Functional Assessment: Effective Evaluation Tools

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Functional AssessmentEffective Evaluation Tools

• Susan Hillier
• University of South Australia
• Centre for Allied Health Evidence

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Why?

• To evaluate human behaviour
• in a functional, meaningful manner
• For the client, the service provider, the funder
• To establish management and intervention plans
• Compare an individual performance with another
• Compare the individual with changes within
  themselves
• after an intervention
• in a progressive illness

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What?

• Quantitively or qualitatively
• Can use the WHO model
• Impairment
• Activity restriction
• Participation restriction Quality of Life
• Depends on the question to be answered????

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Impairment

• Strength weakness
• Range of movement flexibility
• Muscle tone
• Sensation vision - vestibular
• Coordination
• Aerobic
• Cognition etc

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Activity restrictions

• Specific functions in various environments
• In parts or strategies or in toto, often
  simulated
• Upper limb function
• ADLs
• Mobility gait, transfers, higher order,
  wheelchair
• Orofacial speech swallowing

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Participation restrictions (QOL)

• Life roles
• Vocation
• Recreation
• Relationships
• Work, love and play

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How?

• Objective tests clinical tests, simulations
• Self reports
• Reports from significant others

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How many?

• Validity
• Reliability inter and intra rater
• Sensitivity ceiling and floor effects
• Normalisation
• Standardisation
• Significance - Prediction
• (ref Portney LG, Watkins MP. Foundations of
  clinical researchApplications to practice.
  Norwalk, Connecticut Appleton and Lange, 1993.)

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So what?

• Use (or become) experts
• May need to cast a wide net
• Understand your population
• Be clear about the questions you are asking
  clinical, research, tracking, feedback for
  clients, for funders etc
• Trial different assessments
• go to the literature
• ask expert opinion
• dont necessarily follow the herd

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Outcome measurement and EBP

• Measuring outcomes via functional assessment is
  an underpinning of EBP
• Evidence based practice incorporates best
  available evidence from
• the research literature,
• clinical experience and
• individual needs (Sackett, 1992)
• Make clinical decisions using these three and
  re-evaluate via outcomes

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Outcome.

• The term incorporates the health gain and costs
  associated with treatment
• This can involve an episode/s of care (linked
  occasions of service)
• Most routinely collected as cost, number of
  client contacts
• Now broadening to include change in client status
  as per functional assessments

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Common examples

• Global measures
• Barthel Index
• FIM
• FAM
• SF-36 Health Status Questionnaire
• Glasgow outcome scale
• Patient Specific Scale
• Goal Attainment Scales
• AQoL WHO-QoL

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Upper limb

• Fugl Meyer
• Purdue pegboard
• ARAT
• MAS (parts)
• Jebsen
• Activities diary
• Aspects of FCEs

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Mobility

• Rivermead
• MAS (parts)
• COVS (parts)
• Distance and temporal measures speed, step and
  stride length, cadence
• Six minute walk test

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Balance

• MAS (parts sitting and standing)
• Berg
• FRT and other reach tests
• TUGT
• CTSIB

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Tests for specific conditions

• Parkinsons
• Injury severity
• Rivermead stroke
• Tests for PTA
• DHI
• Nordic pain
• Other visual analogue scales

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Outcomes calculator - CAHE

• www.unisa.edu.au/cahe
• The outcome measures contained within the
  Outcomes Calculator have been selected based on
  their validity, reliability, sensitivity to
  detect change over time and clinical utility for
  patient populations frequently treated by
  physiotherapists. They represent a range of
  aspects of functioning / disability, which are
  measured at the level of body functions /
  structure, the individual and society, as defined
  by the International Classification of
  Functioning. Outcome instruments include
• Joint range of movement
• Neck Disability Index
• Graded Chronic Pain Scale
• Patient Satisfaction subscales
• Patient Specific Scales
• Glasgow Pain questionnaire
• Roland-Morris questionnaire
• Oswestry questionnaire
• Timed Up and Go Test
• WL-26 / WL27

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Useful References

• CAHE website outcomes calculator
• Other websites http//www.tbims.org/combi/index.ht
  ml (for brain injury) or http//www.tac.vic.gov.au
  / and search for Physical therapy resources.
• Portney and Watkins (1993) Foundations of
  clinical research. Norwalk, Connecticut Appleton
  and Lange.
• Manual for clinical outcome measurement in adult
  neurological physiotherapy (2001) 2/E, APA
  Neurology Special Group (Vic). Copies at
  placement.
• Many other textbooks discipline specific