Selecting Rehabilitation Outcome Measures: Applying the Findings of the Apta Msedge Task Force

Thursday, May 29, 2014
Trinity Exhibit Hall
Evan T Cohen, PT, MA, PhD, NCS , Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Stratford, NJ
Kirsten Potter, PT, DPT, MS, NCS , Department of Physical Therapy Education, Rockhurst University, Kansas City, MO
Susan E. Bennett, PT, DPT, EdD, NCS, MSCS , Department of Rehabilitation Science and Department of Neurology, University of Buffalo, SUNY, Buffalo, NY
Kathi G Brandfass, PT, MS , Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, PA
Diane D Allen, PT, PhD , Graduate Program in Physical Therapy, San Francisco State University, San Francisco, CA
Gail L Widener, PT, PhD , Physical Therapy, Samuel Merritt University, Oakland, CA
Amy M Yorke, PT, PhD, NCS , Physical Therapy Department, University of Michigan-Flint, Flint, MI

Background: Despite the benefits in assessing individual and programmatic outcomes, a variety of barriers limit the use of outcome measures (OM), and clinicians do not routinely use OMs in practice. Evidence suggests that clinicians lack the knowledge to choose the most effective or appropriate OMs. Clinicians working with persons with Multiple Sclerosis (PwMS) have additional challenges in OM selection because of the heterogeneous patient population and symptom variability in individual patients. In 2010, the Neurology Section of the American Physical Therapy Association (APTA) appointed the Multiple Sclerosis Outcomes Measures Task Force (MSTF) to review and make evidence-based recommendations for the use of OMs in clinical practice, education, and research specific to PwMS. Sixty-three OMs were reviewed. An Evaluation Database to Guide Effectiveness form, developed by the Research Section of APTA, modified by the MSTF to incorporate MS-related constructs was used to record the OM properties, psychometrics, clinical utility, and recommendations. Recommendations were based on an analysis of the constructs measured, a synthesis of psychometric data, and a consensus evaluation of the appropriateness of the OM for PwMS, via a modified Delphi process. A four-point rating scale, based on the strength of the OM’s psychometrics and clinical utility, was used to evaluate OMs for use in patients across the MS-disability spectrum, and in five practice settings.

Objectives: The purpose of this presentation is to illustrate use of the MSTF recommendations to select appropriate OMs for a patient with MS.

Methods: The patient was a 43-year-old man with a 10-year history of relapsing-remitting MS who recently had an exacerbation leading to increased difficulty walking and increased fatigue. The patient’s goal was to return to work as a computer programmer. Based on the case history, three health-related constructs were deemed most important for this patient: upper extremity (UE) function, fatigue, and gait. Using the recommendations of the MSTF, several candidate OMs were identified for each of the three constructs (seven for UE function; fourteen for fatigue; and nine for gait). A systematic decision-making process was used to evaluate the appropriateness of each OM, and determine the most appropriate for each construct.

Results: The systematic decision-making process led the team to select the following OMs: 9-Hole Peg Test for UE function, Modified Fatigue Impact Scale for fatigue, and two OMs for gait: the 12-Item MS Walking Scale (a self-report OM) and the Timed 25-foot Walk Test (a performance-based test).

Conclusions: Utilizing the recommendations established by the MSTF facilitated selection of OMs that pertained to the health-related constructs of interest, were clinically feasible, and had psychometric data relevant to individuals with MS.