Category: Physical Therapy

For over a decade, physical therapists have been urged to use standardized outcome measures the management of patients.  Standardized outcome measures are tools that survey how a patient can perform certain activites.  The tools give the therapist a quatitative way to assess a level of disability and clear ways to track progress.  Many tools have been developed by investigators and education about the measures is an integral part of physical therapist curriculum.  The tools are theorized to improve clinician decision making, improve patient safety, and improve the ability to describe patient progress over time.  Interestingly, they have never been equivocally demonstrated in any sort of controlled trial to improve outcomes that I'm aware of.  Regardless, there are many good reasons to use these tools, but many physical therapists tend not to use them.  The February issue of Physical Therapy Journal includes a nice paper which conducted a survey to assess exactly how many do use the surveys, and why or why not they may do so.

The study, from the University of Vemont's Dr. Diane Jette, sampled 1000 APTA members asking about their usage and beliefs about standardized outcome measures. 

Overall, slightly less than 50% of physical therapists reported using the measures.  Of the 52% that reported not using outcome measures, only a small portion reported they intended to use them in the future.  Not exactly widespread use!

Percieved Problems

Physical Therpapists reported that the biggest problems with outcome measures were that they took too long to fill out, were confusing or too hard for patients to fill out.  There were also patterns among practice setting, patient age, and clinical specialization, with those who had obtained clinical specialization 2 times more likely to use outcome measures.

So, it might seem that we have clinical specialists treating patients with muscuoloskeletal complaints using these at a higher rate.  Overall, 90% of the therapists who employed outcome measures found them to improve communication.  But still, they are not widely used.

The problems reported seem to be patient-centered in nature and also related to clinic management to install processes for easy adminstration of the measures.  One might surmize that well-intended therapists are simply having problems employing these tools versus not percieving value in their use.  

It can be difficult to decide which ones to use, and managerial support for this might help drastically.  Perhaps automating the completing and scoring in easy to use electronic formats could also help.  This study indicated than only 7% of those who used surveys used computers to complete or score the measures.

Finally, one last bit of interesting data from this survey was the fact that quite a few therapists used "home-grown" or departmentally developed outcome measures.  This seems a little surprising given the vast quantity of validated and tested outcome measures freely available.  I'm interested to learn if those home-grown measures might be easier for everyone to fill out?

If outcome measures are going to be utilized, they need to fit into the busy clinic schedule, be simple to fill out and score, and therapists need to be well-educated in their use and value.  As the authors so politely concluded, "physical therapists have some distance to go in implementing their use routinely in most clinical settings."  For sure!

ERIC

D. U Jette, J. Halbert, C. Iverson, E. Miceli, P. Shah (2008). Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications Physical Therapy DOI: 10.2522/ptj.20080234

Back pain is a real problem in the United States.  Many people have it and many people end up suffering needlessly with chronic low back pain.  I say needlessly because most back pain is easily remedied, most, in fact, gets better on its own.  But, most people recieve over-agressive care in the form of drugs, surgery, and expensive imaging.  This helps contribute to a widespread misunderstanding about low back pain and creates an environment which enables disability from low back pain.

The other day the LA Times had a feature piece by Amber Dance on low back pain.  Quite a few physical therapists I know got excited about the article, as it showed the profession in a positive fashion.  Go click here and read the article.  How many times did you see any mention of physical therapists?  Twice?  In passing?  

"When you do magnetic resonance imaging or computerized tomography scans of the spine, you sometimes see horrible things in normal people," Deyo says. One-fourth of people under 60 have a herniated disc, he says, and half have a bulging or degenerated disc. "And yet these are people who have no back pain."

The other goat grabbing portion of this option had to do with the lack of focus on physical therapists. Physical therapists are a key cog in the arena of low back pain care, yet were underrepresented in the article.  There are litterally thousands upon thousands of orthopaedic physical therapists, and far and away, the most common diagnosis we see is for low back pain.  It drives the profession in many ways.  We have a lot of work to do to be recognized by the general public for the work we do with back pain.