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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Measuring Up To Our Full Potential

Published June 8, 2012 1:51 PM by Danielle Bullen
 Tampa--"Guidelines will reveal the value of physical therapy services." So said Edelle C. Field-Forte, PT, PhD of the University of Miami Miller Medical School at the 17th Annual John H. P. Maley Lecture today. The lecture, named for Maley, a past president of the Foundation for Physical Therapy, honors a physical therapist who has made significant contributions to the profession in the area of clinical practice.  Dr. Field-Forte called the lectureship, "the highest honor I can imagine."

The ability to standardize is critical in our lives. Dr. Field-Forte asked the audience to imagine life without building codes or traffic laws. A standard, by her definition is "a framework of agreements to which relevant parties adhere to ensure performance and quality." Yet in the physical therapy field, she argued that there is a lack of good standardization in several areas.  Her talk focused on the lack of standardized outcome measurements and its impact on the profession.

The idea that standardized outcomes measurements is a good one has been around for a while. In the late 1980s, an APTA task force convened to address the issue. Yet, the theory has not translated into practice. In a 2009 survey, 48% of US PTs admitted to using standardized outcome measurements. Of the PTs who did not, 49% had no plans to start. So, what are clinicians using instead to determine if their interventions worked? Clinical impressions, informal assessments, clinical judgment and intuition are all options. Dr. Field-Forte cautioned subjective assessments can be misleading. "We can be fooled by our frame of reference."

 For therapists who do use a standardized outcome measurement, the choice of which scale is arbitrary. For example, the Berg, Tinetti and Timed Up and Go are all valid ways to measure mobility and balance. Differences in how these tests measure make it difficult to compare their results.

 Dr. Field-Forte argued,  "The true value of physical therapy remains hidden because we can't measure the effects of our treatments." She told the audience that a profession-wide commitment to assessment with valid measures is imperative. "The structure is in place. All we need is the commitment."

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