Outcome Measurement Tools as Evidence
In a day of medicine in which physical therapists feel stressed by increasing demands for specified insurance guidelines, codes, and outcome measures, it serves a therapist well to have a great understanding of various outcome measurement tools. Standardized outcome measurement tools are vital to a therapist’s ability to establish baseline performance and track change over time. In addition, good outcome measurement tools have high inter-tester reliability, making them easily replicated by another therapist. This means that if I do an evaluation and my colleague were to perform the reassessment, my scoring methods will remain in line with each other.
The beauty of outcome measurement tools is that they provide evidence as to what improvements my patient makes as a result of therapy. If any of my claims go to review or I need to submit an appeal for denied coverage, using proper outcome measurement tools gives I justification for services. Nowadays it seems like insurance representatives scour medical documents, looking for any reason they can to deny payment. As a therapist, my job is to fill my documentation with reasons that they must pay. They key to this evidence lies in choosing an appropriate outcome measurement tool for my patient.
Figure 1. Data “persists” from document-to-document and within one document. This means you can view Prior or Current Levels or Goals from any of the relevant sections
First, I determine what my primary patient population will be. There are functional outcome measurements that are specific to predicting fall risk or rating extent of disabilities. These types of outcome measurements are ideal for the therapist working with the geriatric population in various settings. There are many outcome measurements tools that test specific body parts, such as functional use of an arm or a leg. In addition, there are many pediatric specific outcome measurement tools. Because of high interest in research, more and more outcome measurement tools are being created each year, by highly motivated and dedicated clinicians. I find the type of outcome measurement tool I are seeking and then I become well acquainted with it.
Outcome measurement tools should not take long to administer and should be easily recreated and repeated. If I am learning how to administer a new tool, I try practicing with an experienced clinician. I have the clinician present as a patient might and administer the testing items. After I perform a test a few times, I will likely master it.
Outlined are several common and highly reliable outcome measurement tools based on topic:
Geriatrics: Tinetti Outcome Measurement Tool, BERG Balance Scale, BESTest, Functional Independence Measure (FIM)
Pediatrics: Alberta Infant Motor Scale, Batelle Developmental Inventory, Peabody Developmental Motor Scale, Pediatric Evaluation of Disability Inventory
Upper Extremity: Disability of Arm and Shoulder and Hand (DASH), Penn Shoulder Score, Shoulder Pain and Disability Index (SPADI)
Lower Extremity: Lower Extremity Functional Scale (LEFS), Get Up and Go, Six Minute Walk Test, Lysholm Score
Functional Mobility: Timed Up and Go (TUG), Six Minute Walk Test, Get Up and Go
Figure 2. Only relevant fields appear for selected functions. No unnecessary fields get in the way.
The beauty of outcome measurement tools is that they are standardized and tested in the literature. Once I become familiar with some of the most common outcome measurement tools used in therapy, I can more readily understand current evidence and quickly understand the functional status of my patients. When documenting within the bestPT software, I can easily utilize outcome measurement tools. I simply select the outcome measurement tool I would like to input in my evaluation or reassessment note. You can easily compare my patient’s evaluation score with their (hopefully improved) score at discharge. This evidence of improvement serves to satisfy me as a therapist, the patient, and the insurance payers.
Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.