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OT Outcome Measures
5
Outcome Measures
OT Stroke Rehab
Aims for Today
Aims
- Discuss the importance of Outcome measure
- Discuss the difficulty with using outcome measures in Stroke Rehab
- Have a brief look at some outcome measure we are currently using in the team
- Explore potential outcome measures that we could use in the future
Outcome measures in Stroke Rehab
Intro
Very important:
- Monitor change
- Prove effectiveness
- Facilitate research
- Adhere to health and social care guidelines
Katherine Salter PhD (cand.), Nerissa Campbell PhD, Marina Richardson MSc, Swati Mehta PhD (cand.), Jeffrey Jutai PhD, Laura Zettler MSc, Matthew Moses BA, Andrew McClure MSc, Rachel Mays BSc (cand.), Norine Foley MSc, Robert Teasell MD
Outcome measures in Stroke Rehab
Challenges
Not as simple as it sounds
Roughly, can be splint into:
- Upper limb
- Lower Limb
- Vision
- Cognition
- Communication
Many domains = many measures
OT specific measure are few and far between
Currently Used OM
- There are currently hundreds of outcome measures which can be used in Stroke and Stroke rehab.
- As a team we already use many of them.
- A good doc for overview and review:
http://www.ebrsr.com/sites/default/files/Chapter%2020_Outcome%20Measures.pdf
Outcome Measures
Barthel's Index
- Well known / well established
- Good evidence base
- Majority of research conducted from 60-80's
- More recent research focuses on translating the measure / using it with different population groups.
Barthel's
Index
Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Medical Journal 1965;14:56-61. Used with permission. Loewen SC, Anderson BA. “Predictors of stroke outcome using objective measurement scales.” Stroke. 1990;21:78-81.Gresham GE, Phillips TF, Labi ML. “ADL status in stroke: relative merits of three standard indexes.” Arch Phys Med Rehabil. 1980;61:355-358.Collin C, Wade DT, Davies S, Horne V. “The Barthel ADL Index: a reliability study.” IntDisability Study.1988;10:61-63.
Using the measure:
Cross-sectional = snapshot of what the patient can do now
The need for supervision renders the patient not independent
Middle categories imply the patient contributes over 50% of the effort
FYI
Kessler Foundation Neglect Assessment Process
TM
KF-NAP
- Catherine Bergego Scale (free)
- KF-NAP = developed to provide a detailed description on how to administer the CBS = standadised (not free)
- 18-64+
- 15-45 mins
Peii Chen, PhD et al. Kessler Foundation Neglect Assessment Process Uniquely Measures Spatial Neglect during Activities of Daily Living. Archives of Physical Medicine & Rehabilitation, February 2015 DOI: 10.1016/j.apmr.2014.10.023
How is it done:
Assessment
10 items scored from 0-3
Items:
- Gaze orientation
- Limb awareness
- Auditory attention
- Personal belongings
- Dressing
- Grooming
- Navigation
- Collisions
- Meals
- Cleaning after meals
Shirley Ryan, 2019. CBS [Internet]. Available from https://www.sralab.org/rehabilitation-measures/catherine-bergego-scale-kessler-foundation-neglect-assessment-process. Accessed 08/07/2020
Scoring
0 = No neglect
1 = Mild neglect (patient will cross midline after one side is attended to first
2 = Moderate neglect (with clear and consistent side omission
3 = Severe neglect
Scoring
0-10 = mild behavioural neglect
11-20 = Moderate behavioural neglect
21-30 = Sever be behavioural neglect
Shirley Ryan, 2019. CBS [Internet]. Available from https://www.sralab.org/rehabilitation-measures/catherine-bergego-scale-kessler-foundation-neglect-assessment-process. Accessed 08/07/2020
Would it be useful for us?
Evidence
- Lots of studies stating its reliability and validity, but these were all completed by the same people and sponsored by the Kessler Foundation
- Suitability for our patients?
- Can all tasks be completed in acute environment?
- "Free to use". Training would set you back £127.
- Application of the results?
- Sensitivity to change
To Summaries
Summary
Outcome measures are useful and needed in everyday practice
Selecting the right outcome measures can be difficult
The Barthel's Index was discussed with attention drawn to small details to help us use it more accurately
The KF-NAP was discussed as well as its suitability to our team