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Raising the Bar in Rehab

Quality Outcomes Assessment

Published May 19, 2011 3:28 PM by Lisa West

I had a treatment session with a patient last week who walked very slowly. Very, very slowly. I prompted this patient multiple times to increase the stepping pattern, with minimal improvements noted. Although the pace was slow, for the most part the patient was very safe with no huge balance deficits (while using a wheeled walker). I started writing my documentation mentally as we were walking. "The patient ambulates with a slow cadence." But that didn't seem to capture how slow we were actually going. So I dug into my toolbox of skills and pulled out the six-minute walk test.

I can't tell you the last time I used an outcomes measure. Maybe it's just the acute nature of my patients or the multiple other things I need to complete in a 30-minute session, but completing tests like the Berg Balance Test or the Tinetti, Timed-Up-And-Go just seems to be lower on my priority list. Is it just me? How many therapists use quantifiable outcomes testing regularly while treating a patient? If you see a patient with arthritic knee pain, do you immediately reach for your KOOS measurement?

Maybe outcomes assessments are more prevalent in different settings, and for different reasons. In my acute-care setting, my focus is more on getting patients up and moving, period, and further describing their mobility with assessment scores is an added bonus. Patients are discharged so quickly from the acute-care setting that following progress is difficult simply due to time. In outpatient settings it is more common for therapists to need data for reimbursement purposes, and these settings are more conducive to watching improvements over a longer period of time.

There are many times in my day when I will use aspects of these tests as a way to treat my patients' deficits. Just last week I had a patient perform alternating testing (a part of the Berg Balance Test) as an intervention to improve balance and stair negotiation. But I could probably incorporate more of the tests themselves into my sessions. Most are fairly quick to complete and can offer our patients (as well as our physicians and coworkers) an easy gauge of a patient's deficits and progress.

How often do you use physical therapy standardized tests? Do you find your patients appreciating the data? Have you written goals based on your patient's scores, such as "Improve six-minute walk test by 50 feet within one week?"

1 comments

I work in a special falls clinic. Every patient gets a tinetti and a timed up and go on evaluation and discharge. We have to provide objective evidence to the NHS commissioners that our interventions are having a measurable positive outcome. It also helps us to improve our services as we look at trends over time.

I agree, in acute care there is no time for that, but in a specialized service, it seems almost mandatory.

Dean

Dean Metz May 19, 2011 6:50 PM

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