Reasons For Objective Outcomes

OUTCOMES ASSESSMENT TOOLS

Lifestyle And Disability Questionnaires

Doctors and therapists are often faced with requests for information regarding services offered and estimates of success rates. Requests from payers, employers, patients or referring physicians regarding outcome data documenting the impact of care on patients health and well-being are on the rise. This module reviews some of the outcomes tools that could be utilized in evaluating the effect of your practice on the health of your patients.

Validity & Reliability

Outcomes researchers have defined methods to evaluate the validity and reliability of their questions by examining the responses of standard populations. The extent to which a question measures what it was intended to defines validity. Reliability defines the stability of a measurement. Using archery as a metaphor, reliability is symbolized by the scatter of the arrows, and validity is portrayed as how close you can get to the target and hit the bull's eye. The outcomes instruments presented in this module have been field tested to determine their validity and reliability.

Outcome Assessment Tools

Outcome tools can be used to aid you when setting goals for your patients care. These tools provide measures to evaluate the patients ability to function with everyday activities of daily living.

Outcome Assessment Tools

The Questionnaires
Form 500 Revised Oswestry Questionnaire Form 501Neck Disability Index Form 502 Henry Ford Headache Disability Index Form 503 Roland-Morris Activity Scale Form 504 Visual Pain Diagram and Visual Analog Scale Form 505 Numerical Rating Scale Form 506 Carpal Tunnel Questionnaire Form 507 Shoulder Pain Score Questionnaire Form 508 Abbreviated McGill Pain Questionnaire Form 509 Chiropractic Satisfaction Questionnaire Forms 510-512 Dartmouth Primary Care COOP Chart System Form 513 Lysholm Knee Rating Scale Form 514 Neck Bournemouth Form 515 Back Bournemouth

Form 500 Revised Oswestry Questionnaire

Developed in the 1970's within a hospital spine unit in England. Ten categories Each category has six ranked questions with statements scored from 0 to 5. Total possible score is 50 points. The final score is then expressed as a percentage of 100.

Revised Oswestry 10 Categories

1. Pain Intensity 2. Personal Care 3. Lifting 4. Walking 5. Sitting 6. Standing 7. Sleeping 8. Social Life 9. Traveling 10. Changing Degree of Pain

Each Section Has 6 Boxes

The upper box in each section indicates no disability and is worth 0 points The next box indicates minimal disability and is worth 1 point The next box indicates mild disability and is worth 2 points The next box indicates moderate disability and is worth 3 points The next box indicates severe disability and is worth 4 points The last box indicates complete disability and is worth 5 points

Oswestry Disability Index Scoring

0% to 5%: No Disability 2 % to 20%: Mild Disability 20% to 40%: Moderate Disability 40% to 60%: Severe Disability 80% to 100%: Crippled

Form 501 Neck Pain Disability Questionnaire

Structured and scored the same as the Oswestry. 0 8%: No Disability 10 28%: Mild Disability 30 48%: Moderate Disability 50 68%: Severe Disability > 70%: Complete Disability

Form 502 The Henry Ford Hospital Headache Disability Index

25 statements describing behavior that may be affected by the patient's headaches. 13 E Questions = Emotionally based questions: 1, 3, 5, 6, 8, 9, 10, 11, 12, 14, 20, 22, 23 12 F Questions = Functionally based questions: 2, 4, 7, 13, 15, 16, 17, 18, 19, 21, 24, 25 Yes 4 pts, Sometimes 2 pts, No 0 pts

3 Headache Disability Index Scores

TOTAL SCORE Total sum of E + F questions Total possible score (100) FUNCTIONAL SCORE Total sum of the F questions Total possible score (48) EMOTIONAL SCORE Total sum of the E questions Total possible score (52)

Headache Index Interpretation

TOTAL SCORE (100 Points Possible) 34 61 Points Mild Moderate > 61 Points Severe FUNCTIONAL SCORE (48 Points Possible) 18 31 Points Mild Moderate > 31 Points Severe EMOTIONAL SCORE (52 Points Possible) 14 29 Points Mild Moderate > 29 Points Severe

Form 503 Roland-Morris Activity Scale

A low back pain disability scale. Each item the patient checks receives one point. Add the points to achieve a total score Ranges from 0 24 A score of over 14 is associated with a poor prognosis.

Roland-Morris Scoring
15 6 10 11 14 15 19 20 24 Minimal Moderate Severe Crippled Bed Bound

Form 504 Visual Pain Diagram

OUTCOMES ASSESSMENT OF PAIN

Gives insight as to the tissue structures involved: Neurological Give characteristic symbols of numbness tingling, pins & needles Articular/Joint Complex Represent sharp, knife-like, stabbing sensation Myotoganous/Muscular Depict dull, burning, aching, stiffness sensation

Pain Diagram Multifunctional Use

Quantifying pain is an essential component of reporting outcomes. The Visual Pain Diagram has clinical, psychological, and outcomes assessment based uses. Evaluate the Pain Diagram for widespread depiction of symptomatology specifically with nonorganic anatomical source of pain. Visual Pain Diagrams not consistent with the patient's mode of onset derived in the history should be suspect of potential psychological influences.

Pain Diagram Unreal Drawings (Poor Anatomical Localization)

Total leg pain (2 pts) Whole lateral leg pain (2 pts) Circumferential thigh pain (2 pts) Bilateral anterior tibial pain (2 pts) Circumferential foot pain (1 pt) Bilateral foot pain (1 pt) Use of four adjectives (1 pt) Example: burning, stabbing, pins & needles, numbness

Pain Diagram Magnification of Pain

Back pain radiating to the iliac crest, groin, anterior perineum. Coccygeal pain allowed. (1 pt.) Anterior knee pain (1 pt.) Anterior ankle pain (1 pt.) Pain drawn outside the line (1 and/or 2 pts.)

Pain Diagram "Hurts Here" Indicators

Adds explanatory notes (1 pt.) Circles painful areas (1 pt.) Draws lines to demarcate painful areas (1 pt.) Use of arrows (1 pt.) Goes to excessive trouble and detail to demonstrate painful areas (1 pt.)

Pain Diagram "Look How Bad I Am" Indicators

Additional painful areas noted within the trunk, head, neck and upper extremities Tendency toward total body pain depiction. (1 pt.) if limited to small area (2 pts.) if expanded to large areas

Form 504 Visual Analog Scale (VAS)

Linear scale measuring 100 mm in length with two pain descriptions at its ends; left indicating no pain and right indicating severe pain. The patient is asked to place a mark along the horizontal linear scale which best reflects the pain intensity.

Form 505 Numerical Rating Scale

A subcategory of the visual analog scale Numerical rating scales give patients defined numerical increments NRS 11 Scale of 110 NRS 101 Scale of 1100

Form 506 Carpal Tunnel Questionnaire

Eleven questions with five responses each. Responses have a five point range 1 represents mildest and 5 represents most severe.

Scoring Carpal Tunnel Questionnaire

The individual points are then added and the mean is computed. Calculate the mean by dividing the total points scored by total number of responses (eleven possible). The mean represents the total score. The higher the mean score the more severe the patients symptoms.

Form 507 Shoulder Pain Score

A combo VAS/NRS 101 is used to document pain level. The patient marks a line between 0 (no pain) and 100 (unbearable pain) representing the amount of pain that he or she feels. The scale is set up so that patients with lower scores have less pain than patients with higher scores on the test. The minimum score is 7 and the maximum score is 28.

Shoulder Pain Scoring

None Light Pain Average Pain Severe Pain 1 point 2 points 3 points 4 points

Form 508 Abbreviated McGill

Since 1975, the McGill Pain Questionnaire (MPQ) has become the standard for quantitative profiling of a patient's pain. A self-administered test comprised of a list of words describing pain. Add points to obtain a Pain Rating Index (PRI) for each category as well as a total score. The first word in each subclass is given the value 1, the next word is given the value 2, and so on. Example: First subclass Flickering = 1, Quivering = 2, Pulsing = 3, Throbbing = 4, Beating = 5, and Pounding = 6.

Form 509 Chiropractic Satisfaction

14 item measure of satisfaction Includes interpersonal quality, technical quality, time spent with the chiropractor, cost of care, and overall satisfaction with care.

Forms 510-512 Dartmouth Primary Care Coop

Similar to Snellen charts, used to measure visual acuity Each Chart consists of a title, a question referring to the status of the patient over the past 2-4 weeks, and 5 response choices. Each response is illustrated by a drawing that depicts a level of functioning or well being along a 5 point scale. The illustration makes the Charts appear "friendly.

Form 513 Lysholm Knee Rating Scale

Consists of 8 sections that cover all areas of knee function. The knee rating scale is scored out of a possible 100 points. The lower the patients score, the greater the patients disability.

Lysholm Knee Rating Scoring

Poor Fair Good Excellent < 65 points 65 83 points 84 90 points 90 + points

Instability in sports and almost all ADLs Problems during sports Minor limitations No problems

Forms 514 & 515 Bournemouth Questionnaires

Works under the assumption that neck and back pain are lifestyle illnesses, rather than "diseases." Contains 7 core items: Pain Intensity, Disability in ADLs, Social Activities, Anxiety, Depression, Fear Avoidance, & Locus Of Control.

Bournemouth Questionnaires
A score of 0 to 10 is possible for each of the seven categories. 70 represents the highest disability score and 0 the best score.

Functional Goal Setting

Outcomes Assessment Questionnaires can be used as a component in setting functional goals for the patient. All categories scored greater than 0 points can be used as functional goals. Those categories scored the highest are prioritized as the highest goals. The functional goal is to move down the list, decreasing in severity.

Revised Oswestry Questionnaire

Section 5: Sitting I can sit in any chair as long as I like. I can only sit in my favorite chair as long as I like. Pain prevents me from sitting more than one hour. Pain prevents me from sitting more than 30 minutes. Pain prevents me from sitting more than 10 minutes. Pain prevents me from sitting almost all the time.

How to Write a Goal

Increased Tolerance to Return to Normal Name ADL For a Duration of Time By When. Increased tolerance to sitting for up to 60 minutes within the next 4 weeks.

When To Administer
Administer Form 504 Symptom Diagram and Visual Analog Scale at the first visit and at each re-exam. Administer the area-appropriate Outcomes Assessment Form at the second office visit. Re-administer the Forms at the final re-exam and any time an insurance company requests a progress report.

OUTCOMES ASSESSMENT TOOLS

Lifestyle And Disability Questionnaires