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What is health outcome?
- - is a change in health status where the cause is not specified
- - a health outcome cahnge in the health of an individual, group or population , which is whollu or partially attributable to an intervention or series of interventions
Why should we use outcome measures?
- - evaluate treatment techniques, modalities and strategies
- - managing cases. This can vary from treatment regimes implemented to decisions about whether a pt is a candidate for a particular program
- - develop clinical pathways for specific diagnosis
- -collate data to enable the formation of a database upon which health workers can develop standards or program goals
- - evaluate programs
- - compare the outcome of treatment between one institution and another
- - allocate resourses
What should we measure?
- - perspective
- - what constitutes progress or success
- - traditional measures of health outcome
- - quality of life
What is a definition of health?
- a state of complete hysical, mental and social well- being, and not merely the absence of disease or injury
What is the multidemensional models of health?
- - morbidity (diease or impairment)
- - limitations to functional activities (disability)
- - role limitations due to health problems( handicap)
- - bodily ain
- - menatl health
- - vitality (energy/ fatigue)
- - general perception of heatlh
Reliability of selecting instruments and measures?
- - what was the sampled tested
- - internal consistency
- - stability
- - standards of reliability
- - face validity
- - content validity
- - concurrent validity
- - construct validity
- - large scale studies
- - published estimates of clinically significant change
- - length of questionnaire
- - expense of its administration
- - clinicains need instruments that are simple, inexpensive and, if possible versatile
What can we measure?
- - physical imapirment
- - pain
- - function
- - quality of life
Physical impairment measures
- - probably most common outcome measured in clinic physio
- - includes measurements such as jt ROM and mm strength
- - measurements both within an individual treatmentand between treatments
- - verbal rating scale
- - visual analogue scale
- - McGil pain questionnaire
- - behavioural rating scales
- - pain perception profiles
- - roland morris disability questionnaire
- - oswestry low back pain disability questionnaire
- - therapists judgement of function- unreliable
- - pt specific function scale
- - sickness impact profile
- most common health outcome qu used today
- 36 qu to measure 8 diff dimensions: physical functioning, role physical, body pain, general health, vitality, social functioning, role emotion and mental health
- can only make comment on what you measure using outcome instruments
- it is not possible to make accurate inferences about one of these elements based on another eg predict pain status based on ROM
What are the problems and danger in measuring outcomes?
- - statistical significance vs clinical change
- - quality of data- garbage in- garbage out
- - causality
- - bias- rehab professionals as raters have a stake in outcome