quiz #1 – a primer on musculoskeletal outcome measures and instruments

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quiz #1 – a primer on musculoskeletal outcome measures and instruments
2011-01-18 00:16:47

a primer on musculoskeletal outcome measures and instruments
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  1. what do outcome measures tell us?
    • the patient's injury, condition, or pathology is improving
    • validates our intervention
    • improves our performance as physical therapists
    • justifies our treatments to the insurance companies
  2. what is pay-for-performance?
    it is an evaluation of outcome measures of the physical therapist or physical therapy clinic. It outcome measure scores are high the physical therapist or clinical will have a higher reimbursement rate. If outcome measures are low than the physical therapist or clinic will have a lower reimbursement rate
  3. what are the three principles when considering patient treatment and intervention

    Are any of these principles more important than the other?
    • evidence
    • client factors/patient values
    • clinical art and expertise

  4. what is evidence-based practice?
    the integration of current best evidence

    The physical therapist clinical expertise

    Patient values
  5. what is a PICO question
    the formulation of answerable clinical question
  6. what does PICO stand for?
    • patient
    • intervention
    • comparison
    • outcomes
  7. what are patient values
    they are unique preferences, concerns and expectation each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient
  8. what are the five things that a physical therapist should do when treating a patient ( from beginning to end)?
    • examine
    • evaluate
    • diagnose
    • prognosis
    • intervention
  9. What is traditional research
    cover standard evaluation of range of motion, strength, radiographs, etc.
  10. what is outcome research and is this important?
    outcome research covers what the patient thinks of the results of care given

    it is meant to enhance evaluation, not replace the usual methods

    it also identifies what the patient wants from physical therapy

    Yes this is very important because we care about the patient thinks
  11. what are the barriers that outcomes research
    • attitudes, paradigms, lack of understanding
    • time pressures – the biggest barrier
    • unseen value by some
  12. who came up with the "end result" idea
    Ernest Armory Codman, M.D.
  13. what is the "end result" idea
    it is the idea that every hospital should follow every patient treats, long enough to determine whether or not the treatment has been successful, and then to inquire if not, why not?... With a view to preventing similar failures in the future
  14. Ernest Codman is also known for his?
    • pendulum exercises– often used in physical therapy
    • Codman paradox
    • Coman's triangle
  15. true or false – as physical therapy develops as a career there has been a greater focus on patient outcome measures over the last 20 years
  16. true or false – almost all outcome measure tools can be administered to any patient of any age for any condition
    false – as physical therapist we need to know the conditions for each outcomes measurement tool we use
  17. why do we use outcome measures
    impairment measures alone are not enough

    Enhance patient care

    May improve clinical decision-making

    Communication – we can show patients, physicians, surgeons, referral sources, research groups, insurances, and employers how the intervention has improved the patient's condition from start to finish in a numerical fashion
  18. what are the three major components that make a quality outcomes measures instrument


    Clinical utility
  19. what are three major things to consider when looking at psychometric properties
    validity, responsiveness, reliability
  20. what is validity
    extent to which the instrument measures what it is supposed to measure
  21. what is responsiveness
    ability of instrument to change as the status of the patient changes – referred to as sensitivity to valid change
  22. what is reliability
    ability of the instrument to measure something the same way twice

    Doesn't matter who administers the outcome measurements instrument
  23. what is construct validity
    refers to items like pain or disability – can be divergent or convergent

    convergent – high correlation between two different tools measuring similar attributes

    Divergent to similar tools do not correlate highly if they measure different attributes – emotional versus physical
  24. when talking about validity what is important about the criterion of outcome measurement
    the criteria correlates with the gold standard
  25. what is internal consistency when talking about reliability
    how consistent the questions are in measuring the same outcome
  26. what is reproducibility when talking about reliability
    reproducibility is how well this outcome measurement tool can be administered by two different people in the score comes out the same both times
  27. what is the minimal detectable change
    error estimate of change for oven instrument
  28. what is the minimal clinical importance difference
    the minimal change in a score, indicative of change in function, that is truly important to the patient
  29. in order to show true change in outcome measure the second score must exceed the minimal detectable change value
  30. floor and ceiling effects

    True or false – useful measurements must provide room for client to demonstrate improvement or deterioration
  31. what is the ceiling effect
    top out – on scale, achieving normal function when some disability remains
  32. what is floor effect
    bottom out – on scale, unable to detect a decline in status
  33. what is an example of a floor and ceiling effect
    an outcome measurement tool administered to young athletes that is designed for older athletes
  34. what is clinical utility
    the clinical usefulness of an outcome measurement tool
  35. what are some important things to consider about clinical utility
    • patient friendly
    • time to administer
    • clear, concise, easy to understand
    • patient comfort and answering questions

    • Clinically friendly
    • staff versus self administration
    • staff effort/cost of administering, recording, and analyzing
  36. what is a visual analog scale
    a scale that can measure pain
  37. what does PSFS stand for

    what does it measure
    patient specific functional scale

    the functional ability of the patient
  38. true or false – the patient specific functional scale it's great for follow-up appointments with doctors.
    true –
  39. what is the NDI
    neck disability Index
  40. what is the Oswestry disability index
    questionnaire that assesses pain related disability in patients/clients with low back pain
  41. what does SANE stand for
    single assessment numeric evaluation
  42. how is the single assessment numeric evaluation administered
    asked the patient – on a scale of 0 to 100, how would you rate your shoulder function with 100% be in normal?
  43. is the single assessment numeric evaluation a valid test in comparison to other tests, such as ASES and ROWE
  44. is a simple shoulder test condition specific?
  45. true or false – the DASH is only used for the elbow when assessing function
    false – it evaluates the function of the shoulder elbow wrist and hand. Or other words the entire upper extremity

    • Higher the score = higher the disability
    • most commonly used in the world
  46. what is a Harris hip score
    client-based outcome designed to assess the level of pain and functional impairment of a total hip replacement
  47. what is a lower extremity functional scale
    a test that measures the level of disability for lower extremity
  48. the lower extremity functional scale is similar to what test for the upper extremity
    The DASH
  49. What does KOS stand for
    knee outcomes survey
  50. what does FAAM stand for
    foot and ankle ability measure