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Outcome Measurements and Case Weighting in Physiotherapy Services for People with Learning Disabilities: A learning experience
469
Standardisation of a Disease-specific Component of a Generic Outcome Measurement Instrument ~~~~
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J Snell Department of Physiotherapy and Occupational Therapy, Coventry and Warwickshire Hospital, Coventry
D C Pennington J Sim School of Health and Social Sciences, Coventry University There is a need for standardised outcome measurement tools which can be used generically, but which are responsive to changes in specific client groups. The aim of the study reported here was to evaluate the comparability of the disease-specific components of a generic outcome measurement instrument to be used for outpatients with low back pain (LBP) and rheumatoid arthritis (w).
were asked t o rate the severity of each of these on a five-point ‘severity scale’, in order to validate the two ‘moderate’scenarios. Once validated, the moderate scenarios were sent to a second group of 20 therapists with the nine tasks previously identified. They were asked to rate the challenge posed by each task on a five-point ‘difficulty scale’, in respect of the hypothetical patient in each scenario. By examining the distribution of responses, the spread of difficulty within each set of tasks was assessed. As a result, changes were made to the difficulty scale, and to those tasks listed for the LBP scenario. The task lists were then re-rated by this group of therapists and by a group of 19 RA and LBP patients. The Mann-Whitney U test was used to compare the overall difficulty of the sets of tasks, in terms of therapistltherapist and patienupatient agreement between scenarios, and therapistlpatient agreement within each scenario. This analysis revealed no statistically significant difference (p > 0.05). Summary statistics found the spread of difficulty to be satisfactory. The task lists were deemed to have been standardised, and were incorporated into the generic instrument.
For each condition, a list of nine tasks was identified which would measure disability. These tasks were generated by a group consensus technique with a panel of 24 experienced therapists. These therapists were then given five patient scenarios, two of which (lRA, 1LBP) had been formulated as ‘moderate’ according to the American Rheumatism Association criteria. They
This study shows that it is possible to generate diseasespecific components for generic outcome instruments which will allow comparisons to be made between patients with different conditions of comparable severity.
Outcome Measurements and Case Weighting in Physiotherapy Services for People with Learning Disabilities: A learning experience
were weighted with the followingcriteria: type of input required, other support services involved, physical status of the client, clientltherapist interface, and clientlcarer compliance.
Ilias Papathanasiou National Hospital for Neurology and Neurosurgery, London
S J Lgon-Maris Southampton Univeristy Hospitals NHS Trust Very little is known about evaluating physiotherapy intervention in physiotherapy services for people with learning disabilities. The radical changes in health service delivery have increased the pressure on all services providers to investigate methods of evaluating their intervention. This study presents an approach to measure outcome and to calculate input in physiotherapy services for people with learning difficulties.
A case weighting system was developed in order to evaluate the cost of physiotherapy service, predicting the need for physiotherapy intervention, balancing and prioritising the caseload between physiotherapists and finally being used as an outcome measure. The clients
A protocol of physiotherapy assessment was designed, which included a functional ability checklist? body chart, and quality of movement assessment. This protocol was used in 48 cases of people with learning disabilities. Goals of intervention were focused on improvement of the clients’ functional skills, quality of movement, quality of life and maintenance of abilities. Goals were measured as fully, partly or not achieved. Following a review of our approach a year later, we were able to highlight inadequacies of our services, develop predictive outcome measures of our intervention, predict the type and frequency of our input required over a six-month period and approximate the cost of our service. It is suggested that t.his problem-solving specific therapy approach can be used widely in the clinical area of learning disabilities. This has great clinical validity? as isolated generic methods of measurement cannot evaluate physiotherapy intervention in this client group.
Physiotherapy, August 1996, vol82, no 8
Standardisation of a Disease-specific Component of a Generic Outcome Measurement Instrument ~~~~
~
J Snell Department of Physiotherapy and Occupational Therapy, Coventry and Warwickshire Hospital, Coventry
D C Pennington J Sim School of Health and Social Sciences, Coventry University There is a need for standardised outcome measurement tools which can be used generically, but which are responsive to changes in specific client groups. The aim of the study reported here was to evaluate the comparability of the disease-specific components of a generic outcome measurement instrument to be used for outpatients with low back pain (LBP) and rheumatoid arthritis (w).
were asked t o rate the severity of each of these on a five-point ‘severity scale’, in order to validate the two ‘moderate’scenarios. Once validated, the moderate scenarios were sent to a second group of 20 therapists with the nine tasks previously identified. They were asked to rate the challenge posed by each task on a five-point ‘difficulty scale’, in respect of the hypothetical patient in each scenario. By examining the distribution of responses, the spread of difficulty within each set of tasks was assessed. As a result, changes were made to the difficulty scale, and to those tasks listed for the LBP scenario. The task lists were then re-rated by this group of therapists and by a group of 19 RA and LBP patients. The Mann-Whitney U test was used to compare the overall difficulty of the sets of tasks, in terms of therapistltherapist and patienupatient agreement between scenarios, and therapistlpatient agreement within each scenario. This analysis revealed no statistically significant difference (p > 0.05). Summary statistics found the spread of difficulty to be satisfactory. The task lists were deemed to have been standardised, and were incorporated into the generic instrument.
For each condition, a list of nine tasks was identified which would measure disability. These tasks were generated by a group consensus technique with a panel of 24 experienced therapists. These therapists were then given five patient scenarios, two of which (lRA, 1LBP) had been formulated as ‘moderate’ according to the American Rheumatism Association criteria. They
This study shows that it is possible to generate diseasespecific components for generic outcome instruments which will allow comparisons to be made between patients with different conditions of comparable severity.
Outcome Measurements and Case Weighting in Physiotherapy Services for People with Learning Disabilities: A learning experience
were weighted with the followingcriteria: type of input required, other support services involved, physical status of the client, clientltherapist interface, and clientlcarer compliance.
Ilias Papathanasiou National Hospital for Neurology and Neurosurgery, London
S J Lgon-Maris Southampton Univeristy Hospitals NHS Trust Very little is known about evaluating physiotherapy intervention in physiotherapy services for people with learning disabilities. The radical changes in health service delivery have increased the pressure on all services providers to investigate methods of evaluating their intervention. This study presents an approach to measure outcome and to calculate input in physiotherapy services for people with learning difficulties.
A case weighting system was developed in order to evaluate the cost of physiotherapy service, predicting the need for physiotherapy intervention, balancing and prioritising the caseload between physiotherapists and finally being used as an outcome measure. The clients
A protocol of physiotherapy assessment was designed, which included a functional ability checklist? body chart, and quality of movement assessment. This protocol was used in 48 cases of people with learning disabilities. Goals of intervention were focused on improvement of the clients’ functional skills, quality of movement, quality of life and maintenance of abilities. Goals were measured as fully, partly or not achieved. Following a review of our approach a year later, we were able to highlight inadequacies of our services, develop predictive outcome measures of our intervention, predict the type and frequency of our input required over a six-month period and approximate the cost of our service. It is suggested that t.his problem-solving specific therapy approach can be used widely in the clinical area of learning disabilities. This has great clinical validity? as isolated generic methods of measurement cannot evaluate physiotherapy intervention in this client group.
Physiotherapy, August 1996, vol82, no 8