Physiotherapy UK Outcome Measurement in Parkinson s. Fiona Lindop Specialist Therapist in Parkinson s Derby Hospitals NHS Foundation Trust

Transcription

1 Physiotherapy UK 2013 Outcome Measurement in Parkinson s Fiona Lindop Specialist Therapist in Parkinson s Derby Hospitals NHS Foundation Trust

2 Introduction Definition of outcome measures Outcome measures and Audit of NICE Guidelines for Physiotherapy in Parkinson s New recommended outcome measures in Joint European Guidelines How long do they take? Leading questions for group work

3 Outcome Measurement: CSP Using standardised, validated outcome measures is an explicit requirement of the CSP's Standards of Physiotherapy Practice o An outcome measure is a measure of change, the difference from one point in time (usually before intervention) to another point in time (usually after an intervention) (Kendall 1997) o A physical therapy outcome measure is a test or scale administered and interpreted by physical therapists that has been shown to measure accurately a particular attribute of interest to patients and therapists and is expected to be influenced by intervention (Cole 1994, based on Mayo 1994)

4 WHO-ICF: International Classification of Functioning, Disability & Health A classification of health and health-related domains: 2 Lists: body functions and structure domains of activity and participation factors As functioning and disability occurs in a context, the ICF also includes a list of environmental factors

5 Advantages of ICF ICF can be used as a framework for goal and treatment planning (Think before you measure Symposium, Australia 2011) Encourages physiotherapists to think beyond immediate therapy intervention and can enable treatment programme and therapy goals to be related to the individual s long-term goals and environment European Guidelines Group have tried to separate and address WHO-ICF classifications and recommend appropriate outcome measures in the new European Guidelines

6 2011 National Audit of NICE Guidelines for Parkinson s: Physiotherapy Audit 1278 patients across 65 services Outcome Measures Standards

7 NICE Physiotherapy Audit 2011: Reported Outcome Measures Used In order of how many therapists (1043) reported using them: Berg Balance (17%) Timed up and Go (15%) 10 Minute Timed Walk (14%) Lindop Parkinson s Assessment Scale (LPAS) (9%) 6 Metre Timed Walk (9%) 180 degree turn (9%) Tragus to wall (7%) Timed unsupported Stand (5%) 4 score balance (5%) UPDRS (Unified Parkinson s Disease Rating Scale) (4%) EQ5D (Health Questionnaire) (3%) 360 degree turn (2%)

8 Recommendations from NICE Physiotherapy Audit 2011 The three quality standards were not being fully implemented. 1. Areas of anticipated interventions are recorded in initial assessments 2. Initial assessment notes record treatment strategies & techniques to be used for interventions 3. Outcome measures are used ( 81.6% used outcome measures) Variance in the understanding of what outcome measures were appropriate for assessing this patient group Although awareness of the UK QRC was reasonably high, this was not matched by use of the cards, and some physiotherapists reported that they were not using any suggested evidence-based guidelines.

9 European Physiotherapy Guideline for Parkinson s Change in measurement tools, e.g. new tools and more information for evaluative purposes Addressing Core Areas for intervention

10 European Guideline: Selection Criteria for Measurement Tools Criteria Validity Reliability Responsiveness & Interpretability Feasibility Meaning Does it measure what it is supposed to measure? Does it have the same meaning for pwp? Is it within the scope of physiotherapy, i.e. related to the core areas and, preferably, linked to the level of limitations in activities domain of the ICF? Are the results consistent when used in consistent conditions? Can it detect change over time in the construct to be measured? Can we assign a qualitative meaning to the (change in) quantitative scores? Do benefits outweigh the burden in terms of cost, time, space and effort? Is it currently used by (many) physiotherapists? Is it available in many languages?

11 European Guideline: Recommended Outcome Measures CORE AREA: BALANCE Transfers Modified Parkinson s Activity Scale (M-PAS) Chair 5 Times Sit to Stand Test (STSTS) Gait Dynamic Gait Index Functional Gait Assessment M-PAS Gait Timed up and Go Freezing Snijders & Bloem Freezing of Gait Test Stationary Berg Balance General Push and Release Test

12 Some of the Newer Tests 5 Times Sit to Stand Test: Assesses likelihood of falling in older adults. Inability to complete in 13.6 seconds indicates increased disability and morbidity Dynamic Gait Index: tests likelihood of falling in older adults. Eight facets of gait tested Functional gait Assessment: requires 6 metre long/30.48 cm wide walkway. Assesses postural stability during various gait tasks Snijders & Bloem Freezing of Gait test: tests for freezing on straight walking (4 metres), turning 360degrees, small step walking Push and Release Test: patient leans back onto examiners hands, then examiner suddenly removes hands! Scored on corrective response

13 Estimated Time Required For Balance: minutes Transfers Modified Parkinson s Activity Scale (M-PAS) Chair (5 minutes) 5 sit to stands (STSTS) (1 minute) Gait Dynamic Gait Index Functional Gait Assessment (Less than 10 minutes for both) M-PAS Gait Timed up and Go ( 5minutes for both) Freezing Snijders & Bloem Freezing of Gait test (2 minutes) General Push and Release Test (1 minute)

14 European Guideline: Recommended Outcome Measures CORE AREA: GAIT M-PAS Gait & TUG 10 Meter Walk Test 6 Minute Walk Test Snijders & Bloem Freezing of Gait Test

15 Estimated Time Required for Gait: 15 minutes CORE AREA: GAIT M-PAS Gait & Timed Up and Go (5 minutes) 10 Meter Walk Test (5 minutes) 6 Minute Walk Test (10 minutes) Snijders & Bloem Freezing of Gait Test (2 minutes)

16 European Guideline: Recommended Outcome Measures CORE AREA: TRANSFERS Bed M-PAS Bed Chair M-PAS Chair TUG

17 Estimated Time Required for Transfers: minutes CORE AREA: TRANSFERS Bed M-PAS Bed (10minutes) Chair M-PAS Chair (5 minutes) TUG (5 minutes)

18 European Guideline: Recommended Outcome Measures CORE AREA: PHYSICAL CAPACITY 6 Minute Walk Test with Borg Scale (Rating Perceived Exertion) 5 Times Sit to Stand Test

19 Estimated Time Required for Physical Capacity: 10 minutes CORE AREA: PHYSICAL CAPACITY 6 Minute Walk Test with Borg Scale (Rating Perceived Exertion) (10 Minutes) 5 Times Sit to Stand Test(1 minute)

20 Summary Use clinical reasoning! Use appropriate outcome measures Don t try to use ALL outcome measures at once! You can use others as long as they are validated and appropriate Use outcome measures!

21 Notes Ready for Group Work Take a few minutes to write down the measures your currently use, the ones you might consider using as expected to be recommended by the Joint European Guidelines, and the ones you would like further information about We will take this discussion forward into the group work.. Fiona.Lindop@nhs.net

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