Standard Outcome Measures

Problems

• Rehab recommendations sometimes questioned due to assessments’ high degree of subjectivity

• If legitimate need for update, same provider not always available

• Condition changes between admission and discharge

Goals

• Concrete, objective evidence for decision making

• Clarity regarding functional status

• Modify discharge disposition based on repeat of measure, or project discharge plan based on score

Standardized Measures

• Objectify decision making

• Reproducible

• Pinpoint specific limitations- CTSIB

• Estimate Fall Risk• Independence = 0% Risk?

Acute rehab vs. SNF

• If we demonstrate objectively that a patient is appropriate for acute-level rehab, more patients who need that service should be accepted

• Tests to predict activity tolerance?• Most are higher level i.e. assess COPD impact

• Room for improvement

On the fence

• If we aren’t completely sure about discharge disposition• Cases where patients have some support

• Deficits unclear

• Possibility of significant change in condition during acute stay

• Cases where patients refuse STR; quantify fall risk

Frequent Flyers

• If patients return, we can repeat test instruments to quickly compare function/ assess changes

• Case managers can refer to rehab evaluations from prior admit to determine discharge plan early on

Balance/ Fall Risk

• Berg Balance Scale

• Tinetti

• Timed Up and Go (TUG)

• Five Times Sit to Stand (LE strength)

• Four-Step Square Test

Gait

• 2 min walk test

• 10 meter walk test

• Gait Speed

• Functional Gait Analysis

• Dynamic Gait Index

• Measuring distance

Functional Status

• Acute Care Index of Function

• Function in Sitting Test

• Activity Measure for Post Acute Care (AMPAC)

• Barthel Index

• FIM

Cognition

• Mini Mental State Exam

• MoCA

• _____________

ACIF

• All items are already part of acute assessment

• No threshold score

• Good reliability

• Subscales for • Mental Status

• Bed Mobility

• Transfers

• Ambulation (gait or wheelchair)

AMPAC- Short Form

• 6 items, already part of assessment

• “How much difficulty does the pt have…”• Sit <> Stand

• Unable

• A Lot

• A Little

• None

• “How much help does the pt need…”• Walking in hospital room

• Total

• A Lot

• A Little

• None

AMPAC Metrics

• 24 = highest functioning, 6 = lowest

• 20.1 = Home

• 17.9 = Home with home care

• 14 = SNF

• 13.6 = IRF

• 11.5 = LTAC

• Also used for G-Codes/ CMS Modifier

Berg

• Extensively studied for prediction of fall risk

• Many items are already part of assessment

• Short Berg“The 7-item BBS-3P measure has sound psychometric

properties and practical utility for use with people who have had a stroke. The 7-item BBS-3P, therefore, is suggested for use in people with stroke in both clinical and research settings.”

Short Berg

• Reaching Forward

• Eyes Closed Standing Unsupported

• Tandem Stance

• Unilateral Stance

• Turning to Look

• Object Retrieved from Floor

• Stepping Reciprocally to a Stair

Chiu et al.

Timed Up and Go

• 13.5 sec

• 30 sec

Functional Reach

• For “Frail Elderly”• < 18.5 cm indicates fall risk

• For “Community-Dwelling Elderly”• < 7” means

• Unable to leave neighborhood without help

• Limited in mobility Skills

• Most restricted in ADLs

Four Step Square Test

• Quick test; < 5 min

• Simulates negotiation of environmental obstacles

• For geriatric population: > 15 sec = at risk for multiple falls

• Useful for patients resistant to STR

5x Sit to Stand

• > 15 sec = risk of recurrent falls

Psychometric Properties

• Populations tested

• Standard Error of Measurement

• Minimal Detectable Change

• Minimal Clinically Important Difference

• Cut-off Scores

• Norms

Psychometric Properties

• Test-retest reliability

• Intrarater, Interrater reliability

• Criterion Validity

• Professional Association Recommendations

• All on rehabmeasures.org

Improvising

• Measured parameters for gait• Time to walk x distance

• Distance walked in x seconds

• Cadence: i.e. 8 steps in 10 seconds

• For balance• Inches shifted from midline

• Maintain sitting at midline x 30 sec with CTG

• Perturbations tolerated

• Romberg

Some Standards

• Shumway-Cook: Community Distance = 150’

• Gait Speed: < 0.57 m/s associated with falls/ predictor of disability ( slower than 32 ft. in 10 sec.)

• Change in Gait Speed: Decline > 0.15 m/sec/year is predictive of falls (Quach et al. MOBILIZE study)

ICU

• Determine when patients appropriate for mobilization

• FSS-ICU

• PFTI-s

Time

• Some tests are time-consuming• Some have shorter versions• We can still use parts as objective measures

• We should identify opportunities where using them will:• Improve patient care• Save time compared to alternatives• Facilitate better communication with team, family• Help determine if both disciplines should consult

on a patient

Resources

• Rehabmeasures.org• Also has specificity/ sensitivity, validity data

• APTA.org

• Ptnow.org

• Acutept.org