Wheelchair Related Outcome Measures: Difference between revisions

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== Introduction ==
== Introduction ==
An '''outcome measure''' is any characteristic or quality measured to assess a patient’s status<ref name=":0">Fetters L, Tilson J. Evidence based physical therapy. FA Davis; 2012 May 5.</ref>. An outcome measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy. With the move towards [[Evidence Based Practice (EBP)]] in the Health Sciences, objective measures of outcome are important to provide credible and reliable justification for treatment. The instrument should also be convenient to use for the wheelchair service personnel and comfortable for the wheelchair user. An integral part of evaluating clinical practice is to objectively assess the intervention and measure it against a set of outcomes to determine its efficacy. <ref name="p1">Debuse D, Brace H. Outcome Measures of Activity for Children with Cerebral Palsy: A Systematic Review. Pediatr Phys Ther. 2011 Fall;23(3):221-31</ref>&nbsp;
An '''outcome measure''' is any characteristic or quality measured to assess a patient’s status<ref name=":0">Fetters L, Tilson J. Evidence based physical therapy. FA Davis; 2012 May 5.</ref>. An outcome measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy. With the move towards [[Evidence Based Practice (EBP)]] in the Health Sciences, objective measures of outcome are important to provide credible and reliable justification for treatment. The instrument should also be convenient to use for the wheelchair service personnel and comfortable for the wheelchair user. An integral part of evaluating clinical practice is to objectively assess the intervention and measure it against a set of outcomes to determine its efficacy. <ref name="p1">Debuse D, Brace H. Outcome Measures of Activity for Children with Cerebral Palsy: A Systematic Review. Pediatr Phys Ther. 2011 Fall;23(3):221-31</ref>&nbsp;This means the wheelchair service personnel can ensure they are providing the most appropriate intervention that meets the goals and expectations of the wheelchair user, their family member/caregiver and the wheelchair service provision team. &nbsp;
==Considerations before Choosing an Outcome Measure==
If you are considering using an outcome measure for a wheelchair user it is worth considering the questions posed on the [[Guide to Selecting Outcome Measures]] Physiopedia Page. At the very least you should consider these questions with your wheelchair user in mind.


This means the therapist can ensure they are providing the most appropriate intervention that meets the treatment goals and expectations of the child, parent/caregiver and the clinical team. Change is inevitable in growing and developing children with Cerebral Palsy and the change that occurs is nonlinear and variable by subset of Cerebral Palsy.<ref name="p2">Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. Jama. [Multicenter Study Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.]. 2002 Sep 18;288(11):1357-63</ref> The outcomes of interventions should be based on the expectations for children with Cerebral Palsy of the same age and gross motor function, rather than the established norms for children without developmental delays.<ref name="p3">Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. [Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Validation Studies]. 2000 Oct;80(10):974-85</ref>&nbsp;
=== Why Am I Using an Outcome Measure? ===
==Reliability, Validity, Specificity and Responsiveness==
*Am I trying to establish a baseline measure from which I can monitor changes over time for an individual user?
Selecting the appropriate outcome measures can be used to establish more efficient and effective methods of intervention for children with varying presentations of Cerebral Palsy.<ref name="p4">Stanger M, Oresic S. Rehabilitation approaches for children with cerebral palsy: overview. J Child Neurol. [Review]. 2003 Sep;18 Suppl 1:S79-88</ref> The elements that constitute effective outcome measures include:
*Am I trying to predict how the wheelchair is going to perform?&nbsp;
*Am I trying to evaluate the impact of a wheelchair, a wheelchair component or treatment programme on an individual or a group?
*Am I trying to evaluate the needs of the wheelchair user attending my service?
*Am I trying to evaluate how my service is responding to needs of the wheelchair user?


1. Reliability: measures are constant over time and when used by different raters. <ref name="p1" />&nbsp;<ref name="p5">Jerosch-Herold C. An evidence-based approach to choosing outcome measures: a checklist for the critical appraisal of validity, reliability and responsiveness studies. British Journal of Occupational Therapy. 2005;68(8):347-53</ref>
=== What Am I Aiming to Measure? ===
*Impairments of Body Structure and Function?
*Activity Limitations?
*Participation Restrictions?
*Quality of Life?
*Something Else?


2. Validity: appropriate to assess what the clinician or researcher wants to assess in a manner that makes intrinsic sense.&nbsp;<ref name="p1" />&nbsp;<ref name="p5" />
=== Have the Clinimetric Properties been Measured in a Population Similar to Mine? ===
#Is the Outcome Measure Reliable?
#*Do I know the rate of error detected with scores?
#*Do I know the minimum detectable change?
#Is the Outcome Measure Valid?
#*Does it measure what I want it to measure?
#Is the Outcome Measure Responsive to Change?
#*Is there a known minimum clinically important difference?


3. Specificity: the ability to distinguish between the presence or absence of a certain condition in people.&nbsp;<ref name="p1" />&nbsp;<ref name="p5" />
=== Other Considerations ===
Other considerations ([[Outcome Measures]]) may come into play when deciding which outcome measure to use:


4. Responsiveness: the ability to detect minimal, but clinically relevant changes.&nbsp;<ref name="p1" />&nbsp;<ref name="p5" />
==== Financial Considerations: ====
* What is the cost of this test?
* Is a licence required?
* Is equipment required? 


The International Classification of Function, Disability and Health (ICF) is the World Health Organization's framework for measuring health and disability at both individual and population levels. The ICF has shifted the focus of the impairments in children with Cerebral Palsy from restriction in joint ROM or abnormal muscle tone to the evaluation of functions by assessing the quantitative and qualitative aspects of a child’s Activities of Daily Living (ADL). <ref name="p6">World Health Organisation. International Classifiaction of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization 2001</ref> It states that the focus of rehabilitation should be shifted from identifying a person’s disability to focusing on enhancing a person’s function, ability and performance quality for each individual in a contextual manner. The ICF identified domains that should be evaluated in children with Cerebral Palsy to include body function and structure, activity and participation. A consensus-based survey of clinicians, parents and youth with Cerebral Palsy supported these domains as relevant to the evaluation of all health care interventions in children with Cerebral Palsy. <ref name="p7">Vargus-Adams JN, Martin LK. Measuring what matters in cerebral palsy: a breadth of important domains and outcome measures. Arch Phys Med Rehabil. [Research Support, N.I.H., Extramural]. 2009 Dec;90(12):2089-95</ref>
==== Therapist Implementation ====
* Is the measure easy for a clinician to conduct?
* Is special training required/available?
* Are there clear standardised instructions on how to carry out and score the measure?
* How long does it take to carry out the measure?
* How long does it take to record results?


== Sub Heading 2 ==
==== Resources ====
* Is special equipment or are special forms required?
* Is space sufficient for this measure to be carried out?


== Sub Heading 3 ==
==== Wheelchair User ====
* How much time does it take for the person to complete?
* Is the task difficult?
* Is privacy required?


== Resources  ==
==== Patient-Reported Outcome Measures (PROQ) ====
*bulleted list
* Is face-to-face contact required or can this measure be completed in the waiting room?
*x
* Does the questionnaire cover sensitive personal issues?
or
* Is there a specific reading level required?
* Is the measure available in other languages?


#numbered list
== Sub Heading 2 ==
#x


== References  ==
== References  ==


<references />
<references />
[[Category:Occupational Health]]
[[Category:Outcome Measures]]
[[Category:Wheelchair Service Provision]]

Latest revision as of 20:42, 3 October 2018

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Introduction[edit | edit source]

An outcome measure is any characteristic or quality measured to assess a patient’s status[1]. An outcome measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy. With the move towards Evidence Based Practice (EBP) in the Health Sciences, objective measures of outcome are important to provide credible and reliable justification for treatment. The instrument should also be convenient to use for the wheelchair service personnel and comfortable for the wheelchair user. An integral part of evaluating clinical practice is to objectively assess the intervention and measure it against a set of outcomes to determine its efficacy. [2] This means the wheelchair service personnel can ensure they are providing the most appropriate intervention that meets the goals and expectations of the wheelchair user, their family member/caregiver and the wheelchair service provision team.  

Considerations before Choosing an Outcome Measure[edit | edit source]

If you are considering using an outcome measure for a wheelchair user it is worth considering the questions posed on the Guide to Selecting Outcome Measures Physiopedia Page. At the very least you should consider these questions with your wheelchair user in mind.

Why Am I Using an Outcome Measure?[edit | edit source]

  • Am I trying to establish a baseline measure from which I can monitor changes over time for an individual user?
  • Am I trying to predict how the wheelchair is going to perform? 
  • Am I trying to evaluate the impact of a wheelchair, a wheelchair component or treatment programme on an individual or a group?
  • Am I trying to evaluate the needs of the wheelchair user attending my service?
  • Am I trying to evaluate how my service is responding to needs of the wheelchair user?

What Am I Aiming to Measure?[edit | edit source]

  • Impairments of Body Structure and Function?
  • Activity Limitations?
  • Participation Restrictions?
  • Quality of Life?
  • Something Else?

Have the Clinimetric Properties been Measured in a Population Similar to Mine?[edit | edit source]

  1. Is the Outcome Measure Reliable?
    • Do I know the rate of error detected with scores?
    • Do I know the minimum detectable change?
  2. Is the Outcome Measure Valid?
    • Does it measure what I want it to measure?
  3. Is the Outcome Measure Responsive to Change?
    • Is there a known minimum clinically important difference?

Other Considerations[edit | edit source]

Other considerations (Outcome Measures) may come into play when deciding which outcome measure to use:

Financial Considerations: [edit | edit source]

  • What is the cost of this test?
  • Is a licence required?
  • Is equipment required? 

Therapist Implementation [edit | edit source]

  • Is the measure easy for a clinician to conduct?
  • Is special training required/available?
  • Are there clear standardised instructions on how to carry out and score the measure?
  • How long does it take to carry out the measure?
  • How long does it take to record results?

Resources [edit | edit source]

  • Is special equipment or are special forms required?
  • Is space sufficient for this measure to be carried out?

Wheelchair User[edit | edit source]

  • How much time does it take for the person to complete?
  • Is the task difficult?
  • Is privacy required?

Patient-Reported Outcome Measures (PROQ) [edit | edit source]

  • Is face-to-face contact required or can this measure be completed in the waiting room?
  • Does the questionnaire cover sensitive personal issues?
  • Is there a specific reading level required?
  • Is the measure available in other languages?

Sub Heading 2[edit | edit source]

References[edit | edit source]

  1. ↑ Fetters L, Tilson J. Evidence based physical therapy. FA Davis; 2012 May 5.
  2. ↑ Debuse D, Brace H. Outcome Measures of Activity for Children with Cerebral Palsy: A Systematic Review. Pediatr Phys Ther. 2011 Fall;23(3):221-31
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