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T10 OUTCOME ASSESSMENT Why, what and how? Dr. Frederike van Wijck & John Dennis.
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Transcript of T10 OUTCOME ASSESSMENT Why, what and how? Dr. Frederike van Wijck & John Dennis.
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T10 OUTCOME ASSESSMENTWhy, what and how?
Dr. Frederike van Wijck & John Dennis
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Learning OutcomePlan a safe, effective and appropriate
intervention, i.e.: • Design and adapt appropriate progressive
physical activity programme(s) after stroke using findings from the physical/ exercise assessments, etc…
Demonstrate competency in relevant assessment procedures:
• Monitor clients’ progress against agreed goals
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Content1. Measuring outcomes: why?
2. Measurement: general principles
3. Measuring outcomes: what?– General framework: the ICF– Specific suggestions for the exercise-after-
stroke setting
4. Using outcome measures in an exercise after stroke setting: how?
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Outcome measure – a definition:
“ a test or scale administered by therapists that has been shown to measure accurately a particular attribute of interest to patients and therapists and is expected to be influenced by the intervention”
(Mayo, 1995)
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1. Measuring outcomes: why?
1. Screening: testing eligibility for exercise
2. Baseline assessment: establishing starting point for exercise programme
3. Follow-up assessment: charting change following exercise
4. Monitoring: to chart adherence and identify adverse effects
This session: baseline and follow-up assessment using outcome measures
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1. Measuring outcomes: why not?
Common reasons for not using outcome measures:• It takes time away from the actual exercise• It is a burden for participants• It’s complex and a hassle for the instructors• You need training – we don’t have time for
that• What do these measures tell you anyway – I
know if something works!
Do you??!
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SCIENCE VS. COMMON SENSE
Science:
“knowledge, ascertained by observation and experiment, critically tested, systematised and brought under general principles”
Cambridge English Dictionary
Common sense:
“normal understanding, good practical sense in every day affairs, general feeling (of mankind or community)”
Oxford English Dictionary
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• Common sense is not good enough for exercise instructors/ health care professionals;
• Exercise/ rehabilitation/ health care needs to be based on science!
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Content1. Measuring outcomes: why?
2. Measurement: general principles
3. Measuring outcomes: what?– General framework: the ICF– Specific suggestions for the exercise-after-
stroke setting
4. Using outcome measures in an exercise after stroke setting: how?
![Page 10: T10 OUTCOME ASSESSMENT Why, what and how? Dr. Frederike van Wijck & John Dennis.](https://reader035.fdocuments.in/reader035/viewer/2022062309/5697bfa81a28abf838c9939d/html5/thumbnails/10.jpg)
2. Measurement: general principles
Characteristics of good outcome measures:
1. Relevant
2. Valid
3. Reliable
4. Sensitive to change
5. Practicable
6. Results can be easily communicated(Wade, 1992)
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Characteristics of good outcome measures
Relevance:
the pertinence of the information
Consider:Is this information useful – what does it tell
me?What am I going to do with the information?
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Characteristics of good outcome measures
Validity:
the measure does what it is purported to do
Consider:• Which idea/ construct does this measure
address?
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Characteristics of good outcome measures
Reliability:
the measure gives the same result each time the same quantity is measured.
Consider:– Intra-rater variation– Inter-rater variation-> Importance of protocols! (tutorial)
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Characteristics of good outcome measures
Sensitivity to change:
the measure can detect changes that are relevant
Consider:• On what scale is/ are the item(s) scored?
E.g.:– 0/ 1 or Yes/ No– 0-10 (Visual Analogue Scale)
• Floor and ceiling effects
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Characteristics of good outcome measures
Practicability:
the measure is quick and easy to use
Consider:• Amount of information required• Duration of the process• Complexity of the process• Burden on client (and you!)
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Characteristics of good outcome measures
Communicability:
The results can easily be reported and understood
Consider:• Amount• Format• Standardisation of the information
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Summary - general principles of measurement:
Characteristics of good outcome measures:
1. Relevant
2. Valid
3. Reliable
4. Sensitive to change
5. Practicable
6. Results can be easily communicated(Wade, 1992)
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Content1. Measuring outcomes: why?
2. Measurement: general principles
3. Measuring outcomes: what?– General framework: the ICF– Specific suggestions for the exercise-after-
stroke setting
4. Using outcome measures in an exercise after stroke setting: how?
![Page 19: T10 OUTCOME ASSESSMENT Why, what and how? Dr. Frederike van Wijck & John Dennis.](https://reader035.fdocuments.in/reader035/viewer/2022062309/5697bfa81a28abf838c9939d/html5/thumbnails/19.jpg)
3. Measuring outcomes: what?
A general framework for outcome measurement in clinical practice: the ICF
International Classification of Functioning, Disability and Health
“Aim of the ICF classification is to provide a standard language and framework for the description of health and health-related
states.”
http://www.who.int/classification/icf/intros/ICF-Eng-Intro.pdf
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ICF definitions
Impairments are problems in body function or structure such as a significant deviation or loss.
Activity limitations are difficulties an individual may have in executing activities.
Participation restrictions are problems an individual may experience in involvement in life situations.
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ICF model
http://www.who.int/classification/icf/intros/ICF-Eng-Intro.pdf
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The ICF: A general framework for outcome measurement in rehabilitation
Activity Limitations
Impairments Participation Restrictions
Health Condition
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Outcome measures and the ICF
Which outcome measures do you use in your work ?
Where do they fit within the ICF?
Can you think of one outcome measure in each of the ICF domains for a person who has had a stroke?
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Outcome measures for exercise after stroke
Activity LimitationsExample?
ImpairmentsExample?
Participation Restrictions
Example?
Person with stroke
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3. Measuring outcomes: what/ how?
Suggested outcome measures for exercise after stroke specifically :
• 6 min. walk/ 10 m. walk
• Timed up and Go
• Visual Analogue Scale (VAS)
• Stroke Impact Scale
+ Register: for monitoring adherence
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Onto: Measuring Outcomes: how?
• 6 min. walk/ 10 m walk
• VAS
• Timed up and Go
• Stroke Impact Scale
http://figuredrawings.com/Animation.html
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6-minute/ 10 m. walk test
Construct: ?
Evaluation?
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6-minute walk testConstruct: maximum walking distance in 6 minutes• Relevance: functional test for exercise endurance,
O2 uptake• Validity: good• Reliability: high• Sensitivity: ?• Practicability: good• Reporting: easy (distance (m))• Normative data for healthy people aged 60-89 yrs:
345-623 m(Steffen et al., 2002)
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Timed Up and Go
Construct: ?
Evaluation?
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Timed Up and Go
Construct: time to stand up from arm chair, walk 3 m, turn, walk back, sit down
• Relevance: functional test for basic mobility for frail elderly in community
• Validity: acceptable• Reliability: moderate - high• Sensitivity: ?• Practicability: good• Reporting: easy (time (s))• Normative data for healthy people aged 60-89 yrs:
7-12 s(Steffen et al., 2002)
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VAS
Construct: ?
Evaluation?
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VAS
Construct: person’s perception of a particular construct
• Relevance: depending on what is assessed. Can be used to assess individual goal attainment
• Validity: generally good• Reliability: generally high• Sensitivity: high • Practicability: caution with stroke, esp. higher
cortical problems and neglect (Price et al., 1999)• Reporting: easy
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Correct use of VAS in stroke
Price et al. (1999), p. 1359.
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Correct use of VAS in stroke
Price et al. (1999), p. 1360.
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Stroke Impact Scale
Construct: ?
Evaluation?
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Stroke Impact ScaleConstruct: the person’s perceived impact of stroke across
range of domains (incl. movement, ADL, cognition, communication, emotion, participation)
• Relevance: high• Validity: good (devised with target population)• Reliability: moderate – very high• Sensitivity: each item on 5-point scale + one VAS item• Practicability: mixed• Reporting: time-consuming but can be done by mail• Normative data: not applicable• Interpretation: change between 10-15 points clinically
meaningful(Duncan et al., 2003)
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Pitfalls of measurement – and how to fix them
Problem
• Error:– Systematic– Random
• Wrong signals:– False +– False -
Solution?
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Pitfalls of measurement – and how to fix them
Problem
• Error:– Systematic– Random
• Wrong signals:– False +– False -
Solutions:
• Errors:– Calibrate your instrument– Use standardised protocol
• Wrong signals:– Check sensitivity– Verify with other information
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Pitfalls of measurement – and how to fix them
Problem
• Error:– Systematic– Random
• Wrong signals:– False +– False -
Solutions:
• Errors:– Calibrate your instrument– Use standardised protocol
• Wrong signals:– Check sensitivity– Verify with other information
Errors are inherent in any form of measurement!
Always be aware and try to reduce.
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Summary
Outcome measures are necessary to:
• Establish baseline for exercise
• Evaluate change following exercise
-> science underpinning your work
EVIDENCE BASED PRACTICE
(meten is weten!)
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Choosing your Outcome Measure how to go about it
Safe?
NO
YES
Relevant?
NO
YES
Science Robust?
NO
YES
Practicable?
NO
YES
GO
T
H
I
N
K
A
G
A
I
N
Safe?
NO
YES
Relevant?
NO
YES
Science Robust?
NO
YES
Practicable?
NO
YES
GO
T
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References
• DUNCAN, P. W., LAI, S. M., BODE, R. K., PERERA, S. & DEROSA, J. (2003b) Stroke Impact Scale-16: A brief assessment of physical function. Neurology, 60, 291-6.
• DUNCAN, P. W. Stroke Impact Scale (SIS). Rehabilitation Outcomes Research Centre, US Department of Veteran Affairs. Available from: http://www1.va.gov/rorc/stroke_impact.cfm (last accessed 05/12/05).
• WADE, D. T. (1992) Measurement in Neurological Rehabilitation, Oxford, Oxford University Press.
• WORLD HEALTH ORGANISATION (2001). International Classification of Functioning, Disability and Health. Available from http://www.who.int/classifications/icf/en/