Guest Editorial: Rehabilitation Research and Development state-of-the-art conference on outcome measures in rehabilitation

Abstract

Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Avedis Donabedian, 1966 [1, p. 196] In January 2010, the Veterans Health Administration (VHA) Office of Research and Development brought clinical, scientific, and policy experts from a variety of professions to Miami, Florida, for a 3-day State-of-the-Art (SOTA) Conference on outcome measures in rehabilitation. The need for such a SOTA is obvious in light of the clinical complexity and long-term nature of injuries incurred by service personnel returning from international conflicts, combined with the ongoing commitment to aging Veterans who receive their healthcare from the VHA. Less obvious, perhaps, are other pressing matters relevant to the provision of quality care to Veterans with chronic and disabling conditions. First, the United States is experiencing an unprecedented need for measures of quality care in health service delivery. This movement may be best realized in the emergence of the Patient Reported Outcome Measurement Information System (PROMIS; http://www.nihpromis.org/), funded by the National Institutes of Health, for the development, refinement, and use of patient-reported outcomes to benefit consumers, clinicians, researchers, service delivery systems, and policymakers. This ambitious endeavor will promote standards and the implementation of qualitative and quantitative methods in outcome measurement. Across the country, several funded projects are investigating the feasibility and applicability of measures for use with persons who have chronic and disabling conditions. Ideally, measures that emanate from PROMIS will be reliable, valid, sensitive to change, and clinically useful for assessing outcomes across physical, mental, and social domains. Furthermore, these measures should be useful and informative to all health professions--regardless of specialty or discipline--invested in quality care and meaningful outcomes. Second, the push to develop sensitive patient-oriented outcome measures for all health services is consonant with the ascending International Classification of Functioning, Disability, and Health (ICF) [2]. The ICF emphasizes a greater appreciation for the environmental context in which disability--secondary to any diagnostic condition--occurs, and it advocates assessment of specific body functions and structures, activities and participation (and the capacity for and performance of such), and environmental barriers and facilitators of activity and participation [3]. This formula goes beyond the assumed outcome of symptom reduction and anticipates the acquisition and resumption of desired activities in personal and social roles [4]. Although this framework has been described as a workable compromise between medical and social models [3, p. 5], its utility in clinical practice and research is contingent on interdisciplinary collaborations. Indeed, interdisciplinary collaboration is one of the major issues facing clinical service and informed research to benefit returning Veterans with acquired disabilities. The complex nature of polytrauma and its clinical spectrum of posttraumatic stress disorder (PTSD) with brain injury, burns, limb loss, neuromuscular disability (including spinal cord disorders), and sensory loss (vision and hearing impairments, specifically) challenges clinicians and scientists to work in a unified, collaborative fashion to identify best practices and deliver optimal service. Unfortunately, the relative lack of co-occurrence among these conditions in the clinic and in the literature before 2006 (particularly brain injury and PTSD) [5] complicates interdisciplinary endeavors. Traditionally, the predominating diagnostic condition dictates the health specialty that provides and coordinates subsequent service to the Veteran (particularly PTSD and psychiatry, brain injury and rehabilitation). The long-standing boundaries between specialty services contribute to an unfortunate scenario in which each discipline tends to feel superior, dismisses the work of others, and sees interdisciplinary science as second rate [6]. …