Importance of Outcome Measures in Rehabilitation Therapy

By:  Jennifer Heiligman, PT, MPT

Outcome measures are the validated functional tools used to measure a patient’s participation restrictions and activity limitations.  The use of outcome measures in the rehabilitation therapy industry has become more and more common and important. The drive to use these standardized measurement tools has partially been the result of the realization within our industry that goals established for the patient should not only focus on improvement of impairment type of measures, but should also take into consideration the patient’s preferences for activities and life participation. In addition, the implementation of value based care by Medicare and other payers has made the use of standardized outcome tools even more important.  These tools can be used to measure the success of rehab therapy interventions in relation to individual patient management and collectively, as a profession, to help determine which intervention pathways comprise best clinical practices.

Some of the most common outcome measures used in rehab therapy include the Neck Disability Index, Quick Dash, Modified Oswestry Low Back Pain Questionnaire, Lower Extremity Functional Scale, Knee Injury Osteoarthritis Outcome Score (KOOS), Hip Disability Osteoarthritis Outcome Score (HOOS), and the Pelvic Floor Distress Inventory.  Choosing the appropriate test will depend on what body region or specific limitation is being assessed.  For most of the tools, appropriate administration includes completion before or at the time of the initial evaluation followed by subsequent administrations at intervals throughout the episode of care.  The subsequent surveys will illustrate the patient’s progress, or lack thereof, as a result of the interventions being rendered by the therapist.  If progress is seen, then the therapist knows the appropriate treatments are being provided.  On the other hand, if no significant improvement is noted, it should help the therapist realize alternate interventions may be necessary.

In order to stay consistent as a practice, a workflow should be established regarding the distribution and collection of the outcome measure tools.  Educating the front office staff regarding which outcome surveys should be given to patients based on their diagnosis, age, and any other pertinent factors will allow tests to be completed prior to seeing the therapist.  It should also be determined what intervals the measures should be administered to the patient throughout their episode of care.  Will they be given after the 3rd visit, 5th visit, and/or at time of discharge?  It is generally recommended to have the patient complete updated measures throughout the plan of care and not just at the time of discharge.  This allows the therapist to adjust interventions if the patient is not moving toward the expected goal.  In addition, if the survey is given out frequently, the therapist will hopefully have at least one update should the patient decide to self discharge and not return to therapy.

How the outcome measure surveys are distributed will be determined by what tools are available to the practice.  When using hard copy forms, they can be given to the patient at the time of check in for their initial visit and subsequent surveys can be given at check in for the predetermined visits thereafter.  If using an EMR, for compliance purposes, you will want to make sure you are uploading the completed forms into the patient’s electronic medical record within your EMR.  The therapist should also be including the score within their documentation.  

To make this process easier you may want to look into an EMR that contains embedded outcome measures that can be sent to your patients electronically.  This functionality alleviates the need for paper and scanning which significantly streamlines the process.  The easier the process is, the more likely it will be completed by your staff and your patients.  

OptimisPT has embedded outcome measures.  If you are an OptimisPT client, you can send your patients their outcome measure survey via email or through our patient engagement app. The surveys can be sent prior to the patient’s initial visit allowing the patient to decrease the time they have to sit in the waiting room filling out paperwork before being seen by the therapist.  There is also functionality available in OptimisPT to auto send updated surveys at specific intervals of your choosing.  When the surveys come back into OptimisPT, the system will score the test and create a PDF to be part of the medical record including how the patient answered each question should you need to review that information.  Efficiency is improved for the therapist as well because they can simply click one button to import the score directly into the patient’s visit documentation. 

Clinical outcome measures offer validated insight regarding how well an intervention or treatment is helping a patient achieve their goals.  This information can be used collectively to illustrate the relevance of our profession.  It can also be used individually to support and justify the skilled treatment being provided within your practice which may result in improved reimbursement and referrals.  If you are not utilizing validated outcome measures within your practice, now is the time to start.

If you are interested in learning more about OptimisPT and our embedded outcome measures please schedule a demo.