Desiree J Lanzino, PT, PhD Assistant Professor Program in Physical Therapy Mayo Clinic College of Medicine lanzino.desiree@mayo.edu Neurologic Outcome Tools Objectives Debate the issues to consider when choosing an outcome tool. MNPTA 2013 Fall Conference, Duluth, MN 1
Objectives Debate the issues to consider when choosing an outcome tool. Define psychometric properties used in research to identify appropriate tools for the neurologic population Objectives Debate the issues to consider when choosing an outcome tool. Define psychometric properties used in research to identify appropriate tools for the neurologic population Confidently administer outcome measures that assess multiple components of the ICF and in patients with various neurologic injuries. MNPTA 2013 Fall Conference, Duluth, MN 2
Objectives Debate the issues to consider when choosing an outcome 4tool. Apply Define psychometric properties used in research to identify appropriate tools for the neurologic population Confidently administer outcome measures that assess multiple components of the ICF and in patients with various neurologic outcome tools to injuries. appropriate case scenarios. What are the issues that affect your choice of outcome measure? Take 5 minutes to talk about this with your neighbors MNPTA 2013 Fall Conference, Duluth, MN 3
What? When? Where? Who? Why? How? Potter et al JNPT 2011;35:57 64 What? MNPTA 2013 Fall Conference, Duluth, MN 4
What? ICF categories? 3 levels of human function: Body function / structure Activities Participation Contextual factors: Environment & Personal When? In patient? vs. Out patient 3 levels of human function: Body function / structure Activities Participation Contextual factors: Environment & Personal MNPTA 2013 Fall Conference, Duluth, MN 5
Where?? Site limitations: Mandated tools Time Space Equipment Tool availability, cost Knowledge Who? Age? (Neurologic) Diagnosis?? Generic measure or disease specific measure? MNPTA 2013 Fall Conference, Duluth, MN 6
Who? Age? Diagnosis? Acute vs. Chronic? Change over time Who? Age? Diagnosis? Acute vs. Chronic? Low level vs. high level? Watch out for floor effects Watch out for ceiling effects MNPTA 2013 Fall Conference, Duluth, MN 7
Who? Yes: Selfreport or performancebased measures Age? Diagnosis? Acute vs. Chronic? Low level vs. high level? Language intact? No: Proxy for self report measures? Ability to follow directions for performance based measures? Who? Age? Diagnosis? Acute vs. Chronic? Low level vs. high level? Communicative or non? Limiting co morbidities Ex: Dementia Performance based > self report measures MNPTA 2013 Fall Conference, Duluth, MN 8
Who? Age? Diagnosis? Acute vs. Chronic? Low level vs. high level? Communicative or non? Limiting co morbidities Culture/language Why? Identify / diagnose / discriminate?? Predict? Evaluate? Barak & Duncan NeuroRx 2006;3(4):505 524 MNPTA 2013 Fall Conference, Duluth, MN 9
Why? Identify? Suspect cognitive impairment Mini Mental State Exam or Montreal Cognitive Assessment Why? Predict? Suspect fall risk BERG MNPTA 2013 Fall Conference, Duluth, MN 10
Why? Evaluate Balance intervention? BERG What, When, Where, Who, Why How?? Outcome measures MNPTA 2013 Fall Conference, Duluth, MN 11
Knowing what, when, where, who, & why will help to identify appropriate outcome measures Bottom line. What psychometric properties are important to consider? Sullivan et al JNPT 2011;35:55 74 Hobart J Neurol Neurosurg Psychiatry 1996;60(2):127 130 MNPTA 2013 Fall Conference, Duluth, MN 12
What questions might you have? Does the tool measure what I want it to measure? Is the tool valid? What questions might you have? What if the same therapist will not be completing both the initial and discharge evaluations? Is the tool reliable? Minimum Detectable Change: Large enough that the change is not due to error/variance MNPTA 2013 Fall Conference, Duluth, MN 13
What questions might you have? What does the score mean? Cut off scores, Normative data What questions might you have? How will I know if my treatment worked? Minimal Clinically Important Difference: Change in score signifies a meaningful improvement in my patient. MNPTA 2013 Fall Conference, Duluth, MN 14
Has it been used before in the way I want to use it and will it tell me what I want to know? Bottom line. Administer tools! Which ones???? With confidence! MNPTA 2013 Fall Conference, Duluth, MN 15
! Those tools that can be applied over multiple (neurologic) patient types Free to use Require no training Cover 3 levels of human function (ICF) Resources: Recommended tests PT Now: http://www.ptnow.org/functionallimitation Reporting/TestsMeasures/Default.aspx MNPTA 2013 Fall Conference, Duluth, MN 16
Some of the measures most frequently mentioned across diagnoses: (Bsf)Act BsfAct Act Act Act Act Act Act Act Act Act Act BsfPart Part 5XSTS (Vestib, CVA, PD) BEST (Vestib, PD, TBI) Funx Reach (all except SCI) BERG 4 Sq step test (Vestib, TBI, MS) 6 min walk (all except vestibular) 10 M walk (all except MS which has a timed 25 foot walk) TUG (all except PD) DGI (all except PD) Funx gait assessment (TBI, Vestib) Rivermead mobility index (MS, TBI) ABC [MS, TBI, Vestib, CVA (not acute)] DHI (MS, TBI, Vestib) Satisfaction with life scale (TBI, SCI) Resources: Recommended tests PT Now: http://www.ptnow.org/functionallimitation Reporting/TestsMeasures/Default.aspx APTA Neurology section outcome measures recommendations: http://www.neuropt.org/professionalresources/neurology section outcome measuresrecommendations Stroke MS TBI SCI PD Vestibular MNPTA 2013 Fall Conference, Duluth, MN 17
Resources: Instrument Databases Rehab Measures Database: http://www.rehabmeasures.org/rehabweb/ links.aspx Stroke Center: http://www.strokecenter.org/profess ionals/stroke diagnosis/strokeassessment scales/ National Multiple Sclerosis Society: http://www.nationalmssociety.org/msclinical care network/researchers/clinicalstudy measures/index.aspx Resources: Instrument summaries Rehab Measures: http://www.rehabmeasures.org/default.aspx MNPTA 2013 Fall Conference, Duluth, MN 18
Administering outcome tools Practice Application Patient cases MNPTA 2013 Fall Conference, Duluth, MN 19
Acute CVA, moderate impairment Acute CVA, minimal impairment MNPTA 2013 Fall Conference, Duluth, MN 20
In patient rehabilitation, CVA Out patient CVA MS SCI TBI MNPTA 2013 Fall Conference, Duluth, MN 21
Summary Define the what, when, where, who, & why To help determine the how (measure to use) Use available resources to examine outcome psychometric properties Build your tool portfolio one patient (type) at a time Collaborate! Live, learn, share MNPTA 2013 Fall Conference, Duluth, MN 22