As a new graduate, I was unaware how important it is to utilize effective outcome measures (functional limitations) until I started my residency program. The declining payment system requires us to use our treatment time wisely. Because of this, it becomes crucial to effectively use outcome measures. These outcome measures need to be consistent, reliable, contextual, and predictable.
Consistent: The patient needs to perform this activity (preferably daily). For example, a patient with knee issues may visit his son’s house where he has to negotiate a flight of stairs 4 days per week.
Reliable/predictable: The intensity and activity level reported should be reliable to decrease chances of guessing/emotional bias.
Contextual: It’s important that the outcome measure is meaningful to the patient. For example, if the patient cannot sit for 30 minutes, it’s very vague and does not have any activity linked to it (context). However, putting the patient’s symptoms into context such as: “I have low back pain in the morning after my morning drive to work that usually comes on after 3 songs or after passing this freeway exit” makes it easier to track progress and is more meaningful to the patient.
We have to train the patients to report outcome measures.
During the evaluation, reinforce the patient to pay particular attention to the target outcome measure. Reinforce that they will be asked each visit to monitor their progress and see if the interventions are on the right path.
For example: “Mr. Jones, when you come back next week, I am going to ask you: how many minutes can you drive in your morning commute before the onset of symptoms and how much was the average intensity?"
Reflections will communicate to your patients that you understand their conditions and build rapport and confidence in the therapist.
At the patient’s following visit, review what they said about the target outcomes measures to help the patient get caught up. “Last time we found x, y, z and we treated you. Last time pain was x/10. I am interested to hear how your pain was during the rest of that day and also your outcome measure x. Did you think the treatment and exercises are effective?”. This will set a tone for patients to become involved and responsible for their condition and help set expectations for future visits. Additionally, it can be empowering to patients when they notice improvements.
In documentation under “plan”, I have been writing specific questions to ask the patients when they return. This is a huge time saver especially at my clinic where we see patients bimonthly.
What I have mentioned above is nothing elaborate, something very basic. I think we as professionals sometimes lose sight of how important it is to do the basics well and end up developing bad habits. Without a systematic approach, we can become lost on treatment directions with the patients and end up chasing our tails.
Stay tuned! I will continue to post more of my learning experiences from the Kaiser Residency program. It will contain more visual appeal (pictures and better formatting) once I figure out how to work this website!
Kay Lin DPT CSCS