Outcome Measurements and Case Weightings in Physiotherapy Services for People with Learning Disabilities

Abstract

Summary Little is known about evaluating physiotherapy for people with learning disabilities. The radical changes in health service delivery have increased the pressure on all services providers to investigate methods of evaluating their intervention. This study presents an approach designed to measure outcome and to calculate input in physiotherapy services for people with learning disabilities. A case weighting system was developed in order to evaluate the cost of physiotherapy services, predict the need for physiotherapy, balance and prioritise the caseload between physiotherapists and finally to use as an outcome measure. The clients were weighted with the following criteria: type of input required, other support services involved, physical state of the client, client / therapist interface, and client / carer compliance. A protocol of physiotherapy assessment was designed, which included a functional ability checklist, body chart, and quality of movement assessment. It was applied for 48 people with learning disabilities. Goals were improvement of the clients' functional skills, quality of movement, quality of life and the maintenance of abilities. They were assessed as fully achieved, partly achieved and not achieved. Following a review of our approach a year later, we were able to highlight inadequacies of our services, develop predictive outcome measures, predict the type and frequency of our input required over a six-month period, and approximate the cost of our service. It is suggested that this problem-solving specific therapy approach can be used widely with people who have learning disabilities. This has great clinical validity, as isolated generic methods of measurement cannot evaluate physiotherapy in this client group. Little is known about evaluating physiotherapy for people with learning disabilities. The radical changes in health service delivery have increased the pressure on all services providers to investigate methods of evaluating their intervention. This study presents an approach designed to measure outcome and to calculate input in physiotherapy services for people with learning disabilities. A case weighting system was developed in order to evaluate the cost of physiotherapy services, predict the need for physiotherapy, balance and prioritise the caseload between physiotherapists and finally to use as an outcome measure. The clients were weighted with the following criteria: type of input required, other support services involved, physical state of the client, client / therapist interface, and client / carer compliance. A protocol of physiotherapy assessment was designed, which included a functional ability checklist, body chart, and quality of movement assessment. It was applied for 48 people with learning disabilities. Goals were improvement of the clients' functional skills, quality of movement, quality of life and the maintenance of abilities. They were assessed as fully achieved, partly achieved and not achieved. Following a review of our approach a year later, we were able to highlight inadequacies of our services, develop predictive outcome measures, predict the type and frequency of our input required over a six-month period, and approximate the cost of our service. It is suggested that this problem-solving specific therapy approach can be used widely with people who have learning disabilities. This has great clinical validity, as isolated generic methods of measurement cannot evaluate physiotherapy in this client group.