Outcome Measure Unit 3

Outcome Measure
PRESENTED BY- DR. PUSHPLATA ARYA, PT

ASST. PROF.
LFAMS
Introduction
 An outcome measure is a tool used to assess a patient’s current status. Outcome measures may
provide a score, an interpretation of results and at times a risk categorization of the patient.
 Prior to providing any intervention, an outcome measure provides baseline data. The initial
results may help determine the course of treatment intervention.
 Once treatment has commenced, the same tool may be used in serial assessments to determine
whether the patient has demonstrated change.
 With the move towards Evidence Based Practice (EBP) in health care, outcome
measures provide credible and reliable justification for treatment on an individual
patient level.
 The results from outcome measures may also be grouped for aggregated analysis
focused on determining quality of care. When outcome measures are used in an
aggregated data situation to compare results, a risk adjustment process is required
to fairly compare results.
Classification
 Outcome measures that we use in clinical practice are divided into four categories:
 Self-report measures
 Performance-based measures
 Observer-reported measures
 Clinician-reported measures
 Self-report measures are typically captured in the form of a questionnaire. The questionnaires are
scored by applying a predetermined point system to the patient's responses.
 Although self-report measures seem subjective in nature, self-report measures objectify a
patient's perception.
 Historically, the questionnaires required that either a therapist interviewed the patient or the
patient independently completed the questionnaire.
 Self-report outcome measures that use paper and pencil for completion are considered a fixed-
form questionnaire. Computer based or electronic self-report measures are available.
 Electronic measures may be fixed-form or adaptive. Computerized adaptive testing is a method
of testing that determines the questions for a response based on the patient's previous responses.
 The questionnaires where the patient reports on health or physical function are known as patient-
reported outcomes (PRO).
 PROs can be categorized as disease specific or generic. PROs have been defined as "any report of
the status of a patient's health condition that comes directly from the patient, without
interpretation of the patient's response by a clinician or anyone else."
 Performance-based measures require the patient to perform a set of movements or tasks. Scores
for performance-based measures can be based on either an objective measurement (e.g., time to
complete a task) or a qualitative assessment that is assigned a score (e.g., normal or abnormal
mechanics for a given task).
 Performance-based measures and patient reported measures both capture a current status.
 These measures do not typically equate with each other. Performance-based measures tend to
bring to light physiologic factors. Patient reported outcome measures may capture a patient's
perception, beliefs, social factors and/or health factors.
 Observer-reported measures are measurements completed by a parent, caregiver
or someone who regularly observes the patient on a daily basis.
 Clinician-reported measures are measurements that are completed by a health care
professional. The professional uses clinical judgement and reports on patient
behaviors or signs that are observed by the professional.
Statistical Analysis
 Important features of an outcome measure that need to be taken into account when using an
outcome measure are its psychometric properties. Psychometric properties are the intrinsic
properties of an outcome measure. Ideally, the psychometric properties of an outcome
measure used in practice should have been developed and tested through a series of research
studies.
 These properties include validity, inter-rater reliability, intra-rater reliability, responsiveness,

ceiling effects, floor effects and minimal clinically important difference. Validity refers to the
how accurately the test actually measures what it is supposed to measure. High validity means
the measure is consistently stable in its ability to measure its intended focus.
 Inter-rater reliability takes into consideration the consistency of the results of the measure
when two different people are evaluating the results of a common subject. With performance-
based measures, if two physiotherapists scored the performance, high inter-rater reliability
would mean that both determined similar scores on the performance evaluated
 For patient reported outcome measures, a high intra-rater reliability indicates that the patient
consistently responds to attain the same results. (This would be more relevant with serial testing
and no intervention or change in status.
 Intra-rater reliability falls under test-retest reliability.) Responsiveness refers to the ability for the
measure to be able to capture change in status. Ceiling effect occurs when the majority of patients
are able to complete the measure and score within the highest range of the measurement.
 (The test is too easy and is not capturing their full capability.) Floor effect occurs
when the majority of the patients score within the lowest range of the
measurement. (The test is too hard and does not have enough easier items to
distinguish varying levels of status.) When determining if change is relevant, the
p-value has no value.
 For outcome measures, the clinician needs to know the minimal important
difference. Minimal important difference refers to the amount of change that is
relevant from the patient's perspective
Clinical Meaningfulness of an Outcome Measure
 Outcome measures must be valid and reliable and assist us in interpreting change

in our patients to have clinical meaning.
 Clinical significance/meaningfulness is the practical importance of a treatment
effect—whether it has a real genuine, palpable, noticeable effect on daily life.
 Clinical meaningfulness generally refers to an outcome measure’s ability to
provide the clinician and the patient with consequential information. It is a broad
term which is usually described in the following terms for an outcome measure:
 Floor and Ceiling Effect
 Minimal Detectable Change (MDC)
 Responsiveness
 Minimal clinically important difference (MCID)
Clinical Utility of an Outcome Measure
 Choosing appropriate outcome measures for your patients is critical to

understanding their status and progress over time
Guide to Selecting Outcome Measures

The following questions are intended to guide clinicians in selecting the correct outcome measures for their patients
Why Am I Using the Outcome Measure?
 Identifying the impact of a disorder on an individual?
 Establishing a baseline measure from which to monitor changes over time?
 Evaluating the impact of an intervention?
Evaluating the needs of those attending a service?
 What Am I Aiming to Measure?
 Impairments of body structure and function?
 Activity limitations?
 Participation restrictions?
 Quality of life?
 Have the Clinimetric Properties of this Tool Been Measured in a Population
Similar to Mine? Consider:
 Do the study samples have the same condition?
 Is the study sample similar in disease severity?
 Is the study sample similar in disease-specific factors?
 Is the Outcome Measure Reliable?
 Do I know the rate of error detected with scores?
 Do I know the minimum detectable change?
 Is the Outcome Measure Valid?

 Does it measure what I want it to measure?
 Is the Outcome Measure Responsive to Change?
 Is there a known minimum clinically important difference?
 Financial Considerations
 What is the cost of this test?
 Is a licence required?
 Is equipment required?
 Therapist Implementation
 Is the measure easy for a clinician to conduct?
 Is special training required/available?
 Are there clear standardised instructions on how to carry out and score the measure?
 How long does it take to carry out the measure?
 How long does it take to record results?
 Resources
 Is special equipment or are special forms required?
 Is space sufficient for this measure to be carried out?
 Client
 How much time does it take for the person to complete?
 Is the task difficult?
 Is privacy required?
 Patient-Reported Outcome Measures (PROM)

 Is face-to-face contact required or can this measure be completed in the waiting room?
 Does the questionnaire cover sensitive personal issues?
 Is there a specific reading level required?
 Is the measure available in other languages?
 References
↑Iansek R, & Morris ME (Eds.) (2013). Rehabilitation in movement disorders. Cambridge University Press.
Thank You….

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Outcome Measure

PRESENTED BY- DR. PUSHPLATA ARYA, PT

 These properties include validity, inter-rater reliability, intra-rater reliability, responsiveness,

 Outcome measures must be valid and reliable and assist us in interpreting change

 Choosing appropriate outcome measures for your patients is critical to

 Is the Outcome Measure Valid?

 Patient-Reported Outcome Measures (PROM)

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