What Outcomes Should We Measure?
My student and I were talking about outcome measures. Naturally the ICF model came up because it attempts to define disability. The ICF divides tests and measures into three categories: body function and structure, activities and participation. To properly use the ICF model, measurements must be completed at the initial evaluation and at various times along the way thereafter. In order to be thorough, a measure for each of the three categories should be completed.
That was the point of our discussion. While the ICF wants at least three measures completed, it doesn't explain how we are supposed to accomplish this, complete an evaluation and talk to our patients in an hour session. That's not realistic. We often include measures of body structure/function and activities in an evaluation. In my experience, one of them per session is all I have time for.
I attended the "Neurological Toolbox" course last year. It recommended two or three of each category be completed. Maybe they were speaking theoretically. Over the course of a few sessions, I could complete body structure and activities measures but not participation. The course stressed how participation is a vital part of rehabilitation and chided PTs for not completing participation forms as regularly as we should.
Participation measures are completed either by the patient or a family member/caregiver. Depending on the patient's cognition and ability to complete the form, one measure can take more than an hour and be exhausting. If the form is completed prior to the evaluation, the patient may be too tired to participate. If a family member completes the form, there is no way of knowing how much the patient actually contributed.
There is no way my rehab patients are going to complete those forms in a timely manner. Most of them would require help. Unless a family member is willing and patient, it won't get done. I need every second of treatment time for therapy. Support staff doesn't have the time to sit for long periods and assist patients with the forms. That assumes the patient is able to read and understand English.
In theory it's a wonderful idea. In reality it's not very practical. Completion of participation measures might improve if there were one or two generic forms available or if the forms were less complex. Forms aimed at caregivers might have a better completion potential but don't give insight into how the patient perceives his situation.
This is another of those areas that we need to think more about.