Outcome Measurement Tools
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| Outcome | is the term used to qualitatively describe the end result of a particular intervention including changes (good or bad) that occurred to the health of a person, group or community.
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| Factors that influence outcome include: | primary diagnosis, comorbidities, medical stability, prior physical status, current physical status, age and gender, beliefs, and attitudes.
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| Balance: | Berg Balance Scale Functional Reach Test “Get Up and Go” Test Romberg Test Tinetti
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| Berg Balance Scale | A tool designed to assess a patientʼs risk for falling. There are fourteen tasks, each scored on an ordinal scale from 0-4.
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| Berg Balance Scale tasks include | static, transitional, and dynamic activities in sitting and standing positions.
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| Berg Balance Scale The maximum score is a | 56
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| Berg Balance Scale with a score less than 45 | indicating an increased risk for falling.
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| Berg Balance Scale used as | a one-time examination or as an ongoing tool to monitor a patient who may be at risk for falls.
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| Functional Reach Test | A single task screening tool used to assess standing balance and risk of falling. A person is required to stand upright with a static base of support.
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| Functional Reach Test | A yardstick is positioned to measure the forward distance that a patient can reach without moving the feet.
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| Functional Reach Test | Three trials are performed and averaged together. The following are age related standard measurements for functional reach:
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| Functional Reach Test 20 - 40 years – | 14.5 - 17 inches
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| Functional Reach Test 41 - 69 years – | 13.5 - 15 inches
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| Functional Reach Test 70 - 87 years – | 10.5 - 13.5 inches
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| Functional Reach Test A patient that falls below the age appropriate range for functional reach | has an increased risk for falling.
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| Functional Reach Test The outcome measure demonstrates | high test-retest correlation and intrarater reliability.
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| “Get Up and Go” Test | A functional performance screening tool used to assess a personʼs level of mobility and balance.
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| “Get Up and Go” Test The person initially sits in a supported chair with a firm surface, | transfers to a standing position, and walks a few feet. The patient must then turn around without external support, walk back towards the chair, and return to a sitting position.
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| “Get Up and Go” Test The patient is scored based on | amount of postural sway, excessive movements, reaching for support, side stepping, or other signs of loss of balance.
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| “Get Up and Go” Test The 5-point ordinal rating scale designates a score of one | as normal and a score of five as severely abnormal.
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| “Get Up and Go” Test In an attempt to increase overall reliability | the use of time was implemented.
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| “Get Up and Go” Test Patients who require over 20 seconds to complete the process | may be at an increased risk for falling.
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| Romberg Test An assessment of balance that positions the patient in | unsupported standing, feet together, upper extremities folded, and eyes closed.
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| Romberg Test A patient receives a grade of “normal” | if they are able to maintain the position for 30 seconds.
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| Tinetti Performance Oriented Mobility Assessment | A tool used to screen patients and identify if there is an increased risk for falling.
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| Tinetti The first section assesses balance through | sit to stand and stand to sit from an armless chair, immediate standing balance with eyes open and closed, tolerating a slight push in the standing position, and turning 360 degrees. A patient is scored from 0-2 in most categories with a maximum score of
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| Tinetti The second section assesses gait at normal speed and at a rapid, but safe speed. Items scored in this section include initiation of gait, step length and height, step asymmetry and continuity, path, stance during gait, and trunk motion. | A patient is scored either 0 to 1 or 0 to 2 with a maximum score of 12. The tool has a combined maximum total of 28 with the risk of falling increasing as the total score decreases.
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| Tinetti A total score less than 19 | indicates a high risk for a fall.
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| Cognitive Assessment: | Mini Mental State Examination Short Portable Mental Status Questionnaire
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| Mini Mental State Examination | A tool designed to screen patients for cognitive impairment, psychoses or affective disorders.
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| Mini Mental State Examination | Each of the five sections: orientation, registration, attention and calculation, recall and language, and motor skills have multiple questions that receive one point for the correct answer or zero for the incorrect answer.
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| Mini Mental State Examination | There is a maximum score of 30 with a progressive level of cognitive impairment noted when a score of 24 or less is obtained.
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| Short Portable Mental Status Questionnaire | A ten item screening tool used to assess cognitive impairment primarily in the geriatric population.
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| Short Portable Mental Status Questionnaire | Orientation, short and long-term memory, practical skills, and mathematical tasks are tested.
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| Short Portable Mental Status Questionnaire | The maximum score is ten with a score below eight indicating cognitive impairment. The lower the score below eight the more significant the cognitive impairment.
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| Endurance: | Six-Minute Walk Test Borgʼs Rating of Perceived Exertion Scale Dyspnea Levels
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| Borgʼs Rating of Perceived Exertion Scale | A tool designed to measure perceived exertion, dyspnea, and exercise intensity. The original scale measures 6 to 20 points and the revised scale measures 0 to 10 points.
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| Borgʼs Rating of Perceived Exertion Scale The patient is instructed that a 6 (original) or 0 (new) | corresponds to walking at a normal pace without fatigue. A score of 20 (original) or 10 (new) indicates high intensity exercise that cannot be completed due to exhaustion.
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| Borgʼs Rating of Perceived Exertion Scale After an activity | a patientʼs score can indicate cardiopulmonary fatigue versus muscle fatigue. The score correlates with exercise intensity, heart rate, oxygen consumption, and blood lactate levels.
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| Borgʼs Rating of Perceived Exertion Scale Cardiopulmonary training effects can be seen | with exercise intensity beginning at a 14 (original) or 4 to 5 (new) respectively. The scale is commonly used for patients with cardiovascular impairments.
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| Dyspnea Levels | A tool designed by Rancho Los Amigos Medical Center that attempts to rate the intensity and level of dyspnea that a patient experiences with activity.
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| Dyspnea Levels | This ordinal scale consists of ratings from 0 to 4. A patient at level 0 is able to perform an activity and count to 15 without any additional breaths required.
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| Dyspnea Levels Levels 1, 2, and 3 | require progressive extra breaths to count to 15. Level 4 indicates that the patient is unable to count while performing an activity.
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| Dyspnea Levels The test has | not been shown to be valid, however, can be used to measure progress or decline during a course of rehabilitation.
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| Six-Minute Walk Test | A tool used to determine a patientʼs functional exercise capacity. The patient walks as far as he or she can for a timed six minutes with rest periods permitted as necessary.
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| Six-Minute Walk Test | The tool is commonly used upon admission, discharge, and to monitor progress or decline throughout physical therapy. It allows for observation of heart rate and oxygen consumption during activity.
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| Six-Minute Walk Test | This tool is administered to various populations including those with cardiac impairments, pulmonary disease, geriatrics with chronic conditions, and patients recovering from orthopedic surgical procedures.
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| Motor Recovery | Fugl-Meyer Assessment
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| Fugl-Meyer Assessment An ordinal scale used to measure | recovery post CVA. The framework is based on Brunnstromʼs sequence of recovery.
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| Fugl-Meyer Assessment The five areas of assessment are | joint movement and pain, balance, upper extremity motor function, sensation, and lower extremity motor function. Each item tested within an area is assigned a score from 0-3.
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| Fugl-Meyer Assessment The maximum combined score for upper extremity and lower extremity motor function is | 100 and can be interpreted as a percentage of motor recovery. A score of 63 indicates approximately 63% return of motor function.
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| Pain | McGill Pain Questionnaire Numerical Rating Scale Visual Analogue Scale
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| McGill Pain Questionnaire | A pain assessment tool that is divided into four parts with a total of 70 questions.
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| McGill Pain Questionnaire Part 1 | Patient marks on a drawing of the body to indicate area and type of pain (internal or external)
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| McGill Pain Questionnaire Part 2 | Patient chooses one word that best describes the pain from each of the twenty categories
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| McGill Pain Questionnaire Part 3 | Patient describes pattern of pain, factors that increase and relieve pain
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| McGill Pain Questionnaire Part 4 | Patient rates the intensity of pain on a scale of zero to five. This tool can be used to establish a baseline, evaluate particular treatment regimens, and monitor progress. It is valid, reliable, and the most widely used pain assessment scale.
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| Numerical Rating Scale | A tool used to assess pain intensity by rating pain on a scale of 0-10 or 0-100. The 0 represents no discernable pain and the 10 or 100 represent the worst pain ever.
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| Numerical Rating Scale The information is used as a | baseline and should be reassessed at regular intervals in order to monitor progress. This scale is easy to administer, assess, and monitor.
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| Visual Analogue Scale | A tool used to assess pain intensity using a 10-15 cm line with the left anchor indicating “no pain” and the right anchor indicating “the worst pain you can have.”
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| Visual Analogue Scale . | The level of perceived pain is indicated on the line and is reassessed frequently over the course of physical therapy to record changes and progress, and to predict patient outcome
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| Visual Analogue Scale This scale can be highly sensitive | if small increments such as millimeters are used to measure the patientʼs point of pain on the scale.
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| The visual analogue scale is a valid tool | if measurements are taken accurately.
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| Self-Care and ADL- | Barthel Index Functional Independence Measure (FIM) Katz Index of Activities of Daily Living
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| - Barthel Index | A tool designed to measure the amount of assistance needed to perform ten different activities with a total maximum score of 100.
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| - Barthel Index activities include | bowel management, bladder management, grooming, toilet use, feeding, transfers, mobility, dressing, stairs, and bathing.
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| - Barthel Index A score of 75-95 | denotes mild impairment, 50-70 moderate impairment, 20-45 severe impairment, and below 20 indicates a very severe impairment.
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| - Barthel Index does not account for | cognitive or safety issues and is not sensitive to higher level patients regarding their level of disability.
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| - Barthel Index remains one of the | oldest and most widely used tools that is reliable and possesses predictive validity.
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| FIM | A tool that is primarily used in rehabilitation hospitals in order to determine a patientʼs level of disability and burden of care.
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| FIM part of the | Uniform Data System for Medical Rehabilitation (UDS).
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| FIM A seven-point scale | is utilized to examine 18 areas, which include self-care, sphincter control, transfers, locomotion, communication, and social cognitive activities.
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| FIM items were designed based on | the World Health Organizationʼs Model of Disability.
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| FIM Scoring between a 1 and 5 | denotes a level of dependence
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| FIM between 6 and 7 | a level of independence for a specific item.
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| FIM This tool is both | valid and reliable and is used as a predictor of disability for the CVA population. The FIM is utilized on a larger scale to assess change within rehabilitation programs over time.
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| Katz Index of Activities of Daily Living | A nominal scale index used to identify self-care problems and the level of assistance required with the six areas of bathing, dressing, toileting, transfers, continence, and feeding.
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| Katz Index of Activities of Daily Living | The score for each area is combined and the total score correlates with a letter grade scale (A through G).
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| Katz Index of Activities of Daily Living | Each letter represents a level of ability with “A” representing independence in all six areas, the following letters representing increasing dependence and “G” representing dependence in all six areas.
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| Katz Index of Activities of Daily Living was originally intended | only for inpatient and nursing home settings, however, it is now utilized with patients that require outpatient and community-based services.
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| Katz Index of Activities of Daily Living | It is a simple and quick assessment tool used to efficiently gather self-care information and predict outcome and need for ongoing assistance.
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