You’ve heard about outcome measures, so how do you use them? Integrating clinically relevant outcome measures in orthotic management of stroke

Robinson, Carol; Fatone, Stefania

doi:10.1177/0309364612446650

Cited by 19 publications

(23 citation statements)

References 39 publications

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“…For example, despite even optimal management of diabetes those with a diagnosis are more likely to develop diabetic peripheral neuropathy (DPN) with an increase in age and duration of diabetes [29] increasing the risk of ulceration and amputation [30]. The difficulty collecting and recording OMs with changing clinical pictures, like diabetes, is also noted by professionals providing care in conditions, such as stroke [31].…”

Section: Discussionmentioning

confidence: 99%

An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

Hall

Parker

Williams

2020

Preprint

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Background: Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely record outcomes to demonstrate efficacy of services. This research aimed to explore orthotic service professional perspectives on outcomes in orthotic practice. A secondary aim was to explore potential barriers to the routine use of outcome measure tools in practice.Methods: Following a review of the literature, an initial advisory group involving experts in the field was conducted. From this, semi-structured questions were developed, and a focus group was undertaken. Data from the focus group was transcribed and analysed using thematic analysis, creating themes and subthemes for discussion.Results: The participants considered a successful outcome as a ‘usable’ orthosis, this linked to a preference for evaluation of patient reported outcomes. The setting of realistic joint goals via patient education was seen as a method of improving outcomes. Barriers to collection of data were associated with inadequate technology to manage the ‘data burden’, lack of clinical time to complete and difficulties selecting outcome measure tools for a varied population. Issues around usability of current outcome measure tools were also highlighted. Participants discussed ways of addressing these barriers, such as the use of ‘snapshots’ and delegation of data collection. Conclusions:This research is unique in that it is the first-time orthotic service professional opinions have been analysed specifically relating to outcomes, outcome measure tools and possible barriers to their use. The participants acknowledged the relevance of outcome measure tools, identified barriers to use but had created novel ways to address barriers. Further, they indicated that to achieve good outcomes it was important to address service user expectations of treatment, discuss and establish joint goals for care at the outset and communicate/ educate on the clinical reasoning process. This research has contributed to current knowledge within the field of orthotics and may provide a theoretical basis for future research in the field.

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Section: Discussionmentioning

confidence: 99%

An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

Hall

Parker

Williams

2020

Preprint

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“…On an individual basis, the use of an OM can be helpful to capture changes in a patient's status following a particular intervention or when monitoring patients over longer periods of time, such as follow ups or annual reviews. 6 This information can be shared with the patient to demonstrate progress throughout rehabilitation, and increase motivation, or can be used by the clinician to direct treatment planning or inform funding requests. 4 A more organised approach to outcome measurement along a pathway of care can be described as routine outcome measurement (ROM).…”

Section: How Is Outcome Measurement Useful?mentioning

confidence: 99%

“…One approach taken by a number of authors is to identify and explore possible outcome constructs related to health using a framework like the International Classification of Functioning. 6,13 These studies have yielded large numbers of constructs which may be impractical to measure clinically, and do not give an indication of which constructs could be most meaningful to prosthetic users themselves.…”

Section: Barriers and Facilitators For Outcome Measurement In Clinicamentioning

confidence: 99%

“…A health outcome can be defined as a change in a person's health status as a result of an intervention 5 and a measurement tool as a standardised instrument used in research and clinical practice to capture and evaluate this change. 6 The inherent usefulness of information concerning health outcomes in understanding the effectiveness and value of costly health care interventions might go some way to explaining why, despite implementation issues, these authors often hear clinicians working in prosthetic rehabilitation discussing `What OMs do you use?' `When do you use them?'…”

Section: Introductionmentioning

confidence: 99%

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From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

Ostler¹,

Scott²,

Sedki³

et al. 2020

Preprint

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Background: Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional encouragement outcome measurement has failed to become embedded in clinical practice and its value continues to be questioned. Objectives: To address the outcome measurement debate within lower limb prosthetic rehabilitation and provide a critical synthesis of the evidence surrounding the discussion applied within the clinical context of the UK National Health Service (NHS).Study Design: Narrative review Methods: The authors drew on over 20 years clinical experience in prosthetic rehabilitation to synthesise and critique the outcome literature across a breadth of healthcare services. A narrative review methodology was selected to give voice to the clinical narrative thread.Results: This review addresses why we should measure health outcomes, the health care delivery and organisational scenarios in which outcome measurement can be beneficial and explores where lessons can be learnt for prosthetic rehabilitation from approaches in different specialities. The current outcome measurement literature within prosthetic rehabilitation is critiqued and we discuss the issues facing this field in the future.Conclusions: The dilemma of successful outcome measurement in clinical practice is multifaceted. Understanding and embedding value at every step is key to success. Addressing the questions of `why’, `what’ and `how’ we measure outcome will move us closer to a national consensus. Routine outcome measurement implementation at the clinical level must ensure data collection is valuable to clinical practice, makes use of IT solutions and has all important organisational buy in.

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“… 2 , 3 The increasing number of ICF-related publications in P&O subject areas is an indication of rising acceptance by the field: specific studies have linked the content of clinical outcome measures to ICF, 4 developed P&O specific core sets 2 , 5 and recommended instruments for addressing elements of the ICF. 6 – 10 Studies have also used ICF as a framework for reviews, 11 , 12 clinical trials 13 and reported experiences of implementing ICF in clinical practice. 14 , 15 Given growing acceptance in many medical and allied health professions and the holistic nature of the concepts contained within the ICF, the authors consider it to provide a useful framework for developing a P&O process model to guide the clinical decision-making process.…”

Section: Introductionmentioning

confidence: 99%

A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics

Jarl

Ramstrand

2018

Prosthetics &Amp; Orthotics International

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Background:The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model.Proposed model:A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient’s satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.Conclusion:The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice.Clinical relevanceThe Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

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You’ve heard about outcome measures, so how do you use them? Integrating clinically relevant outcome measures in orthotic management of stroke

Cited by 19 publications

References 39 publications

An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics

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