Physical therapists encounter many barriers to using outcome measures (OMs) in clinical practice. Clinicians working with patients with multiple sclerosis (MS) have additional challenges related to the heterogeneous patient population and frequent symptom variability in individual patients. Although many OMs are available for patients with MS, few resources exist to assist the physical therapist with identifying and selecting the most appropriate measures for this patient population. In 2010, the Neurology Section of the American Physical Therapy Association appointed the Multiple Sclerosis Task Force (MSTF) to review and make evidencebased recommendations for the use of OMs in clinical practice, education, and research specific to persons with MS (PWMS). The purposes of this paper are 1: to describe the process used by the MSTF to evaluate the psychometric data and clinical utility of OMs for use in individuals with MS, 2: to describe the consensus process used to recommend OMs for this patient population, and 3: to provide evidence-based recommendations to assist clinicians in selecting appropriate OMs for PWMS. The MSTF reviewed 63 OMs. A modified Delphi process was used to build consensus on recommendations for PWMS across the disability spectrum and in various health care settings. Nearly half of the OMs received ratings of 3 or 4 (Recommended or Highly Recommended, respectively) for use in in-patient rehabilitation and outpatient settings, and three of four MS- related disability groupings. The MSTF concluded that the recommendations have broad applicability for clinicians working with PWMS across the disability spectrum, in any health care setting. The recommendations can assist with making sound decisions when selecting OMs for PWMS.
Standardized outcome measures (OMs) are a vital part of evidence-based practice. Despite the recognition of the importance of OMs, recent evidence suggests that the use of OMs in clinical practice is limited. Selecting the most appropriate OM enhances clinical practice by (1) identifying and quantifying body function and structure limitations; (2) formulating the evaluation, diagnosis, and prognosis; (3) informing the plan of care; and (4) helping to evaluate the success of physical therapy interventions. This article (Part I) is the first of a 2-part series on the process of selecting OMs in neurological clinical practice. We introduce a decision-making framework to guide the selection of OMs and discuss 6 main factors-what to measure, the purpose of the measure, the type of measure, patient and clinic factors, psychometric factors, and feasibility-that should be considered when selecting OMs for clinical use. The framework will then be applied to a patient case in Part II of the series (see the article "Outcome Measures in Neurological Physical Therapy Practice: Part II. A Patient-Centered Process" in this issue).
Physical therapists working in neurological practice must make choices about which standardized outcome measures are most appropriate for each patient. Significant time constraints in the clinic limit the number of measures that one can reasonably administer. Therapists must choose measures that will provide results that guide the selection of appropriate interventions and are likely to show clinically meaningful change. Therefore, therapists must be able to compare the merits of available measures to identify those that are most relevant for each patient and setting. This article describes a process for selecting outcome measures and illustrates the use of that process with a patient who has had a stroke. The link between selecting objective outcome measures and tracking patient progress is emphasized. Comparisons are made between 2 motor function measures (the Fugl-Meyer Assessment [FMA] of Physical Performance vs the Stroke Rehabilitation Assessment of Movement), and 2 balance measures (Berg Balance Scale vs the Activities-specific Balance Confidence Scale). The use of objective outcome measures allows therapists to quantify information that previously had been described in subjective terms. This allows the tracking of progress, and the comparison of effectiveness and costs across interventions, settings, providers, and patient characteristics.
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