Is This Change Real? Interpreting Patient Outcomes in Physical Therapy.

Abstract

Your first thought on seeing this book title might be, “Do we really need another book on outcome measurement?” If so, you may want to look inside. Unlike other outcome-measurement texts, this book packs a wealth of information into 180 paperback (11×20 cm) pages, largely by stripping away the psychometric baggage that can be overwhelming to clinicians. The authors succeed in demystifying measurement concepts by presenting them from a clinical perspective. The book's clinical practicality becomes apparent when you discover that, in one sitting, you can read about two frameworks relevant to clinical decision making (chapter 2), three methods of interpreting change (chapter 6), four common sources of measurement error (chapter 4), five questions to guide decisions on selecting and using instruments (chapters 4–8), and six barrier-busting strategies for implementing a new instrument or process (chapter 9). Is This Change Real? has 11 chapters, opening with an introduction aptly titled “Outcome Assessment Is Not as Straightforward as It Appears” and closing with “Putting It All Together …” Starting from the rationale that all measurements have error, even those we take for granted, the introduction outlines how the subsequent chapters will help clinicians deal with measurement error. The next two chapters describe two familiar frameworks—the International Classification of Functioning, Disability, and Health and the Hypothesis-Oriented Algorithm for Clinicians II—and demonstrate how they can guide outcome measurement and planning decisions. Chapters 4–8 address measurement issues of reliability, validity, change over time, patient goal setting, and timing of reassessment, all framed as clinically relevant questions. Chapter 9 acknowledges that making a change in practice is not easy and often involves others, then offers strategies to address common individual and organizational barriers. Chapter 10 provides strategies and tools to simplify the search for instruments relevant to a specific practice setting, and chapter 11 gives examples of how to implement each of the steps described previously. While Is This Change Real? was written specifically for physical therapy clinicians, educators, and students, practitioners in other health professions concerned with measuring change in patient status over time may also benefit from the authors' concise and clinically relevant presentation. Brief and clear explanations of measurement concepts, supplemented with illustrations, are highlighted by section subtitles such as “Translating Reliability Coefficients into Clinically Useful Information,” “How the Physical Therapist Applied the Information,” and “The Bottom Line.” Case examples further illustrate how to apply measurement concepts, interpret results, and inform and support clinical decisions. The book does use some statistical terms and equations, but they are limited to indices such as sensitivity, specificity, standard error of measurement, and minimal clinically important improvement, all of which can help clinicians to apply research results to their practice. These concepts are presented with only enough theory and math to facilitate clinical application. Similarly, discussion of concepts such as validity and reliability focuses on applying research results to interpret scores from single assessments and interpreting change between assessments for specific patients. One limitation of this text is its focus on classical test theory (CTT). Although most instruments currently available for clinical practice are CCT based, instruments based on item–response theory (IRT) are becoming more common, and readers would benefit from a discussion of the similarities and differences in interpreting single-point scores and change over time from IRT-based instruments. On the other hand, the authors have included a section on using results published from growth-curve models to plan for and evaluate change over time. This information will be especially valuable to clinicians because growth-curve models are particularly suited to describing rehabilitation outcomes and because few resources are available to help clinicians interpret and apply these models in practice. The practical nature of this book makes it ideal for practising clinicians, particularly those who have had little exposure to measurement theory, and for entry-level students. Educators can use it as a vehicle to communicate otherwise complicated measurement concepts in understandable terms, and researchers and academics may also benefit from the concise nature of the content. Is This Change Real? is a concise and clinically relevant overview and reference guide from which clinicians can build confidence in their ability to select, implement, measure, and interpret outcomes for their patients.