OUTCOME

MEASURES NZAOT Conference 2012

Hamilton

Linda Robertson

Measurement Tools

TASK: • What assessment methods / tools do

you use?

What is an Outcome Measure?

• “It is an assessment or test that is known to accurately measure one or several attributes”

p149 Unsworth (2000)

TASK: • Describe 3 Characteristics of an

outcome measure

Characteristics of instruments

• Valid

• Reliable

• Sensitive to change

• Clinically useful

• Feasible to use in given setting

What purpose do they serve?

• Enable comparisons:

of outputs over time

between different client groups

• Provide judgment of the worth of an intervention

pre-post intervention

comparison between patients with similar diagnosis

• Facilitate effective team communication

What do you want to measure?

• Team outputs

• Occupational therapy outputs

Performance components?

Occupational performance?

What setting are you in?

• Hospital; community; unidisciplinary; multidisciplinary

• What time constraints do you have?

Who has identified the need for outcome measures?

• The manager

• The team

• Yourself

Who will benefit?

• The occupational therapy service?

• The organization?

• The client?

• All of the above?

What will the benefits be?

TASK:

• Identify 3 benefits to your service

Benefits of using Outcome Measures

Why do we need to ensure that measurement is integral to our practice

• Provides explicit expertise

• Identifies the unique perspective of OT

• Informs others about our core knowledge

• Provides evidence of effectiveness

• Focuses on society needs - occupied citizens

Law, Baum & Dunn (2005)

Imbedding Outcome Measures in the OT Process:

Cues

&

Hypotheses

Referral

Assessment

PROBLEM ID

Goal setting / Planning

Intervention

Re-evaluation On-going assessment

Discharge

Review long-term outcome

Can patient goals be used as outcome measures?

• Write 1 goal for a client you are working with

Evaluate this goal. What criteria did you use?

Patient Goals as outcome measures

Quality of the goals:

OTs struggle to articulate and set measurable goals Bowman, 2006

Challenges to incorporating measurement into practice

• Where do I start

• I don’t have time

• Protocols used don’t include measurement

• My team expects certain information from me

• Most out outcome measures do not apply to my clients

• What measure do I use?

• We have no money to buy assessments

Law, Baum & Dunn (2005)

Examples of Measures

OT measures

• COPM

• AMPS

• Allans Test

• AusTOMs

Other measures

• GAS

• FIM (also the community version - Lawtons IADL)

• MMSE (also a shorter version)

• Barthel Index

• Life Satisfaction Qn

What measures are readily available?

TASK:

• Name 3 outcome measures

Selected literature to describe outcome measures

Related to conditions

• Parkinsons

• Stroke patients at home

• Upper limb recovery following stroke

• Children with Cerebral Palsy

• Substance use disorders

• Patients with long-term psychotic disorders

Selected literature to describe outcome measures

Related to instruments

• Validity of the COPM

• A toolkit to measure geriatric outcomes

• Reliability of the COPM

• Therapy outcomes for allied health practitioners (AusTOMs)

Patient-Reported Outcome Measures (PROMS)

• PROMS “provide a means of gaining insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be provided by a patient or individual about themselves, or by others on their behalf.”

PROM group, UHCE, Uni of Oxford

Different Types of PROMS

GENERIC

• Applicable and comparable across a range of treatments or conditions

• Eg. Euro-Qol EQ-5D

• See: http://www.euroqol.org/

• Nottingham Extended Activities of Daily Living (ADL) Scale

CONDITION SPECIFIC

• Considered to be more sensitive to changes in health status

Examples:

• Oxford hip score

• Oxford knee score

• Stroke Impact Scale.

Implementation Impact of Management

• Institutional changes to influence behaviour

Eg.

*Manager insisted that COPM and GAS had to be reported in all reports in Cerebral Palsy setting.

.

References

• Resource – references for PG students: http://groups.diigo.com/group/outcome-measures-in-occupational-therapy

• Bowman, J. (2006). Challenges to Measuring Outcomes in Occupational Therapy: a Qualitative Focus Group Study. British Journal of Occupational Therapy, 69(10), 464-472.

• Unsworth, C. (2000). Measuring the outcome of occupational therapy: Tools and resources. Australian Journal of Occupational Therapy, 47, 147-158.

• Law, M., Baum, C., & Dunn, W. (2001). Measuring Occupational Performance. Supporting best practice in occupational therapy. Thorofare, NJ: SLACK

Conclusions:

• There are many measures available – select carefully; consider the purpose of the measure and the credibility of the tool.

• No measure is perfect

• No single measure covers all of OT

• Do not rely on one measure – use a range