client characteristics, functional abilities, or behaviors, over time Evidence based practice and outcomes?
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 Outcome measure vary according to their structure, purpose, domain and measurement methods and properties. Outcome scales require that measurements or ratings be performed.

Measurements can be observer based or self reported.

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Outcome measure

Patient reported outcomes(PROs)

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Clinician based outcomes(CBOs)

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Classification of Outcome Assessment Tools

Subjective

Objective

(Patient Driven) General Health Pain Perception Condition or Disease Specific Psychometric Disability Prediction Patient Satisfaction

(HCP Driven) Range of Motion Strength - Endurance Nonorganic Proprioception Cardiopulmonary Developmental

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Subjective Questionnaires
Subjective outcomes assessment information is gathered by the patient in self-administered questionnaires and scored by either the:
health care provider staff members or by a computer.

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Subjective vs Objective
It must be emphasized that although the term subjective carries negative connotations, the reliability/validity data published regarding these methods of collecting outcomes is exceptional, typically out-performing the test-retest reliability and validity of most objective physical performance tests.
(Chapman-Smith, 1992).

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Type of outcome based on intended purpose

Evaluate change over time Discriminate between different groups
Predict future status

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TYPES OF MEASURES BASED ON UNDERLYING THEORY

Psychometric methods

Classical test theory

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Types based on scope

Generic instruments
Disease or symptom specific measures Region or body part specific Patient specific measures
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