Neurologic outcome tools handout Lanzino -...
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Neurologic Outcome Tools: So many measures, so little time November 2013 MNPTA 2013 Fall Conference, Duluth, MN 1 Desiree J Lanzino, PT, PhD Assistant Professor Program in Physical Therapy Mayo Clinic College of Medicine [email protected] So many measures, so little time Neurologic Outcome Tools November 2013 Objectives Debate the issues to consider when choosing an outcome tool.
Transcript of Neurologic outcome tools handout Lanzino -...
Neurologic Outcome Tools: So many measures, so little time
November 2013
MNPTA 2013 Fall Conference, Duluth, MN 1
Desiree J Lanzino, PT, PhDAssistant Professor
Program in Physical TherapyMayo Clinic College of Medicine
So many measures, so little time
Neurologic Outcome ToolsNovember 2013
Objectives
Debate the issues to consider when choosing an outcome
tool.
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Objectives
Debate the issues to consider when choosing an outcome
tool.
Define psychometric properties used in research to identify appropriate tools for the neurologic population
Objectives
Debate the issues to consider when choosing an outcome
tool.
Define psychometric properties used in research to identify appropriate tools for the neurologic population
Confidently administer outcome measures that assess multiple components of the ICF and in
patients with various neurologic injuries.
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Objectives
Debate the issues to consider when choosing an outcome
tool.
Define psychometric properties used in research to identify appropriate tools for the neurologic population
Confidently administer outcome measures that assess multiple components of the ICF and in
patients with various neurologic injuries.
4 Apply outcome tools to appropriate case scenarios.
What are the issues that affect your choice of outcome measure?
Take 5 minutes to talk about this with your neighbors
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Issues:
Potter et al JNPT 2011;35:57‐64
• What?• When?• Where?• Who?• Why?• How?
What?
Issues:
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What?ICF categories
Issues:
?
3 levels of human function:
Body function / structure
Activities
Participation
Contextual factors:
Environment&
Personal
When?
Issues:
?
3 levels of human function:
Body function / structure
Activities
Participation
In‐patient
vs.
Out‐patient
Contextual factors:
Environment&
Personal
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Where?
Issues:
?Site limitations:• Mandated tools• Time• Space• Equipment• Tool availability, cost• Knowledge
Who?
Issues:
?• Age?• (Neurologic) Diagnosis?
• Generic measure or disease‐specific measure?
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Who?
Issues:
• Age?• Diagnosis? • Acute vs. Chronic?
• Change over time
Who?
Issues:
• Age?• Diagnosis? • Acute vs. Chronic?• Low‐level vs. high‐level?
• Watch out for floor effects
• Watch out for ceiling effects
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Who?
Issues:
• Age?• Diagnosis? • Acute vs. Chronic?• Low‐level vs. high‐level?• Language intact?
• Yes: Self‐report or performance‐based measures
• No: Proxy for self‐report measures? Ability to follow directions for performance‐based measures?
Who?
Issues:
• Age?• Diagnosis? • Acute vs. Chronic?• Low‐level vs. high‐level?• Communicative or non?• Limiting co‐morbidities
• Ex: Dementia
• Performance‐based > self‐report measures
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Who?
Issues:
• Age?• Diagnosis? • Acute vs. Chronic?• Low‐level vs. high‐level?• Communicative or non?• Limiting co‐morbidities• Culture/language
Why?
Issues:
?Identify / diagnose /
discriminate?
Predict?
Evaluate?
Barak & Duncan NeuroRx 2006;3(4):505‐524
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Why?Identify
Issues:
?
Suspect cognitive
impairment
Mini‐Mental State Exam or
Montreal Cognitive Assessment
Why?Predict
Issues:
?Suspect fall
risk
BERG
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Why?Evaluate
Issues:
?Balance
intervention
BERG
How?
Issues: What, When , Where, Who, Why
?Outcome measures
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Knowing what, when, where, who, & why will help to identify appropriate outcome measures
Bottom line.
What psychometric properties are important to consider?
Sullivan et al JNPT 2011;35:55‐74Hobart J Neurol Neurosurg Psychiatry 1996;60(2):127‐130
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What questions might you have?
Is the tool valid?
Does the tool measure what I want
it to measure?
What questions might you have?
What if the same therapist will not be completing both the initial and discharge
evaluations?
Minimum Detectable Change:
Large enough that the change is not due to error/variance
Is the tool reliable?
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What questions might you have?
Cut‐off scores,Normative data
What does the score mean?
What questions might you have?
Minimal Clinically Important Difference:
Change in score signifies a meaningful improvement in
my patient.
How will I know if my treatment
worked?
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Bottom line.
Has it been used before in the way I want to use it and will it tell me what I want to know?
Administer tools!
With confidence!
Which ones????
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So many measures, so little time!
• Those tools that can be applied over multiple (neurologic) patient types
• Free to use
• Require no training
• Cover 3 levels of human function (ICF)
PT Now: http://www.ptnow.org/FunctionalLimitationReporting/TestsMeasures/Default.aspx
Resources: Recommended tests
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Some of the measures most frequently mentioned across diagnoses:
• 5XSTS (Vestib, CVA, PD)
• BEST (Vestib, PD, TBI)
• Funx Reach (all except SCI)
• BERG
• 4 Sq step test (Vestib, TBI, MS)
• 6 min walk (all except vestibular)
• 10 M walk (all except MS which has a timed 25 foot walk)
• TUG (all except PD)
• DGI (all except PD)
• Funx gait assessment (TBI, Vestib)
• Rivermead mobility index (MS, TBI)
• ABC [MS, TBI, Vestib, CVA (not acute)]
• DHI (MS, TBI, Vestib)
• Satisfaction with life scale (TBI, SCI)
(Bsf)Act
BsfAct
Act
Act
Act
Act
Act
Act
Act
Act
Act
Act
BsfPart
Part
PT Now: http://www.ptnow.org/FunctionalLimitationReporting/TestsMeasures/Default.aspx
Resources: Recommended tests
APTA Neurology section outcome measures recommendations:http://www.neuropt.org/professional‐resources/neurology‐section‐outcome‐measures‐recommendations
Stroke PDMS VestibularTBISCI
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Rehab Measures Database:http://www.rehabmeasures.org/rehabweb/links.aspx
Stroke Center: http://www.strokecenter.org/profess
ionals/stroke‐diagnosis/stroke‐assessment‐scales/
National Multiple Sclerosis Society:http://www.nationalmssociety.org/ms‐clinical‐care‐network/researchers/clinical‐study‐measures/index.aspx
Resources: Instrument Databases
Rehab Measures:http://www.rehabmeasures.org/default.aspx
Resources: Instrument summaries
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Administering outcome tools
Practice
Application
Patient cases
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Acute CVA, moderate impairment
•
Acute CVA, minimal impairment
•
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In‐patient rehabilitation, CVA
•
Out‐patient
• CVA
• MS
• SCI
• TBI
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Summary• Define the what, when, where, who, & why
– To help determine the “how” (measure to use)
• Use available resources to examine outcome psychometric properties
• Build your “tool portfolio” one patient (type) at a time
• Collaborate!
– Live, learn, share
