OUTCOME MEASURESused at the Bobath CentreVirginia Knox MSc PGCE MCSPConsultant Physiotherapist and Bobath tutorApril 2013
Outcome measures at the Bobath Centre Outcome measures are used at the BobathCentre This presentation explains what outc...
Outcomes ‘Hard’ outcomes typically refer to data that can be quantified (i.e.put into numbers) e.g. a child shows improv...
Outcome measures - definitions ‘a measure of change, the difference from one point in timeusually before an intervention,...
How do we use Outcome measures at the BobathCentre? ‘Occasional’ children attending for 2 weeks of therapy If it is poss...
Clinical Audit of Outcome Measures Each year we record how many outcome measures wereused and how many children showed im...
Examples of outcome measuresused at the Bobath Centre
Canadian Occupational Performance Measure COPM Purpose? To detect change in a client’s self-perception ofoccupational per...
Goal Attainment ScalingKiresuk, Smith & Cardillo, 1994Purpose: A structured way to measure change usingindividualised goa...
Example of GAS goalGoal Score Score at endof therapyTo stand still and put jacket on andzip it up himself+2To stand still ...
Gross Motor Function MeasureRussell et al, 1989 Purpose: to evaluate change in gross motor function in childrenwith cereb...
Assisting Hand Assessment AHA Purpose: This measures how effective a child makes use of theassisting hand during two-hand...
Melbourne Assessment Purpose: To measure quality of upper limb function in one arm, inchildren with cerebral palsy aged 2...
Spinal Alignment & Range of Motion MeasureSAROMM Purpose: to give an overall score of spinal posture (alignment) andrange...
Spinal Alignment and Range of MotionMeasure SAROMM0 = Full ROM (i.e. neutral hip ext.) and no hip flexion postureHip flexi...
SAROMM0 = No alignmentlimitations2 = Mild1 = Scoliosis and/or ribhump observed butcan be correctedpassivelyNon reducible s...
Chailey levels of Ability Purpose: assesses level of postural ability in children with cerebral palsy forlying, sitting a...
Pediatric Evaluation of Disability InventoryPEDI Haley et al, 1992 Purpose: To measure functional skills (what the child ...
Caregiver Priorities and Child Health Index of Life with DisabilitiesCPCHILD Narayanan et al, 2006 Purpose? To measure he...
Care & Comfort Hypertonicity Questionnaire CCHQNemer McCoy et al, 2006 Purpose? To assess the degree of difficulty in car...
Pediatric Pain Profile Hunt et al, 2004 Purpose? To identify the frequency of behaviours that mightindicate a child is in...
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Outcome measures used at the Bobath Centre

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Outcome measures used at the Bobath Centre

  1. 1. OUTCOME MEASURESused at the Bobath CentreVirginia Knox MSc PGCE MCSPConsultant Physiotherapist and Bobath tutorApril 2013
  2. 2. Outcome measures at the Bobath Centre Outcome measures are used at the BobathCentre This presentation explains what outcomemeasures are, which ones we use and howwe use them
  3. 3. Outcomes ‘Hard’ outcomes typically refer to data that can be quantified (i.e.put into numbers) e.g. a child shows improved motor function on an outcomemeasure; quality of life of child and/or family improved asdemonstrated by improved scores on a standardised CP qualityof life measure ‘Soft’ outcomes often intangible and hard to measure directly likeimproved self esteem or confidence or belief you could dosomething better, or may represent intermediary stages on the wayto achieving ‘hard’ outcomes, e.g. a family wrote saying that the visit meant a lot to them andwas very supportive, and they understood their child’s difficultiesbetter At the Bobath Centre, we focus on ‘hard’ outcomes to showquantifiable change, but also record ‘soft’ outcomes as these cangive helpful feedback from families and children on our services
  4. 4. Outcome measures - definitions ‘a measure of change, the difference from one point in timeusually before an intervention, to another point in time usuallyfollowing an intervention’Kendall, 1997 ‘a test or scale administered and interpreted by therapists thathas been shown to measure accurately a particular attribute ofinterest to patients and therapists and is expected to beinfluenced by intervention’Mayoet al, 1994
  5. 5. How do we use Outcome measures at the BobathCentre? ‘Occasional’ children attending for 2 weeks of therapy If it is possible to find a relevant outcome measure which will be sensitiveenough to show change in a short period, we administer a test or onepart of a test, at the beginning and end of the 2 weeks If this is not possible, we use Goal attainment scaling to set GAS goals Children attending on a more regular basis, e.g. once aweek over several months Administer an outcome measure once a year or at the beginningand end of their block of therapy Outcome measures may be used more frequently if we want torecord progress before and after other interventions such assurgery or Botulinum toxin injections
  6. 6. Clinical Audit of Outcome Measures Each year we record how many outcome measures wereused and how many children showed improved scores This information is compared against pre-set targets toensure we are continuing to use measures frequently, andto see if we are increasing the frequency of use Therapists receive specific training on an annual basis tohelp them further develop their skills in using outcomemeasures, and the clinical audit can help us determinewhere training is particularly needed
  7. 7. Examples of outcome measuresused at the Bobath Centre
  8. 8. Canadian Occupational Performance Measure COPM Purpose? To detect change in a client’s self-perception ofoccupational performance over time How? An interview with the parent, carer or child to: Identify activities that are difficult to do, or to do wellThen to rate these activities on 10 point scales: Importance (priority) How well the activity is being performed How satisfied the client/parent is with the activityThe rating is repeated after intervention, e.g. 2 week block of therapy Who do we use it with? Often with teenagers to help them engage in therapy and set their owngoals Or to help set goals with parents of children with more severe limitations intheir activity and monitor their progress
  9. 9. Goal Attainment ScalingKiresuk, Smith & Cardillo, 1994Purpose: A structured way to measure change usingindividualised goals How? Goals are identified after discussion with parents andfamilies. The goal is put onto a scale with five possible outcomes: 0 = expected level of attainment – what the therapist is aiming forthe child to achieve at the end of the therapy -1 and -2 are two levels which are less favourable but still animprovement from where the child started +1 and +2 are two levels which are more favourable than theexpected level of achievement at the end of therapy
  10. 10. Example of GAS goalGoal Score Score at endof therapyTo stand still and put jacket on andzip it up himself+2To stand still while jacket is put on byparent and then zip up jacket himself+1 To stand still while jacket is put on byparent0To stand still for 30 seconds -1To stand still for 15 seconds -2
  11. 11. Gross Motor Function MeasureRussell et al, 1989 Purpose: to evaluate change in gross motor function in childrenwith cerebral palsy aged 5 months to 16 years How? The child is observed attempting lots of different gross motoractivities within 5 areas:1. Lying & rolling 4. Standing2. Sitting 5. Walk, run & jump3. Crawling & kneeling Who do we use it with? Any child with cerebral palsy where we are working on improving gross motorskills It is slightly less sensitive with children either with very mild or very severelimitations in their activity so might not be used with those children
  12. 12. Assisting Hand Assessment AHA Purpose: This measures how effective a child makes use of theassisting hand during two-handed activities. It is used withchildren with hemiplegia (cerebral palsy affecting one side of thebody), aged 18m to 12 years. How? A video is taken of a play session using specific toys which wouldtypically require the use of two hands The child is not instructed to use their affected hand – the test looksat their spontaneous typical use of that hand Who do we use it with? Any child with hemiplegia wheretherapy is aiming to improve hand function
  13. 13. Melbourne Assessment Purpose: To measure quality of upper limb function in one arm, inchildren with cerebral palsy aged 2-15 years How? A video is taken of the child performing different tasks, such asreaching and pointing, grasping different objects, manipulatingobjects and a variety of functional tasks, like taking a biscuit totheir mouth. This is then scored for different aspects like range of movement,accuracy, smoothness of the movement and speed Who do we use it with? Children where therapy is aimed atimproving hand and arm function or sometimes to see if wearing asplint or lycra garment changes the level of hand function
  14. 14. Spinal Alignment & Range of Motion MeasureSAROMM Purpose: to give an overall score of spinal posture (alignment) andrange of movement in upper and lower limbsHow? Spinal alignment (posture) is observed and compared to photographsand rated on a 4 point scale Range of motion (ROM) for lower limb joints and upper limbs aremeasured with a goniometer according to specific instructions and theranges recorded on a 4 point scale Total spinal & ROM scores and an overall total score are calculated Who do we use it with? Children and teenagers where improvingmobility is a focus of therapy, e.g. an adolescent child who has recentlybeen getting significantly stiffer
  15. 15. Spinal Alignment and Range of MotionMeasure SAROMM0 = Full ROM (i.e. neutral hip ext.) and no hip flexion postureHip flexion posture1 = Full PROM (ie. >0 hip ext.)Limitation of hip extension2 = Mild (Neutral to 15°)3 = Moderate (15° – 30°)4 = Severe (>30°)Thomas Test
  16. 16. SAROMM0 = No alignmentlimitations2 = Mild1 = Scoliosis and/or ribhump observed butcan be correctedpassivelyNon reducible scoliosis & rib hump3 = Moderate 4 = Severe
  17. 17. Chailey levels of Ability Purpose: assesses level of postural ability in children with cerebral palsy forlying, sitting and standing. They can also be used to determine which type ofequipment, e.g. seating, helps the child achieve the highest level of posture,e.g. Can the child only be placed in sitting, or can they get in and out of sittingfor themselves; can the child lie on their back and use their hands forplay How? The child is observed in different postures, looking at the posturethey adopt, how they move, which parts of the body are taking weight, etc. Who do we use it with? Children with more severe limitations to theirposture to monitor progress in their postural ability, and sometimes todetermine if different equipment or a lycra garment influence their posturalability
  18. 18. Pediatric Evaluation of Disability InventoryPEDI Haley et al, 1992 Purpose: To measure functional skills (what the child can do) and alsothe amount of assistance a parent/caregiver typically has to give achild in everyday activities in three areas: Self care, e.g. eating, bathing, dressing Mobility, e.g. moving around indoors, transfers Social function, e.g. play, problem solving How? The parent/carer completes a questionnaire with a therapist orcompletes a computerised assessmentWho do we use it with? Children attending the Centre on a regularmore long term basis to measure change particularly in self care andlevel of mobility
  19. 19. Caregiver Priorities and Child Health Index of Life with DisabilitiesCPCHILD Narayanan et al, 2006 Purpose? To measure health related quality of lifeincluding the child’s health and how functional activitiesare affected like personal care, positioning, transferring,mobility, communication and comfort, and how much thecaregiver has to help the child with these activities How? A questionnaire for the caregivers of children, atthe beginning of a block of therapy and then repeated afew weeks after returning home. Who do we use it with? Children with more severelimitations in their activity (GMFCS IV & V)
  20. 20. Care & Comfort Hypertonicity Questionnaire CCHQNemer McCoy et al, 2006 Purpose? To assess the degree of difficulty in carrying out specificpersonal care activities and whether there is any discomfort or painduring such activities, e.g. Is there pain or discomfort during nappychanges? Ease of getting in/out of wheelchair How? A questionnaire with a rating scale for parents/carers Who do we use it with? Parents/carers of children with morestiffness, pain or discomfort which we think may change withtherapy
  21. 21. Pediatric Pain Profile Hunt et al, 2004 Purpose? To identify the frequency of behaviours that mightindicate a child is in pain, where they cannot easily communicatethis for themselves e.g. had disturbed sleep, difficult to feed, bit self,pulled away when touched, etc. How? A 20 item rating scale completed by parents or carers. Who do we use it with? Parents/carers of children where painand discomfort are an important issue e.g. monitoring of ongoing musculoskeletal or other conditions likely toresult in pain, e.g. a hip which is disclocating and where we think a child’s level of pain may be influenced and reduced bytherapy

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