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Good Practice: Outcome Measurement

What can I possibly say about outcome measures that hasn’t been said before? The truth is that nothing has really changed when it comes to the importance of gathering outcome measures data since I started work as a physiotherapist in 1995. But are we using outcome measures in practice? Really? And are we able to consistently demonstrate that what we are doing is making a difference to the health of Albertans? Not just a difference between how they feel walking into physiotherapy and walking out an hour later but a real, lasting difference? Sadly, I don’t think we are doing a good job of demonstrating our impact, but now more than ever we need to do so in a clear, measurable, irrefutable manner.

As the saying goes, the best time to start was 20 years ago, the second-best time is today.

In my role, I often have the opportunity to attend presentations and conferences and the one thing that has consistently struck me about the presentations I’ve attended was that every speaker whether an academic or clinician has talked about their outcomes. They didn’t just talk about patient satisfaction, and they weren’t using a single measure to demonstrate their effect. Consistently, speakers are able to show data about the programs they are associated with and the multiple tools that they use to demonstrate their effectiveness and the difference they make to their patient’s lives.

A few years ago, I had the opportunity to meet and speak with Katherine Berg (yes, as in the Berg Balance Scale!) It was quite the thrill to meet someone from our profession who was involved early in the development of outcome measures relevant to physiotherapists and patients. She was in Alberta to speak about another tool that she has been involved in developing and refining, the interRAI. This is a tool that has been commonly used in our healthcare system when determining appropriate living arrangements for people who cannot return to their prior living environment. I was surprised to learn that many of subscales of the interRAI correlate closely to more traditional physiotherapy-related outcome measures such as the Functional Independence Measure (FIM) when it comes to detecting clinically relevant changes1 and measuring the effectiveness of treatment.2

Her key message to physiotherapists was to use big data; universal data sets that are common across disciplines to show our impact. Talking about the change on a Berg Balance Scale is great, if you work in isolation, but as soon as you work as part of a multidisciplinary team the outcomes that you collect need to be relevant and transparent to other members of the team. By using common language and common measurement tools we can demonstrate patient improvement and link that change to the treatment provided or other improvements in care delivery.

Even if you do work in isolation, showing an impact is important for patients and for payers. Those impacts must be relevant to the patient. It seems to me that it doesn’t matter much if the patient changes three points on an outcome measure score unless they perceive an important change in their condition or ability to function. Most well-developed outcome measures have an associated Minimal Clinically Important Difference (MCID) that will give you an indicator of how much change is required to make “a difference in the life of the patient.”3 Clinicians need to be aware of both the outcomes they measure and the MCID of the tools they are using.

Research suggests that early access to physiotherapy services leads to improved patient satisfaction, better functional outcomes5,6,7 and, in some cases, may decrease the need for more costly and invasive interventions. Other research shows that when physiotherapists are used to triage musculoskeletal injuries there are lower costs to the system, fewer inappropriate tests ordered and similar or better patient outcomes.8,9,10 The problem is that these findings are research-based. We don’t know if those findings hold true in a real-world clinical environment. This means that we don’t know what services and models of care are the best investments for our limited health-care dollars. Don’t you want to know? Having a robust, physiotherapy-specific clinical data set and consistently using that data set to guide patient care decisions at both the bedside and system level is an incredibly powerful tool when considering innovative physiotherapy service delivery models of the future.

Of course, the best thing would be if we had 20 years of data. Second best is to start today. By consistently collecting and comparing patient data to identify better ways of caring for patients we can make data-driven decisions about health care delivery and system design, making better use of limited health care resources now and in the future. Let’s not wait another 20 years to start collecting that data!

  1. Glenny C, Stolee P, Husted J, Thompson M, Berg K. Comparison of the responsiveness of the FIM and the interRAI post acute care assessment instrument in rehabilitation of older adults. Arch Phys Med Rehabil. 2010; 91:1038-1043.
  2. Glenny C, Stolee P, Thompson M, Husted J, Berg, K. Underestimating physical function gains: comparing FIM motor subscale and interRAI post acute care activities of daily living scale. Arch Phys Med Rehabil. 2012; 93:1000-1008
  3. Law M, MacDermid J. Introduction to evidence-based practice. Evidence-based rehabilitation: A guide to practice. Thorofare: SLACK Incorporated. 2008.
  4. Canadian Physiotherapy Association Focus on therapeutic outcomes (FOTO): CPA’s national outcome measures database, powered by FOTO. Available at: http://www.physiotherapy.ca/Practice-Resources/Outcome-Measures/FOTO Accessed on May 14, 2015.
  5. Wand BM, Bird C, McAuley JH, Dore CJ, MacDowell M, De Souza LH. Early intervention for the management of acute low back pain. Spine. 2004; 29 (21): 2350-2356.
  6. Zigenfus GC, Yin J, Giang GM, Fogarty WT. Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. Journal of Occupational and Environmental Medicine. 2000; 42(1):35.
  7. MS Australia. Strength and cardiorespiratory exercise for people with multiple sclerosis (MS). MS Practice for Health Professionals. n.d. Available at: http://www.msaustralia.org.au/sites/default/files/strength.pdf  Accessed on May 20, 2015.
  8. Sutton M, Govier A, Prince S, Morphett M. Primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study. Journal of Physiotherapy. 2015; 61: 77-80.
  9. Canadian Physiotherapy Association. The value of physiotherapy: Musculoskeletal conditions. Available at: http://www.physiotherapy.ca/getmedia/ccbbd054-8ff4-4d45-af75-96a9133caf49/CPA_TheValueOfPhysio2012_Musculoskeletal-v1.pdf.aspx Accessed on May 20, 2015.
  10. Canadian Physiotherapy Association. The value of physiotherapy: Stroke. Available at:  http://www.physiotherapy.ca/getmedia/63b49e56-5fc4-42fd-a86f-93faa772e957/CPA_TheValueOfPhysio2012_Stroke-v1.pdf.aspxv  Accessed on May 20, 2015

Page updated: 25/04/2022