The Search for a Functional Outcome Measure for Physical Therapy in Specialist Palliative Care: An Ongoing Journey

Abstract

A perspective article on the field testing of outcome measures and functional assessment tools by physical therapists working in specialist palliative care. Palliative care physical therapy is an evolving field, and there is a pressing need to evaluate interventions. The authors are members of a specialist palliative care physical therapy team in Ireland who evaluated their service by conducting several research and quality improvement activities. This involved trialing the use of a number of outcome measures, including functional, global, patient-specific, and quality-of-life scales. The following tools were piloted: the Edmonton Functional Assessment Tool, Second Version; an adjusted version of the Functional Independence Measure, Timed Up and Go test; Five Times Sit to Stand test; a self-devised Mobility Measure; distress thermometer; Patient-Specific Functional Scale; and EORTC-QLC C30. This article outlines the journey toward finding the most clinically useful outcome measure to use with palliative care patients. All the tools that were trialed had disadvantages, and many were not suitable for use on sizeable cohorts in our palliative care population. The team concluded that a functional outcome measure was the measure most suitable for measuring the effect of physical therapy interventions and that there was a need to devise a new functional measure specifically for palliative care. The next stage is to use pragmatic clinician input in devising a clinically useful tool in collaboration with research-based content experts to ensure acceptable psychometric properties. It is hoped that this approach will advance the evidence for physical therapy in specialist and general palliative care.