An Acute Care Physical Therapy Clinical Practice Database for Outcomes Research

Abstract

Clinical practice databases are frequently used to assess outcomes in various medical specialties. Formulating a computerized physical therapy medical record requires standardization of clinical assessments among the users. The purpose of this article is to describe an acute care physical therapy database system that emphasizes high-quality measures of function. The logic underlying the development of a physical therapy computerized medical record is described. Selected uses of the database are demonstrated by projects that assess data quality, generate clinical hypotheses, manage clinical data, develop clinical measures, and generate pilot data on patient variability. Patients seen in physical therapy for total joint replacement, pain, and decreased ambulation were studied to demonstrate some of the present capabilities of the database. Clinical practice databases contribute to the overall research mission, provided the data are of high quality. The use of databases in conjunction with randomized clinical trials may serve an important role in determining effective physical therapy interventions to reduce disability.

High intertester reliability of the Cumulated Ambulation Score for the evaluation of basic mobility in patients with hip fracture

“…22 Accordingly, the high reliability of the simple and standardized CAS score supports its clinical value in comparison with other more complex score systems, such as the Iowa Level of Assistance Scale, 23 also used in patients with hip facture, 24 that grade levels of assistance for each activity on a seven-point ordinal scale (0-6). 23 Thus, lower intertester reliability (weighted kappa 0.48-0.66) between four physiotherapists with 3-11 years of experience, and after 1 hour of daily training for five weeks, has been reported for activities similar to the three CAS activities when evaluated by the Iowa Level of Assistance Scale. 25 The value of the CAS between experienced and inexperienced score users is important since the same patient is often trained and evaluated by different experienced or less experienced physiotherapists (including physiotherapy students) during their inpatient rehabilitation in our ward.…”

Implementing an Integrated Electronic Outcomes and Electronic Health Record Process to Create a Foundation for Clinical Practice Improvement

“…The study included goal achievement, as perceived by physical therapists, as an outcomes measure. Later, Shields et al 18 demonstrated use of a physical therapy computerized medical record combined with numerous outcomes measurement instruments to assist in standardization of data and clinical research in an acute care setting. These studies and others 19 -22 had objectives similar to those of the current study: they described the use of electronic data retrieved from medical records and outcomes measurement tools to study relationships among patient characteristics, treatment processes, and outcomes.…”

Inter‐rater reliability for function and strength measurements in the acute care hospital after elective hip and knee arthroplasty

“…There has been increased emphasis on the use of functional measures for outcome assessment, particularly in the area of medical rehabilitation (1)(2)(3)(4)(5). Because there are an estimated 300,000 elective total hip and knee arthroplasty procedures performed each year in the United States, the development of objective criteria that evaluate progress during rehabilitation would be extremely useful to the orthopedic surgeons, rheumatologists, physiatrists, physical therapists, occupational therapists, and nurses who care for these patients.…”