PHTY102 Lecture Notes - Lecture 6: Goniometer, Multi-Stage Fitness Test, Cardiorespiratory Fitness
PHTY week 6 LB Outcome measures for impairment, activity and participation
What is an outcome measure?
- A standardised tool, test, scale or assessment which measures a particular construct
and is expected to change as a result of intervention
- May be used to demonstrate change in the construct being measured
- May be used to evaluate cost benefits of intervention (if the construct has/hasn’t
changed)
- May be used to determine clinically worthwhile effect of intervention (if the
construct has/hasn’t changed) costs, risks, time
Assessing physiotherapy intervention and patient outcomes
- Recommended reading Practical Evidence-Based Physiotherapy (Herbert et al
2011)
- Evidence-based physiotherapy is physiotherapy informed by relevant, high-quality
clinical research
- Most important clinical questions concern:
oEffects of intervention
oPatient’s experience
oCourse of a condition – prognosis
oAccuracy of diagnostic tests
Effects of physiotherapy intervention
- Effectors of intervention divided into four parts: useful mnemonic: PICO
oPatient or problem
oIntervention or management strategy
oComparative intervention
oOutcome measure
Clinical Scenario
- Person who presents with acute low back pain. You are considering whether your
advice should be to stay in bed or continue daily routine as actively as possible:
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oPICO question: in patients with acute low back pain, does bed rest or advice
to stay active produce greater reduction in pain and disability?
oPICO analysis of scenario:
Patient adult with acute low back pain
Intervention bed rest
Comparison intervention advice to stay active
Outcome measure pain and disability
oIn addition, need to consider the timeframe of the outcome eg: in patients
with acute low back pain, what is the probability of being pain-free within 6
weeks?
Measurement of physiotherapy intervention
- Historically, outcome measurement was not a routine feature of clinical practice, ie.
No systematic collection of data
- Effectiveness was gained from physiotherapist clinical impression or patient
perception
- Pressure for accountability from makers of healthcare policies
- Workcover NSW pays additional fee to physiotherapists who demonstrate and
document clinical outcomes
- Clinical observations are now supplemented with measures of outcomes of
intervention using validated measurement tools
- Measurement tools are used to determine effectiveness of intervention
Evidence of effect of interventions
- Large part of physiotherapy intervention based on clinical observation
- Simplest way to interpret observations of clinical outcomes is as the effect of
intervention
- Confusion of outcomes and effects of intervention may be reinforced by patients
oImprovement = intervention effective
oNo improvement = intervention didn’t work
- Many factors determine clinical outcomes
Extraneous factors
- Effects of intervention may be ‘confounded’ by extraneous factors eg: factors not
related to the intervention
oNatural recovery condition resolves without intervention eg: acute low back
pain; post-surgical respiratory complications
oSpontaneous resolution statistical regression – ie. All disease has a random
component to severity
oSelf-report (patient) of outcomes ‘polite/good’ patients may exaggerate
recovery – trying to be helpful. ‘Hawthorne effect’ – change behaviours when
under study
oPlacebo effect ritual of intervention rather than intervention itself may
produce beneficial effects
oRecall bias extreme events/cases (positive and negative) feature most
prominently in memory
Interpreting measurements of outcome
- Implication that measures of outcome can provide justification for intervention – not
the case
- Outcome measures, measure outcomes not the effects of intervention
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Document Summary
Phty week 6 lb outcome measures for impairment, activity and participation. A standardised tool, test, scale or assessment which measures a particular construct and is expected to change as a result of intervention. May be used to demonstrate change in the construct being measured. May be used to evaluate cost benefits of intervention (if the construct has/hasn"t changed) May be used to determine clinically worthwhile effect of intervention (if the construct has/hasn"t changed) costs, risks, time. Recommended reading practical evidence-based physiotherapy (herbert et al. Evidence-based physiotherapy is physiotherapy informed by relevant, high-quality clinical research. Most important clinical questions concern: effects of intervention, patient"s experience, course of a condition prognosis, accuracy of diagnostic tests. Effectors of intervention divided into four parts: useful mnemonic: pico: patient or problem, intervention or management strategy, comparative intervention, outcome measure. Person who presents with acute low back pain. Patient adult with acute low back pain. Comparison intervention advice to stay active.
