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Toni Talks about PT Today

What Outcomes Should We Measure?

Published November 15, 2011 3:00 PM by Toni Patt

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.

2 comments

We send self reported questionairres home to the patient after they call in for the appt if possible, otherwise send them home the first visit. This usually works well if there is explanation on why they are important.

For the quantitative tools, this is VERY IMPORTANT to do as part of the initial exam. Pick one or two that are indicated after the interview and screening. If you do not have objective measures, how can you show progress? If you do not utilize T & M that are correlated to function and norms, how do you justify the need for PT? Once you get doing this, you will get the exam done in a shorter period and these tools will actually tell you what you need to work on. Time is not a factor for quality care.

Jill, PT - asst prof/clinician, ALASU/EAMC November 17, 2011 8:39 AM
Montgomery AL

My experience with the ICF is exactly as you describe. For the past year we have had an interdisciplinary task force looking at different outcome measures. The OTs really liked the ICF here in the NHS. They spend ridiculously long periods of time with patients and even they finally admitted that it was not practical for implementation on a day to day basis. Barthel scoring is commonly used because it is a reliable instrument, but not very sensitive. The FIM(R) is currently being piloted here, but the OTs hate it as they claim it doesn't capture enough of the mental health functions nor kitchen functions they want. We've been having this, oft times, spirited debate for over a year.

Yes, we want outcomes. But no two disciplines can seem to agree on which ones to utilize.

Dean Metz November 15, 2011 4:50 PM

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