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Outcome measures

image of journal coverUsing published, standardised outcome measures in routine clinical practice is an explicit requirement of the CSP's Standards of Physiotherapy Practice. Use this page to find out more about what they are and how to use them.

What is an outcome measure?

Some definitions might help answer this question:

  • Outcomes are 'the results of health care processes' (Baumberg, 1995)
  • An outcome measure "is a measure of change, the difference from one point in time (usually before an intervention) to another point in time (usually following an intervention)". (Kendall, 1997)
  • A physical therapy outcome measure is 'a test or scale administered and interpreted by physical therapists that has been shown to measure accurately a particular attribute of interest to patients and therapists and is expected to be influenced by intervention' (Cole (1994), based on Mayo (1994))
    Search our database of outcome measures.
  • An outcome measure should be standardised, with explicit instructions for administration and scoring (McDowell, 1996, p494)

A measure should be reliable, valid, and responsive to the clinical change that occurs over time. This is an attempt to closely define subjective information in a robust manner:

  • Reliability is how uniformly the test can be repeated when administered on more than one occasion or by more than one rater.
  • Validity is the extent to which the measure measures what it intends to measure, (Cole et al, 1994), that is, is it asking the right questions?
  • Responsiveness is the ability of the measure to detect true change in patients' status over time (Binkley, 1999), that is, is it sensitive to the subtle changes patients make?

Measures should be convenient for use by clinicians and especially acceptable for the patient. In this respect they need to be comfortable and painless.

A wide selection of standardised measures have been published. These range from:

  • simple, short questionnaires included in full within a published article (e.g. Knee injury and osteoarthritis outcome score (KOOS), Roos, 1998), to
  • measures that require a manual and / or scoring system to be obtained or purchased (e.g. Bristol Female Lower Urinary Tract Symptoms questionnaire, Jackson, 1996), to
  • more sophisticated systems with software, that require a financial and training investment through a commercial company, providing more in-depth information on outcomes (e.g. TELER, Le Roux, 1993; LIFEware, Granger, 1995).

What to do with the results

The results obtained with a measure should be analysed to see if the change in health status recorded is attributable to the intervention, or not. To make rational decisions about whether an intervention is of value, careful analysis of the cause of the outcome should be made.

The results obtained can be used to evaluate the impact of an intervention, or treatment; provide information to the patient; or provide information for commissioners of physiotherapy.

Disclaimer

The database information is illustrative and not exhaustive and its contunuation in its current form is under review, as database content has not been updated since 2002. The CSP is not recommending the outcome measures in the database, nor is their inclusion on the database any validation of their value. Readers should appraise any measure to ensure it suits the purposes of use.

There may have been other measures and papers published since 2002 so you may wish to undertake a literature search to locate more uptodate resources, in addition to critiquing the use and effectiveness of the differnet measures you are interested in. If you need support with this then either speak to your local health librarian or contact the CSP Library and Information Service.

References

The references listed below are all cited within this section of the website:

  • Baumberg L, Long A, Jefferson J (1995) International workshop: culture and outcomes: Barcelona, 9-10 June 1995; Leeds: European Clearing House on Health Outcomes
  • Binkley JM, Stratford PW, Lott SA et al (1999) The lower extremity functional scale (LEFS): Scale development, measurement properties, and clinical application Physical Therapy 79, 4, 371 - 383
  • Cole B et al (1994) Physical Rehabilitation Outcome Measures Canadian Physical Therapy Association, Ontario ISBN 0-96981-0-5
  • Garratt AM, Schmidt L, Mackintosh A, Fitzpatrick R. Quality of life measurement: bibliographic study of patient assessed health outcome measures. British Medical Journal 2002;324:1417-9.
  • Granger C, Ottenbacher K, et al (1995) Reliability of a brief outpatient functional outcome assessment measure American Journal of Physical Medicine and Rehabilitation 75, 356-363
  • Jackson S, Donovan S, et al (1996) The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing British Journal of Urology 77, 805-812
  • Kendall N (1997) Developing outcome assessments: a step by step approach New Zealand Journal of Physiotherapy Dec, 11 - 17
  • Le Roux AA (1993) TELER: The concept Physiotherapy 79, 11, 755-758.
  • Mayo N, Cole B, Dowler J, Gowland C, Finch E (1994) Use of outcome measures in physiotherapy: survey of current practice Canadian Journal of Rehabilitation 81 - 82
  • McDowell I, Newell C (1996) Measuring Health - a Guide to Rating Scales and Questionnaires, Oxford University Press ISBN 0-19-510371-8
  • Roos EM, Roos HP, Lohmander LS et al (1998) Knee injury and osteoarthritis outcome score (KOOS) - development of a self-administered outcome measure Journal of Sports Physical Therapy 78, 2, 88 - 96
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