Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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26.1 Outcomes in orthopaedic clinical practice
Table of Contents

PATIENT-REPORTED OUTCOME MEASURES - FRAMEWORK, PSYCHOMETRICS, AND USES

Abstract:

This monograph discusses the framework, psychometrics, and uses of patient-rated outcome measures in orthopaedic physical therapy and sets the stage for the remaining monographs in this 6-monograph Independent Study Course (ISC). In particular, this monograph provides a general overview of orthopaedic physical therapy outcomes assessment, compares and contrasts patient- rated and performance-based outcome measures, and discusses various classifications of patient-rated outcome measures. This monograph also reviews the basic psychometric properties associated with the assessment of patient-rated outcome measures including reliability, validity, responsiveness, and floor and ceiling effects. Additionally, this monograph will discuss issues related to the daily use of patient-rated outcome measures in orthopaedic clinical practice and present emerging topics such as item-response theory (IRT), computerized adaptive testing (CAT), and the Patient-Centered Outcomes Research Institute (PCORI).

Keywords:​

responsiveness, performance, effectiveness

References:​

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PERFORMANCE-RATED OUTCOME MEASURES - FRAMEWORK, PHYCHOMETRICS, AND USES

Abstract:

This monograph discusses specific applications and interpretations of functional performance tests for orthopaedic physical therapy. Discussion includes assessment of key comparisons with patient-reported outcomes, and specific indications for the use of functional performance tests. Limitations and recommendations for use are described. Explanation of key psychometric properties includes understanding their presentation in the literature, as well as utilization in screening, diagnosis, prognosis, and assessment of treatment effects. Six examples using functional performance tests for assessment of treatment effect were drawn from the research literature. The section includes a description of the intervention, interpretation of the use and results of the functional performance test, and a description of the psychometric properties of the measure. Body regions assessed include the lumbar spine, knee, shoulder, and ankle; constructs assessed include balance, strength, endurance, power, and motor control.

Keywords:​

responsiveness, performance, effectiveness

References:​

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LOWER EXTREMITY OUTCOME MEASURES

Abstract:

There are a variety of outcome measures that can be used to measure treatment effect, guide the progression of an intervention, or measure baseline status of patients with lower extremity pathology. In this monograph, we will cover some of the most useful and validated tools for patients with lower extremity dysfunction. In particular, we will differentiate between performance-based measurements and patient-reported outcomes. We will also describe general measures of function, joint-specific measures, and outcome measures that are better suited for older versus younger, athletic patients. By the end of this monograph, the reader should be able to identify the most useful tool to quantify outcomes based on the patient’s age, activity level, and location of pathology. The benefits and limitations of using outcome measures in a clinical setting are highlighted in two case studies, one pertaining to a 23-year old female with ankle pain and the other pertaining to a 44-year-old active woman who underwent total hip replacement.

Keywords:​

performance measures, questionnaires, functional ability, mobility tests

References:​

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UPPER EXTREMITY OUTCOME MEASURES

Abstract:

Patient-rated outcome measures and performance measures for the upper extremity can be used to assess patient function and disability, facilitate treatment decision- making, and improve quality and outcomes of care. In this monograph, we will cover the most commonly used and validated tools for patients with upper extremity dysfunction. Specifically, patient-rated measures are presented for the categories of upper extremity joint specific, region specific, condition specific (shoulder, elbow, wrist, and hand) and performance-based measures. The goal of this monograph is to educate the reader, to enable the selection and use of outcomes tools in clinical practice. By the end of the monograph, the reader should be able to select the appropriate outcomes assessment tool based on a patient’s condition and the clinimetric and psychometric properties of the tool. As a clinician, the ability to properly select and implement patient-rated outcomes will allow for the assessment of the quality of care provided, establish improvement initiatives to improve care, and provide a benchmark to national standards and evidenced-based reports of outcomes.

Keywords:​

function, performance, effectiveness

References:​

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PATIENT SELF-REPORT OUTCOME MEASURES FOR INDIVIDUALS WITH SPINE CONDITIONS

Abstract:

Spinal pain is responsible for significant individual morbidity and is a burden to society. These factors combine to make spinal pain a common reason for patients to seek care from a physical therapist. Evidence-based guidelines advocate the use of patient self-report measures to assess disability throughout an episode of care. Valid and reliable patient self-report measures could assist in obtaining a patient history, provide a basis for establishing prognosis, determine functional improvement potentially associated with treatment provided, and indicate the nature of an intervention plan. Clinimetrically credible patient self-report measures also are important to the integration with electronic health records and benchmarking best practices in physical therapy. The purpose of this monograph is to discuss patient self-report outcome measures that assess functional status under cross-sectional and longitudinal conditions in patients with neck and low back pain. Conceptual foundations in patient functioning and disability, clinimetric test properties, and current evidence regarding specific questionnaires will be discussed.

Keywords:​

measurement properties, disability, neck pain, low back pain

References:​

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MEASURES OF COGNITION AND AFFECT

Abstract:

This monograph discusses the importance of assessing aspects of cognition and affect in patient care. Brief descriptions are given for some of the explanatory models for cognition and affect in health behavior change. Characteristics of cognition and affect are then described including anxiety, depression, fear, kinesiophobia, catastrophizing, self-efficacy, coping, motivation, resilience, and quality of life. A discussion is included regarding the advantages and disadvantages of using outcome measures related to cognition and affect. The monograph includes summative tables of some of the more common and established assessment tools for each of these characteristics. Two case studies are presented to review some of the important points regarding assessing cognition and affect. Each case reviews the decision making into outcome tool selection and the interpretation of the outcomes.

Keywords:​

psychobehavioral, outcome measures, screening tools, psychometric properties

References:​

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Outcomes in Orthopaedic PT Practice

This course provides a comprehensive review of commonly used outcome measures in physical therapy practice today.

Academy of Orthopaedic Physical Therapy
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