Mohammed TA, Omar Rehabilitation Health Science Department CAMS-KSU
Mohammed TA, Omar Rehabilitation Health Science Department CAMS-KSU [email protected][email protected] 0542115404 Introduction to Outcome Measurement in Clinical Practice and Research Lecture Outline Terminology related to outcome measures in clinical pr
actice (e.g. Assessment , Examination Evaluation, & outcome measurements ). Physical Therapist Patient/Client Management Model The physical therapist int egrates the five elements of patient/client manage ment in a manner design ed to optimize outcomes. Examinatio n, Outcome Evaluation,
Interventio n Diagnosis, (The Interactive Guide to Physical Therapist P ractice with Catalog of Tests and Measures (20 02) Prognosis, Assessment Assessment is the overall process of selecting and using multiple data-collection tools and various sources of information Outcome measurements It involves interpreting information
collected to make clinical decisions (analysis and synthesis) related to the needs of the person and the appropriateness & nature of their therapy. Evaluation Examinati on Assessme nt Examination Comprehensive screening and specific testing process leading to identifying potential and existing movement-related disorders, diagnostic classification and/or, as appropriate, to a referral to another practitioner Component of examination
History Systems review Tests & measures Evaluation Evaluation is a component of assessment process Evaluation is based on the data gathered from the examination(e.g. history, systems review, and tests and measures) and synthesizes all of these findings to establish the diagnosis, prognosis, and plan of care. Evaluation involves the collection of data to enable the therapist to make a judgment about the amount of a specific construct of interest Measurement measurement
A measurement is the data obtained by measuring. A measurement is obtained by applying a standard scale/tools/equipment to variables, thus translating direct observations or client/proxy reports to a numerical scoring system. Health Outcome Measurements A health outcome is a chan ge in the health of an indivi dual, or a group of people o r population, which is wholl y or partially attributable to an intervention or series of i nterventions. (AHMAC Febr uary 1993; Modified by NHI MG 1996) Health Outcomes Framework
Outcome measurement Outcome measurement is a process undertaken to establish the effect s of an intervention on an individual or the effectiveness of a service on a defined aspect of the health or well-being of a specified population OUTCOMES Outcomes Assessment Collection and recording of information rel ative to health processes Outcomes Management Using information in a way that enhances patient care Primary versus Secondary OM Outcomes
Primary Variable providing the most relevant and convincing evidence related to the main objective of the research. Secondar y Supportive measurements of the primary objective or
measurements of effects related to other secondary objectives. Generic versus Specific OMs Generic Diseases-specific Purpose Assess overall health status across a broad spectrum of norms /and or diseases Gather information about the impact of a specific health condition Population
General population (healthy and non-healthy) Applicable across individuals with differing condition health conditions Used for patients with a specific health Benefit Allow comparison to normative populations More sensitive & provides insight into the relationships among body function/structure impairments, activity limitations, and participation
Limitation Ceiling and floor effects more likely Does not allow comparisons across different groups of patients Example Functional Independence Measure Clinical indicators and physiological measures Patient-reported disease specific measures Performance-Based Measures versus Self-report OMs Self report
Performance based Purpose Assess actual performance in a particular environment at a specific point in time Collect information on patients opinions/ perceptions of the impact of the health condition Determine current level of function Data collection Methods Timing, distance, force , power , strength, Observation of performance
Rating level of independence/difficulty Interview Questionnaire Benefit Allows observation of task performance Less likely to have missing data Can assess constructs not observed during performance (e.g., fear of falling) Can assess activities not observed clinically Limitation Equipment required, environmental factors, fatigue, motivation, and learning effects,
measure inaccuracy Cognitive and communication ability Language and educational level Patient may miss or misinterpret items or over-/underestimate ability Example Functional Independence Measure , Gross motor function measure 10-meter walking test, Time up and go test 36-short form health questionnaire Seattle Angina Questionnaire (SAQ) Child Health Questionnaire (CHQ)
Patient-reported outcomes (PROs) A PRO is any report of the status of a patients health condition that comes directly from the patient, without interpretation of the patients response by a clinician or anyone else. (Food and Drug Administration, 2009) Patient satisfaction and perception Physical functioning Signs and symptoms Treatment adherence
Applied ======Prior to, during and after their treatment Using =========standardized and validated questionnaires Healthrelated Quality of Life (HRQoL) Health, Health Status, Quality of life (QoL), Health realted quality of life(HRQoL) Health Health A state of complete physical, mental and social well-b eing, and not merely the absence of disease or injury (WHO, 1981). Health is an individual's level
of function, where optimum function is judged in comparison to society's standards of physical and mental wellbeing. Quality of life (QoL) QoL An individuals perception of his/her position in life in the context of the culture and value systems in which he/she lives, and in relation to his/her goals, expectations, standards and concerns. health; social well-being; economic wellbeing;
QOL is the general wellbeing of individuals and societies, outlining negative and positive features of life life satisfaction; spiritual or existential wellbeing; and other characteristics valued by humans. What is health-related quality of life? HRQoL can be defined as how well a person functions in their life and his or her perceived wellbeing in physical, mental, and social domains of health HRQoL Its part of a persons overall quality of life that represents the
functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient . On the individual level Includes physical and mental health perceptions correlating with health risks and conditions, functional status, social support, and socioeconomic status At the community level Community-level resources, conditions, policies, and practices that influence a populations health perceptions and functional status Health related Quality of Life HRQoL can be defined as how well a person functions in their life and his or her perceived wellbeing in physical, mental, and social domains of health Health-related Quality of Life Encompasses several aspects of health that are directly
experienced by the person including physical functioning, Social and role function Mental and general health Perception Physical function Questions and answers
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