Outcome Measures In Clinical Practice Research Articles

Exploring the implementation and use of outcome measurement in practice: a qualitative study

Outcome measurement is important to clinical practice--yet outcome many speech and language therapists find it difficult to apply measures in practice, and not all clinicians and services have been able to implement and/ or use outcome measurement successfully. To date there has been little research to explain why implementation is often unsuccessful, and to provide clinicians and managers with direction as to the likely barriers and facilitators which should be considered. To develop a theoretical framework to explain the implementation and use of outcome measurement in clinical practice by speech and language therapists. A qualitative, inductive theory-building approach, using grounded theory methodology, was applied. This included theoretical sampling, constant comparison, memo writing, and theoretical integration. Participants were 16 Australian managers and clinicians who were using, or who had used, outcome measures. The resulting theoretical framework explains two interactive stages that occur when speech pathologists attempt to use outcome measurements in practice. First, clinicians must 'try on' outcome measurement in their own context, examining the way it fits with existing areas, such as their normal practices and priorities, and the wider group and organizational context. Having identified where outcome measurement does not 'fit', clinicians attempt to 'align' outcome measurement with the context (or vice versa), in order to create a better fit between the two. Strategies of 'tailoring' outcome measurement (e.g. using only parts of a measure) or 'accommodating' outcome measurement (e.g. changing routines to allow time for outcome measurement ratings) are possible, but are dependent on clinicians having a true picture of outcome measurement, the role and need for the data, and the existing context. Clinicians must also have control over the areas that need to change in order for outcome measurement and the context to 'align'. Where outcome measurement and the context can be aligned, outcome measures are more easily used. The theory provides a framework for considering the use of outcome measurement in clinical practice. Implications for implementing outcome measurement in clinical practice are discussed, including the need to clarify the role and need for the data; the requirement that clinicians understand how outcome measurement fits with context outside of their own personal purview; and the need for managers to support change to areas that are outside of the control of clinicians.

The awareness and use of outcome measures by South African physiotherapists

Physiotherapists as well as otherhealth care providers a reunder pressure to provide evidence for the effectiveness of their interventions. Therefore it has become necessary to employ standardized androbust outcome measures in clinical practice. The objective of this study was to determine the awareness of and use of outcome measures (OM’s)amongst physiotherapists in South Africa. A survey was conducted in2004 using a self-developed electronic questionnaire consisting of 18questions, both open- and closed-ended. A population-based sample consisting of 1102 members on the email address list of the South Africa Society of Physiotherapy (SASP) was used. Data analysis consisted ofboth descriptive statistics and qualitative analysis for the open-endedquestions. The response rate was 15.2% (n=168). Ninety one percent of respondents reported to have heard of OM’s while 84% reported using OM’s regularly. Impairment related measures were predominantly in use. The two main themes that emerged from therespondents’comments related to reasons forusing OM’s were “effective clinical practice”(82%) and “evidence-basedpractice” (15%). Time constraints and lack of sufficient knowledge in the use of OM’s, were cited as obstacles tousing OM’s. These findings have implications forthe South African physiotherapy community in terms of education,continuous professional development (CPD) and future research in the usage frequency of OM’s.

The Family Dermatology Life Quality Index: measuring the secondary impact of skin disease

Skin diseases are known to have a major impact on the lives of patients and their families. Many instruments are available to measure the health-related quality of life (HRQoL) of patients but no measure has been developed so far to quantify the secondary impact on family members of the patients. To develop and validate a dermatology-specific instrument to measure the adverse impact on the HRQoL of family members of patients with skin disease. Detailed semi-structured interviews were conducted with family members of patients to identify different aspects of HRQoL affected. An initial draft version of the questionnaire based on the main topic areas was pilot tested to assess the face and content validity. A 10-item questionnaire, the Family Dermatology Life Quality Index (FDLQI), was finalized after modifications to the draft questionnaire based on feedback from families and dermatology professionals and on item reduction. Psychometric evaluation was conducted on a new cohort of family members (n = 132) who completed the FDLQI and the patients (n = 109) who completed the Dermatology Life Quality Index (DLQI). Fifty-nine different aspects of family members' HRQoL were identified from the analysis of the interviews, which were categorized into main topic areas. Factor analysis of 10 items of the final questionnaire revealed two factors and together these explained 60% of the common variance. The FDLQI demonstrated high internal consistency (Cronbach's alpha = 0.88) and test-retest (intraclass correlation coefficient = 0.94) reliabilities. The responsiveness of the instrument to change was shown by significant change in the family members' FDLQI scores in cases where patients' clinical condition either improved or worsened. Construct validity was assessed by testing a number of a priori hypotheses. A strong correlation was seen between the family members' FDLQI scores and patients' DLQI scores (r = 0.69), a significantly higher FDLQI score was seen for inflammatory skin diseases compared with noninflammatory diseases/isolated lesions (P < 0.0001), and there was a positive relationship between the family members' FDLQI scores and patients' disease severity (r = 0.49). The FDLQI is simple and practical and seems to have the potential to be used as an additional outcome measure in clinical practice and evaluation research.

Connecting stuttering management and measurement: I. Core speech measures of clinical process and outcome

There will always be a place for stuttering treatments designed to eliminate or reduce stuttered speech. When those treatments are required, direct speech measures of treatment process and outcome are needed in clinical practice. Based on the contents of published clinical trials of such treatments, three 'core' measures of treatment outcome are presented for consideration by clinicians: measures of stuttering rate, speech rate and speech naturaleness. In contrast to clinical trials, however, clinicians are at liberty to have as many outcome measures as thought necessary, and to design non-standard ones to suit their needs and those of their clients. In that context, the merits of severity ratings of stuttering are considered. It is argued that the prime source of guidance of suitable measures of treatment process are the manuals of the treatments that have figured in clinical trials. Although there are independent data sources that contradict the axiom that treatment outcomes should be measured beyond the clinic, it is argued that it is premature to dispense with beyond-clinic process outcome measures for clinical practice. It is argued that for clinicians who conduct treatments in non-research contexts, one pretreatment outcome measurement occasion is sufficient, along with post-treatment measures at each maintenance visit. More than anything else, the numerous advantages of severity ratings of stuttering facilitate clinical measurement of treatment outcome and treatment process in several settings and on several occasions.

Calidad de vida en pacientes intervenidos de catarata

To evaluate quality of life improvement after cataract surgery. Measurement of quality of life in 60-80-year-old patients undergoing phacoemulsification, both genders and able to comprehend the SF-36 quality of life questionnaire. The SF-36 explores the differences in quality of life before and after surgery. The questionnaire was completed prior to cataract surgery and six months after. The answers of 75 patients were evaluated in this study. The average age was 73.88 S.E. 5.27 years old. After the surgery physical function increased (p=0.001), as did role limitation due to physical problems (p=0.007) and social function (p=0.003). Body pain, role limitation due to emotional problems, vitality, energy or tiredness, general health perception and health improved after surgery compared to one month before, but these findings were not statistically significant. Quality of life can be measurably improved by cataract surgery. Disease-specific questionnaires, such as the SF-36, should be used whenever possible as an outcome measure in clinical practice. The phacoemulsification cataract surgery has proved to be effective in improving quality of life.

An Evidence-Based Approach to Choosing Outcome Measures: A Checklist for the Critical Appraisal of Validity, Reliability and Responsiveness Studies

Selecting outcome measures for clinical practice or research needs to be based on a critical evaluation of the evidence on the validity and reliability of the available measures. This paper presents both a theoretical framework based on the methodological literature of how these psychometric properties can be assessed and a checklist designed to facilitate the critical appraisal of studies on outcome measures. Through examples drawn from the published literature, the concepts of instrument validity, reliability and responsiveness and how these can be evaluated and reported are illustrated. It is suggested that a structured checklist can facilitate a more evidence-based approach to the selection and employment of outcome measures in clinical practice and research.

The Brief Impairment Scale (BIS): A Multidimensional Scale of Functional Impairment for Children and Adolescents

This article provides the results of the psychometric testing of the Brief Impairment Scale (BIS). The BIS is a 23-item instrument that evaluates three domains of functioning: interpersonal relations, school/work functioning, and self-care/self-fulfillment. It capitalizes on the strengths of existing global measures while addressing some of their limitations. Cross-sectional parent respondent data from one clinical (N = 757) and two community samples (N = 1,888 and 1,132) of children ranging in age from 4 to 17 years is employed to test the reliability and validity of the BIS. Receiver operating characteristic analyses are employed to assess useful cutoff scores on the scale. The total scale's internal consistency ranged from 0.81 to 0.88 and from 0.56 to 0.81 on the three subscales. Test-retest reliability for individual items ranged from fair to substantial in all but six items. The BIS has high convergent and concurrent validity. Receiver operator characteristic analyses suggest possible thresholds for different uses. The BIS is psychometrically sound, useful in assessments and as an outcome measure in clinical practice and research. Its advantages over other global impairment instruments are that it is respondent based, short in administration time, and multidimensional.

Outcomes Measurement for Patients With Low Back Pain

Outcomes tracking provides a systematic method of monitoring treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is very important for clinicians working in orthopaedic settings, where patients with lumbar pain are prevalent. The clinician must be able to evaluate and choose appropriate measurement tools, and understand the clinical meaning of measurements to successfully employ these instruments. The purposes of this article are to review measurement instruments and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided, with specific commentary on the use of the SF-36, SF-12, Oswestry, Roland Morris, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.

Measuring responses to therapy in headache patients: new and traditional end-points

Changes in numerical indices of the intensity, duration and frequency of attacks are traditionally used to assess the effectiveness of treatments for migraine and other primary headaches. However, recent clinical and therapeutic guidelines and guidelines for conducting clinical trials specify that the essential aim of symptomatic and prophylactic migraine treatments should be to reduce the global impact of the headaches on the patient's life. Some standardised instruments for assessing disability and health-related quality of life seem sensitive to treatment-induced changes in primary headache patients. However, further studies to determine the suitability of these instruments as outcome measures in clinical practice are necessary.

The Use of Outcome Measures by Psychologists in Clinical Practice.

This survey investigated psychologists' use of outcome measures in clinical practice. Of the respondents, 37% indicated that they used some form of outcome assessment in practice. A wide variety of measures were used thatwere rated by the client or clinician. Clinicians who assess outcome in practice are more likely to be younger, have a cognitive-behavioral orientation, conduct more hours of therapy per week, provide services for children and adolescents, and work in institutional settings. Clinicians who do not use outcome measures endorse practical (e.g., cost, time) and philosophical (e.g., relevance) barriers to their use. Both users and nonusers of outcome measures were interested in similar types of information, including client progress since entering treatment, current strengths and weaknesses, and determining if there is a need to alter treatment. Implications for practicing clinicians are discussed.

Guide to outcomes measurement for patients with low back pain syndromes.

The Guide for Physical Therapist Practice states that the physical therapist determines the expected outcomes for each intervention and engages in outcomes data collection and analysis. Outcomes tracking provides a systematic way for therapists to monitor treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is indispensable for therapists in the outpatient orthopaedic setting, where patients with lumbar pain often comprise the majority of the caseload. The therapist must be able to evaluate and choose appropriate measurement tools and understand the clinical meaning of measurements to successfully employ these instruments. The purpose of this article is to review measurement instruments for patients with low back pain and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided with specific commentary on the use of the SF-36, SF-12, Oswestry Questionnaire, Roland-Morris Questionnaire, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.

Selecting outcomes measures in children[apos]s rehabilitation: A comparison of methods

Law M, Hurley P, Hurley D, King G, Hanna S. Selecting outcomes measures in children[apos]s rehabilitation: a comparison of methods. Arch Phys Med Rehabil 2003;84:496-9. Objective: To evaluate the effects of using a computerized self-directed software program, All About Outcomes[copy], to facilitate decisions about the most appropriate outcome measures to use in specific pediatric rehabilitation scenarios. Design: A randomized controlled trial using a crossover design to test the accuracy, time, and ease of use of the decision-making outcome software in selecting 3 potential clinical outcome measures for each of 2 clinical scenarios. Setting: The trial was conducted in a university school of rehabilitation science in Ontario, Canada. Participants: Thirty student occupational therapists and physiotherapists enrolled at the university participated in the trial. Interventions: Six clinical scenarios were created and paired into 3 sets with similar levels of difficulty. Participants were randomly assigned to select the 3 most appropriate outcome measures for 2 scenarios in 1 of the 3 sets by using the library or the software program. The order of the method of searching was randomized to control for order effect. Main Outcome Measures: Accuracy in identifying appropriate outcome measures, time for the search, ease of searching, and satisfaction with the search process were measured for all participants. Accuracy was rated by 2 independent raters who were unaware of the search method used to identify the outcome measures. Results: In comparison to the library search method, the software search method was significantly more accurate, took less time, and was rated as easier in identifying appropriate outcome measures for the clinical scenarios. Users were also significantly more satisfied with the software searching method. The accuracy of the software method was not affected by whether participants used it first or second. However, the accuracy of the library search method improved if it was used after the software method. Conclusions: Software improved the accuracy and ease of identifying outcome measures for rehabilitation students. Further research is needed to evaluate whether identifying appropriate measures leads to an increased use of outcome measures in clinical practice.

The Infants’ Dermatitis Quality of Life Index

The impact on quality of life (QOL) caused by atopic dermatitis (AD) has been quantified in children and adults using established QOL measures. However, these are not suitable for use in infants under the age of 4 years, when AD usually develops. To validate a new parent-generated QOL questionnaire, the Infants' Dermatitis QOL Index (IDQOL), which measures the impact of AD on the infant, and to provide further validation of the Family Dermatitis Index (FDI), which measures the impact of a child's dermatitis on the family. Parents of 102 predominately caucasian infants under 4 years with AD (34 postal and 68 outpatients) were asked to complete the IDQOL and the FDI on two separate occasions to test for repeat validity. The Infants' Behavioural Check List (BCL) was also given to the study group and to parents of 22 normal control infants. Post-treatment IDQOL and FDI questionnaires were obtained from 25 of the study group. The return rate for initial questionnaires was 87.3% (61 boys, 28 girls) and for retest 70.6%. The mean score for IDQOL was 7.89 and for FDI 8.87. Spearman rank correlation between the IDQOL and FDI was high (r = 0.87). Correlations of IDQOL and FDI with clinical severity assessment by parents were lower (r = 0.58 for IDQOL and r = 0.5 for FDI). Test-retest data for IDQOL and FDI confirmed repeatability, there being negligible differences between the pairs using the method of Bland and Altman. The three highest scoring questions for IDQOL referred to itching and scratching, mood change and sleep disturbance. For the FDI they were parental sleep disturbance, tiredness and exhaustion, and emotional distress. Post-treatment questionnaires from 25 patients indicated sensitivity to clinical change with both IDQOL and FDI. Parameters of behaviour measured using the BCL in 82 study infants and 22 controls showed greater problems with frequent night-time wakening (43% vs. 4.5%) and miserable mood changes (24.4% vs. 9%) in the study infants. Initial validation of the IDQOL and further validation of the FDI show good test-retest repeatability and apparent sensitivity to change with treatment. The effect on health-related QOL as measured by these methods is poorly correlated with clinical severity, confirming that QOL measures should be used in conjunction with clinical measures for global assessments of disease impact. This work requires further validation but suggests that QOL measures may be useful as outcome measures in clinical practice and research. Their simple construction allows quick and easy use, which is particularly valuable in large-scale and postal studies.

Measuring outcomes in children's rehabilitation: A decision protocol

Objective: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. Design: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. Setting: A children's rehabilitation center in a city of 50,000. Participants: All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. Intervention: Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. Outcome Measures: Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). Results: Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. Conclusions: The “All About Outcomes” software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

Getting Better: Outcome Measurement and Resource Allocation in Psychiatry

Traditionally, clinicians have been paid on the assumption that their advice or intervention helps the patient. This practice is being increasingly challenged – documented improvement is becoming a necessary condition for allocating staff or monetary resources. Traditionally, too, reputation and diplomas decorating a wall were the primary validators of a clinician's skill. Again, in an era of third party payment of health care, objective indices of patient outcome are becoming the new standard. In 1996, the first ‘Getting Better’ meeting on outcome measurement in psychiatry brought together a group of health professionals bound by a common interest, to endorse and promote the use of outcome measures in clinical practice and to shape the provision of care to improve outcomes [1]. The past two years have seen much activity in Australasia in the ‘outcomes’ area. The second ‘Getting Better’ Conference, held recently in Sydney, allowed participants to share their experience, enthusiasm and initiatives. Promine...

Statistical methods for measuring outcomes.

This issue of the journal concerns promotion of the routine use of outcome measures in clinical practice; the purpose of this particular article, however, is to warn care providers to think very very carefully before routinely using such measures. Just what are the benefits of their use? What are the outcome measures intended to demonstrate? In order to try to convince the reader that there might be real difficulties in the interpretation of the results, the main body of the paper concentrates on the difficulties in the interpretation of data from a structured research project that has been specifically designed to evaluate an innovation in mental health care provision. The difficulties of interpreting haphazardly collected data as part of routine clinical or administrative practice will be far greater. One of the main purposes of an evaluative exercise is comparison: which approach to service provision is the better? If care providers really want to be involved in mental health service evaluation then their time would be much better spent in taking part in a large multicentre trial.

Pediatric Functional Outcome Measures

This article presents a review of conceptual and methodologic issues regarding the selection of pediatric functional outcome measures in clinical practice. Selected functional outcome measures, their technical and clinical merits, and state-of-the-art advances in instrument development are described. Suggestions regarding the use of functional outcome measures for improved clinical documentation, evaluation studies, and the establishment of multi-institutional outcome studies in pediatric rehabilitation are made.