Function and Disability w/ Self-Report Outcome Tools for Pts w/ Spinal Conditions

Question 1

SRO

self-reports

3 components:

Answer 1

1. Pain
2. Functional Limits
3. Disability

Question 2

For SRO tool to have clinical utility

Psychometric props must be known:

what are they?

Answer 2

• validity→ does it measure what I want it to?
• reliability→ if I do it again w/ someone else will it tell me the same result?
• Error and accuracy
• responsiveness to change

Question 3

Using SRO’s

w/ indiv. pts

Answer 3

• @ initial visit
  
  • baseline
  • establishes goals/outcomes
• repeat @ follow-up/re-exam
  
  • monitors change (improve or deterioration
• repeat @ time of discharge
  
  • doc. outcomes following course of care

Question 4

Use of SRO’s

Assessing performance of clinics or clinicians

compare groups of pts across:

Answer 4

• facilities (loc’s)
• different PTs or teams
• Pts w/ certain dis’s or patho’s such as LBP

Question 5

Use of SRO’s

in Research Applications

Answer 5

• Pre/Post intervention measures
• Descriptive studies

Question 6

Standard Error of Measurement (SEM)

SEM (95% CB) ==>

Answer 6

Error in single day’s score

Question 7

EX. SEM of Roland-Morris

Roland-Morris SEM (95% CB)= ±3 pts

Answer 7

• Helens score on the Roland-Morris is 20pts
• Accounting for measurement of error, we can be reasonably confident that her “true score” lies b/w 17 and 23

*NOTE: when you know the SEM (95% CB), just ADD/SUBTRACT that value from the score. You can be 95% confident that their “true score” @ a given point in time lies w/in the calculated range

Question 8

Minimal Detectable Change

MDC (95% CB)

Answer 8

Used to determine clinical meaningfulness of change over time

Question 9

EX. MDC of Roland-Morris

Roland-Morris MDC (95% CB)= 5pts

Answer 9

• after 3wks of PT, Helen is again asked to complete Roland-Morris. Her score has changed and is now 13 (7 pts LESS than her score 3wks ago)
• we can be reasonably confident that Helen’s change in score reflects TRUE improvement in her status, bc it has improved by MORE than the MDC of 5pts***

*NOTE: When you know the MDC (95% CB) of a SRO tool, you can be reasonably confident that the pt has truly improved (or worsened) if their follow-up score has changed by the MDC value or more.

Question 10

Minimally Clinically Important Difference

MCID

Answer 10

• used SAME WAY as the MDC
  
  • det’s change in pts status over time
• Methodological research to det. MCID value is a bit diff than that used to det. MCD value
• IF BOTH MCD and MCID values are known, you can use either!
• Usually, the MCD and MCID values are pretty similar

Question 11

For pts w/ LBP or Disability:

Roland-Morris Questionnaire

Answer 11

see pics

Question 12

Roland-Morris Disability

Take-aways

Answer 12

0= NO DISABILITY

24= SEVERE DISABILITY

Question 13

Pts w/ LBP or Disability

Revised Oswestry

Answer 13

• 10 sections, 6 options ea.
• 0 pts for 1st option, 1 pt for 2nd option, 2pts for 3rd, etc
• Tally and multiply sum by 2
• Scale 0-100%
• 0%= NO DISABILITY
• Completion= 5mins
• Score time= 1 min

Question 14

For pts w/ Neck Pain or Disability

Neck Disability Index (NDI)

Answer 14

• 10 sections, 6 options per ea.
• 1st option= 0 pts, 2nd option=1 pt, etc..
• Sum points
• Scale: 0-50 (or, convert to %→ NOTE THIS)
• 0=NO DISABILITY
• Scoring time=1min

Question 15

Fear Avoidance Behavior Questionnaire

FABQ

Answer 15

• Not really a tool for function or disability
• More of a prognostic tool to ID yellow flags of fear or avoidance
• BUT, can be used @ follow up to see if pts are having LESS fear or LESS avoidance

Question 16

Pts w/ any type of problem:

Patient Specific Functional Scale

PSFS

Pts ID the problems!!!

Answer 16

• Pt IDs up to 5 functional acts
• Scale:
  
  • 0= unable to perform
  • 10= no diff performing
• Scoring:
  
  • calculate avg scores of items
• 3-5mins to complete

MDC for avg score= 2 pts; MDC for single item= 3 pts

Question 17

For pts w/ any type of problem

Global Rating of Change Scale

GROC

Answer 17

• Used @ time of re-exam to det. overall perception of improvement by pt
• fast & easy
• Does not req any scoring

Question 18

Issues you might run into with SRO’s

Answer 18

• Literacy (native lang.)
  
  • have Spanish versions avail.
• Health literacy
• Accurate scoring and docs of scores
• Compliance by all PTs in clinic to use consistently