- Email: [email protected]
Measuring the Outcome of Stroke Rehabilitation: A validation study
466
Results: A total of 3,700 data sets were collected and analysed. The instrument has been fully incorporated into departmental recording systems. Uses of the instrument have been identified as: Measuring effectiveness of physiotherapy outcomes. Offering quantifiable data which can be used in patient profiling. An educational tool for junior and less experienced staff in terms of realistic goal setting, documentation and choice of therapeutic programmes. A base-line measurement tool for future clinical research.
TELER
Bunny Le Roux Anne Parry
Conclusions: The tool has been shown to have face validity among its users and to be user-friendly It provides useful information for clinicians, patients and managers about progress and effectiveness of treatment and possible confounding variables and their effect on outcomes of therapy. Full inter- and intra-therapist reliability studies are currently under way. Reference Mayo (1994).Editorial, Physiotherapy Canada, 46, 3, 145-148.
methods of clinical note-taking shows that in both the therapist’s and the manager’s perspective all the advantages are with the TELER method, and all the disadvantages are with the conventional method. The ‘test of construct validity’ is used on the Barthel
School of Health and Community Studies, Sheffield Hallam University
ADL index, and shows that it, for example, provides the
The aim of the study is to provide a unique method of clinical note-taking. Such a method uses,measuring scales which have the properties required b&he theory of measuring scales (Stevens, 1946; Senders, 19581, and clearly shows how a patient changes while under treatment. The purpose of the method is to facilitate effective delivery of treatment, effective management of the treatment service, and effective clinical audit.
The extent to which TELER has an acceptable level of validity is shown by enumerating the professional groups which use TELER, the clinical areas in which they use TELER, and the approaches in which they use TELER. The geographical distribution of TELER users is also given.
The conventional clinical notes for a patient are rewritten in TELER format, and the two sets of notes are compared from a therapist’s and a manager’s perspective. The requirements of the theory of measuring scales are analysed to determine how they can be satisfied. A simple ‘test of construct validity’ is presented. Avalidated TELER indicator is also presented. The term ‘indicator’ is used show that a TELER measuring scale is unlike any existing scale available for use in physiotherapy.
therapist with virtually no useful clinical information.
Experience over 2%years of use shows that TELER is an effective replacement for the conventional method of clinical note taking, and results first in a significant improvement in the quality of treatment delivered, and secondly in a significant saving of valuable clinical time. References Le Roux, A A (1993).‘TELER: The concept‘ , Physiotherapy,79, 11,755-758. Senders, V L (1958).Measurement and Statistics,Oxford University Press. Stevens, S S (1946). ‘On the theory of measuring scales,
The comparison of the conventional and TELER
Science, 103, 667-680.
Measuring the Outcome of Stroke Rehabilitation: A validation study
the Motor Assessment Scale MAS (Carr et a l , 1985; Poole and Whitney, 1988).The aim of this phase was to establish whether the indicators measured similar functional tasks and which of the two measures provide information that could be used in a n effective clinical audit.
Sue Mawson Sheffield Hallam University and Northern General Hospital, Sheffield
Aims: The initial aim of this three-year study was to develop a set of TELER (Treatment Evaluation m o u x method) outcome indicators (Le Roux, 1993) to be subsequently used to evaluate the outcome of stroke physiotherapy. Following the initial development of the indicators, their concurrent validity was assessed in a study comparing scores obtained using TELER and by
Physiotherapy, August 1996, vol 82, no 8
Design: The initial phase to develop the ‘face’ validity of the TELER indicators was carried out on five stroke units in a patient-oriented task analysis of functional goals by senior Bobath-trained physiotherapists. The task components became the six points of the TELER ordinal scale, each definition of which denoted an observable clinically significant step in the recovery of the patients? functional skill. The British Bobath Tutor
467
Association was subsequently involved in a consensus meeting when agreement was reached regarding the components of the indicators.
A consolidation and acquisition pattern of motor recovery was identified in 29 patients, the pattern being statistically significant using a chi square test analysis.
The final validation process to establish the concurrent validity of the indicators involved ten stroke units and 20 senior physiotherapists in a cross-over design using the two measures of motor function.
Conclusion: The TELER indicators developed during this study are a valid measure of motor recovery following a stroke. They are more sensitive to changes in certain motor functions than the MAS. A pattern of recovery during rehabilitation by Bobath physiotherapists was identified, which may provide some evidence of the theoretical basis underlying the approach.
During the validation process a total of 69 patients were included in the study.
Results: Data were analysed using Spearman rank correlation coefficient. High correlations were obtained between the MAS and TELER scores for individual items (r = 0.36 to 0.99) 67% of the scores falling into a range of r = > 0.9. Of particular interest were the high levels of correlation found between the sitting, sit-to-stand, walking and upper arm function scores. Further analysis using the chi square test demonstrated that the TELER indicator was more sensitive to change, particularly in the measurement of standing and stepping.
A Patient-specific Approach for Measuring Functional Status in Low Back Pain A J H M Beurskens HCWdeVet Department
of
Epidemiology, University of Limburg
A J A Koke University Hospital Maastricht, The Netherlands
Objective:To develop and evaluate a patient-specific approach to measuring functional status in low back pain. Methods: At baseline patients selected their main complaints in a standardised way: they selected three activities they performed frequently, which they perceived as important in day-to-daylife, and which low back pain made difficult for them. A cohort of 150 patients with non-specific low back pain scored their main complaints a t baseline and 12 weeks later on a 100 mm visual analogue scale.
References Carr, J, Shepherd, R, Lynne, D and Nordholm, L (1985). ‘An investigation of a new motor assessment scale for stroke patients’, Phsicai Therapy,65, 175-1 80. Le Roux, A A (1993).‘TELER: The concept’, Physiotherapy,79, 11,755-758. Poole, J and Whitney, S (1988).‘Motor assessment scale for stroke patients: Concurrent validity and interrater reliability’, Archives of Physical Medicine and Rehabilitation, 69, 195-1 97.
The feasibility of this procedure was evaluated. Effect size statistics and correlations between change scores were used to evaluate the responsiveness. The results of the patient-specific approach were compared with more established instruments such a s the Roland disability questionnaire and pain during the past week evaluated on a visual analogue scale.
Results: The patient-specific approach was feasible, it was easy to understand and the time required to complete it was short. Patients appreciated that attention was paid to their specific situation and that they could select the complaints of importance to them. The responsiveness of the patient-specific approach was good and comparable with that of more established outcome measures. The patient-specific approach was able to discriminate between improved and nonimproved patients. The correlations between change scores were high. Conclusion:The patient-specific approach was able to detect changes on complaints that were highly relevant for an individual. I t would be valuable to apply the patient-specific approach in future studies to try to replicate our results and provide further evaluation.
Physiotherapy,August 1996, vol82, no 8
Results: A total of 3,700 data sets were collected and analysed. The instrument has been fully incorporated into departmental recording systems. Uses of the instrument have been identified as: Measuring effectiveness of physiotherapy outcomes. Offering quantifiable data which can be used in patient profiling. An educational tool for junior and less experienced staff in terms of realistic goal setting, documentation and choice of therapeutic programmes. A base-line measurement tool for future clinical research.
TELER
Bunny Le Roux Anne Parry
Conclusions: The tool has been shown to have face validity among its users and to be user-friendly It provides useful information for clinicians, patients and managers about progress and effectiveness of treatment and possible confounding variables and their effect on outcomes of therapy. Full inter- and intra-therapist reliability studies are currently under way. Reference Mayo (1994).Editorial, Physiotherapy Canada, 46, 3, 145-148.
methods of clinical note-taking shows that in both the therapist’s and the manager’s perspective all the advantages are with the TELER method, and all the disadvantages are with the conventional method. The ‘test of construct validity’ is used on the Barthel
School of Health and Community Studies, Sheffield Hallam University
ADL index, and shows that it, for example, provides the
The aim of the study is to provide a unique method of clinical note-taking. Such a method uses,measuring scales which have the properties required b&he theory of measuring scales (Stevens, 1946; Senders, 19581, and clearly shows how a patient changes while under treatment. The purpose of the method is to facilitate effective delivery of treatment, effective management of the treatment service, and effective clinical audit.
The extent to which TELER has an acceptable level of validity is shown by enumerating the professional groups which use TELER, the clinical areas in which they use TELER, and the approaches in which they use TELER. The geographical distribution of TELER users is also given.
The conventional clinical notes for a patient are rewritten in TELER format, and the two sets of notes are compared from a therapist’s and a manager’s perspective. The requirements of the theory of measuring scales are analysed to determine how they can be satisfied. A simple ‘test of construct validity’ is presented. Avalidated TELER indicator is also presented. The term ‘indicator’ is used show that a TELER measuring scale is unlike any existing scale available for use in physiotherapy.
therapist with virtually no useful clinical information.
Experience over 2%years of use shows that TELER is an effective replacement for the conventional method of clinical note taking, and results first in a significant improvement in the quality of treatment delivered, and secondly in a significant saving of valuable clinical time. References Le Roux, A A (1993).‘TELER: The concept‘ , Physiotherapy,79, 11,755-758. Senders, V L (1958).Measurement and Statistics,Oxford University Press. Stevens, S S (1946). ‘On the theory of measuring scales,
The comparison of the conventional and TELER
Science, 103, 667-680.
Measuring the Outcome of Stroke Rehabilitation: A validation study
the Motor Assessment Scale MAS (Carr et a l , 1985; Poole and Whitney, 1988).The aim of this phase was to establish whether the indicators measured similar functional tasks and which of the two measures provide information that could be used in a n effective clinical audit.
Sue Mawson Sheffield Hallam University and Northern General Hospital, Sheffield
Aims: The initial aim of this three-year study was to develop a set of TELER (Treatment Evaluation m o u x method) outcome indicators (Le Roux, 1993) to be subsequently used to evaluate the outcome of stroke physiotherapy. Following the initial development of the indicators, their concurrent validity was assessed in a study comparing scores obtained using TELER and by
Physiotherapy, August 1996, vol 82, no 8
Design: The initial phase to develop the ‘face’ validity of the TELER indicators was carried out on five stroke units in a patient-oriented task analysis of functional goals by senior Bobath-trained physiotherapists. The task components became the six points of the TELER ordinal scale, each definition of which denoted an observable clinically significant step in the recovery of the patients? functional skill. The British Bobath Tutor
467
Association was subsequently involved in a consensus meeting when agreement was reached regarding the components of the indicators.
A consolidation and acquisition pattern of motor recovery was identified in 29 patients, the pattern being statistically significant using a chi square test analysis.
The final validation process to establish the concurrent validity of the indicators involved ten stroke units and 20 senior physiotherapists in a cross-over design using the two measures of motor function.
Conclusion: The TELER indicators developed during this study are a valid measure of motor recovery following a stroke. They are more sensitive to changes in certain motor functions than the MAS. A pattern of recovery during rehabilitation by Bobath physiotherapists was identified, which may provide some evidence of the theoretical basis underlying the approach.
During the validation process a total of 69 patients were included in the study.
Results: Data were analysed using Spearman rank correlation coefficient. High correlations were obtained between the MAS and TELER scores for individual items (r = 0.36 to 0.99) 67% of the scores falling into a range of r = > 0.9. Of particular interest were the high levels of correlation found between the sitting, sit-to-stand, walking and upper arm function scores. Further analysis using the chi square test demonstrated that the TELER indicator was more sensitive to change, particularly in the measurement of standing and stepping.
A Patient-specific Approach for Measuring Functional Status in Low Back Pain A J H M Beurskens HCWdeVet Department
of
Epidemiology, University of Limburg
A J A Koke University Hospital Maastricht, The Netherlands
Objective:To develop and evaluate a patient-specific approach to measuring functional status in low back pain. Methods: At baseline patients selected their main complaints in a standardised way: they selected three activities they performed frequently, which they perceived as important in day-to-daylife, and which low back pain made difficult for them. A cohort of 150 patients with non-specific low back pain scored their main complaints a t baseline and 12 weeks later on a 100 mm visual analogue scale.
References Carr, J, Shepherd, R, Lynne, D and Nordholm, L (1985). ‘An investigation of a new motor assessment scale for stroke patients’, Phsicai Therapy,65, 175-1 80. Le Roux, A A (1993).‘TELER: The concept’, Physiotherapy,79, 11,755-758. Poole, J and Whitney, S (1988).‘Motor assessment scale for stroke patients: Concurrent validity and interrater reliability’, Archives of Physical Medicine and Rehabilitation, 69, 195-1 97.
The feasibility of this procedure was evaluated. Effect size statistics and correlations between change scores were used to evaluate the responsiveness. The results of the patient-specific approach were compared with more established instruments such a s the Roland disability questionnaire and pain during the past week evaluated on a visual analogue scale.
Results: The patient-specific approach was feasible, it was easy to understand and the time required to complete it was short. Patients appreciated that attention was paid to their specific situation and that they could select the complaints of importance to them. The responsiveness of the patient-specific approach was good and comparable with that of more established outcome measures. The patient-specific approach was able to discriminate between improved and nonimproved patients. The correlations between change scores were high. Conclusion:The patient-specific approach was able to detect changes on complaints that were highly relevant for an individual. I t would be valuable to apply the patient-specific approach in future studies to try to replicate our results and provide further evaluation.
Physiotherapy,August 1996, vol82, no 8