OCS Outcome measures & testing for OCS – Flashcards

MCID is 10 points (out of 100) (some sources say 6 points) or 30% from baseline. Avg. for acute LBP is 20-25%, mean for starting PT is 40%. 10 sections, 1 section for pain severity and the other 9 representing various functional activities, each has 6 responses score 0-5

Alternative to ODI, MCID is 5 points or 30% change from baseline. Derived from generic Sickness Impact Profile by choosing 24 items that appeared to have face validity in describing LBP. Pts asked to gauge whether each of the 24 ietms is possible to accomplish.

10 items addressing different aspects of fxn, each scored from 0-5, max score of 50 points. Reliable and valid. MDC 5-9.5 points (10- 19.6%) most recent conclusion was 10% for MDC, MCID b/w 5-19points (10pts seems to be the standard). criticized for not adequately capturing low levels of disability (potential for a floor effect) and for not being responsive to small, but clinically important, changes in patientswith low levels of initial disability. Scores > 60% seem to indicate pts may have substancial nonmovement componenet to their sx that may not respond to management that focuses exclusively on movement-related strategiest. Extremely high score = yellow flag as pt's perceptions may be influenced by psychosocial factors, could also be serious neck cond. not all high scores represent a reason to refer out.

16-item scale, measures level of fear of mvt and beliefs regarding need to avoid activity. Higher scores indicate higher levels of fear-avoidance. 2 subscales: work and PA. Work subscale score ranges b/w 0-42. Scores > 34 in pts w/ work-related LBP should raise concerns about prolonged disability and may indicate need for a multidisciplinary approach, FABQ-W scores > 18 assoc w/ reduced likelihood of success w/ manip. The PA subscale contains 4 items, score range from 0 to 24. Scores above 13 to 14 on PA subscale may benefit from a cognitive behavioral approach to classification-based therapy, including a de-emphasis on the patient's pain and establishment of specific exercise goals agreed on by the patient and therapist

The pragmatic advantage of the numeric pain rating scale is the ease of scoring without any measurement of the length of a line. useful for judging the acuity of the patient's symptoms and monitoring the effectiveness of txs. MCID on a 0 to 10 numeric pain rating scale= 1.3 points and MDC is 2.1

Alternative to measure fxnl limits in pts w/ neck pain. Captures pt's specific functional limits, suggested to be more responsive outcome than NDI. Reliable, valid, responsive. Pts asked to ID up to 5 important activities that are limited as a result of their neck pain. Fxnl limitation rated by pt on 11pt numeric scale anchored on left w/ phrase "unable to perform activity and on right w/ "able to perform same level as b4'. Avg score for up to 5 activites is established as the overall score. MDC for pts w/ mechanical neck pain and no radicular sx is 1 pt on 11 pt scale. MCID of 2 points and MDC is 2.1pts. Valid for pts w/ knee, neck, and LBP. Can be used for thoracic p, but hasn't been validated for that yet.

measure of patient perception that asks people to rate the change in their symptoms at a 12-month follow-up compared with 12 months earlier (ie, at baseline). The question reads, "Please imagine how you would have described your OVERALL health status 1 year ago. How do you feel in general today as compared to 1 year earlier as far as your osteoarthritis of the left/right hip is concerned?" The GRCS has 15 possible answers, ranging from +7 ("a very great deal better") to −7 ("a very great deal worse").

The DASH Outcome Measure is scored in two components: the disability/symptom section (30 items, scored 1-5) and the optional high performance Sport/Music or Work section (4 items, scored 1-5). he QuickDASH is scored in two components: the disability/symptom section (11 items, scored 1-5) and the optional high performance sport/music or work modules (four items, scored 1-5). The intended population for the DASH is any pt w/ 1+ UE musculoskeletal disorders. QuickDASH designed to be used on patients presenting with one or more disabilities of the arm, shoulder, and hand. On both, higher score= higher disability. Both are valid and reliable. MDC for DASH is 12.75%-17.23%, QuickDASH is 11.2% w/ MCID 8%

applicable to LE musculoskeletal conditions including the hip and total knees. Excellent reliability and has construct validity. 20 different activities, scores range 0-80 (max fxn), MCID and MCD both 9 points.

KOS-ADLS: pt self report measure of fxnl limits & impairments of knee during ADLs. 7 times related to sx, 10 to fxn, each scored 0-5 & total score expressed as % (lower %= greater disability). MDC is 8.87 has higher internal consistency than Lysholm Knee scale, responsive for assessment of fxnl knee limits

for pts w/ knee and hip OA, it's sensitive, specific and valid. ordinal scale w/ 24 questions (5pain, 2 stiffness, 17 physical fxn) assigned score b/w 0 (extreme) and 4 (none). Raw score ranges 0 (best) to 96 (worst). Raw score normalized by multiplying it by 100/96 to give score b/w 0% (best)-100% (worst). MCID reported in range of 12%-22% change from baseline.

the Blankenship system, ERGOS work simulator, the Ergo Kit, and the Isernhagen (only this one has established interrater reliability and predictive value)

1. "During the past month, have you often been bothered by feeling down, depressed, or hopeless" 2. "During the past month, have you often been bothered by little interest or pleasure in doing things?". No to both means depression highly unlikely, yes to 1 or both raises suspicion of depressive sx.

Psychosocial distress. Can also use 5 item CPR to ID pts w/ LBP who are at risk for long-term fxnl limitations: feeling everything is an effort, trouble getting breath, hot/cold spells, numbness/ tingling in parts of body, and pain in heart/chest at elevated risk for poorer 2yr outcomes

asses extend of catastrophic cognitions d/t LBP. p catas. defined as exaggerated neg. orientation toward actual or anticipated p experiences. 13-itms w/ range of 0-52, higher =more catas'ing. Assess 3 indep. dimenisions of catas'ing: rumination (worrying, inability to inhibit pain related thoughts), magnification (magnification of unpleasantness of p situations & expectancies for neg. outcomes), and helplessness (inability to deal w/ painful situations)

self-report form used to determine if pt has potentially serious medical condition mimicking common musculoskeletal disorder. Questions 1-6 and 9 relate to subarachnoid hemorrhage/ischemic stroke (if pt hasn't been previously dx w/ these and answers yes to any ,PT must make sure pt under medical care). Questions 6-9 relate to VBI, yes to any= screen for VBI. questions 10-14 relate to meningiits, yes to any= explore responses in more detail & refer for immediate medical management if bacterial menigitis suspected. Questions 4, 8, 9, 13, 14 relate to mild brain injury, postconcussion syndrome, subdural hematoma

screens for cervical fractures, ligt. instability, cervical central cord lesion, Pancoast tumor, septic arthritis (SC joint). Questions 1-4 screen for fx's and/or ligt. instability, if pt answers yes to any (1-4) then REFERRAL TO MD WARRANTED. 3-5 relates to cord, if yes's do neuro exam. 6 relates to Pancoast, if yes then ask more questions. 7 relates to IV drugs (exposes pt to incr. risk of sepsis and septic arthritis) if yes & clinical finding consistent then refer

10 items from NDI and ODI, scored 0-4 for max score of 40 interpreted as a % w/ higher indicating higher disability. Reliable & responsive. potential for valid measure in pts w/ primary thoracic pain.

most often used generic health status and pt satisfaction survey, captures outcome assessment of LBP include pain, back-specific function, work disability, generic health status, and pt satisfaction. lacks region specificity and sensitivity to change in specific pt populations

easy to administer, assess pain very specifically, fails to adequately capture majority of the "core" outcome areas in LBP assessment; MCID is 15 using 100mm scale, for numeric scale its 2 on a 0-10 scale

blankenship system, ERGOS work simulator, Ergo-Kit, Isernhagen work system (good interrater reliability and predictive validity w/ Iser..)

one at TL junction and one at sacrum w/ pt. in neutral, difference in motion is calculated

low reliability or ordered scales w/ poor to min agreement, mod to good agreement/reliability for determining presence of hypo/hyper-mobility, valid w/ correlation of radiographic lumbar segmental instability and w/ response to tx

moderate to good kappa values (reliability) in lumbar spine

positive= pain in resting position that subsides substantially or resolves. negative= mild or no improvement in second position or no pain w/ P-A's at all; good to excellent agreement, limited diagnostic value independently w/ +LR=1.7, -LR=0.48, but useful as a component in a cluster of tests to predict response to motor control ex

the presence of any of the following: painful arc w/ flexion or return from flexion (pain during movement but not at end range), instability catch (deviates from from straight during flx/ext), Gower sign, and reversal of lumbopelvic rhythm (upon return from flx, pt suddenly bends knees to extend hips, shifting pelvis ant as returning to standing position); moderate to good reliability for observation, variable reliability for individual tests, painful arch most reliable (k=0.61-0.69)

dural and LE nerve mobility sign, passive raise LE flexing hip w/ extended knee, positive= reproduction of LE radiating/radicular pain; pts w/ new episode of pain radiating below gluteal fold = good reliability for ID'ing pain in dermatomal distribution, moderate reliability for ID's pts w/ sx for angles below 45 deg

excellent reliability, relatively sensitive but not specific

flexors: supine, elevate LE's until sacrum begins to rise off table, pt to maintain contact of low back w/ take while slowly lowering to table, measure when low back loses contact w/ table d/t ant pelvic tilt, if w/ hip flx > 50 deg in males or 60 in females=more likely to have chronic LBP; extensors- raise check off table to approx 30 deg and hold, highly correlated w/ development of persistent LBP, unable to hold 31sec in males, 33 females= sig. more likely to have LBP w/ good reliability; lateral abs: lateral plank w/ knees flx'd to 90 and hold, reliable measurement; TA- prone, inflate biofeedback to 70 mmHg, pt to draw in abs for 10sec w/o pelvic motion while breathing, record max decrease in pressure. 4 mmHg decrease is normal, inability to decrease by 2 assoc w/ LBP; hip ABD grade on quality of mvmt, had discriminative ability to predict pts who will develop pain w/ standing; hip ext- supine w/ knees flx to 90 & soles of feet on table, pt raise pelvis off table to where shld's, hips, knees in straight line and hold, assesses glue max w/ good relability, mean hold w/ pts w/ LBP is 76.7sec and 172.9sec in ppl w/o LBP

2 specific questions from primary care evaluation of mental disorders patient questionnaire: during the past month, have you often been bothered by feeling down, depressed, or hopeless? During the past month, have you often been bothered by little interest of pleasure in doing things? no to both = depression highly unlikely, yes to 1 or both raises suspician

Pain Catastrophizing Scale (PCS), a 13-item scale that assesses the extend of catastrophic cognitions a patient experiences while in pain (defined as exaggerated negative orientation toward actual or anticipated pain), 3 independent dimensions: rumination (inability to inhibit pain-related thoughts), magnification, and helplessness

Orebro musculoskeletal pain questionnaire (OMPQ)- predicts long-term pain and disability; subgroups for targeted treatment (STarT) back screening tool; 5 item CPR

also called acute low back pain screening questionnaire. predicts long-term pain, disability, and sick leave

predictive validity for disability and work loss in pts w/ LBP, cutoff score >29 = indicator of poor return to work status in pts receiving PT for ocaute occupational LBP and cuttoff score of >22 in nonworking populations. score >29 in this is a better predictor of slef-reported disability then >14 in the other subscale

cutoff score > 14 = indicator of poor tx outcomes

specific but not sensitive

18 on the work subscale

35 on the work subscale

13 or 14 on the PA subscale

fxnl outcome measure. scores 10 different variables including pain, ROM, gait/limp, gait distance, fxn, ADL's and deformity. Score ranges 0 (worst) to 100 (best)

evaluates sports injures & outcomes in young & middle-aged athletes. 5 domains (pain, sx, ADL's, sport and recreation fxn, knee-related QOL). each subscale summed and transformed to score of 0 (worst) to 100 (best) MDC for pain 13.85, sx 9.97, ADLs 11.92, sport and recreational fxn 22.96, knee-related QOL 15.45 The pain, sport and recreation, and QOL domains are the most responsive to change w/ the largest effect size for active, young pts. KOOS contains itms regarding sx & disabilities important to pts w/ ACL tear, isolated meniscal tears, or knee OA

jt specific outcome measure for assessing sx, fxn, and sports activity pertinent to a variety of knee conditions. has items regarding sx & disabilities important w/ ACL tear, isolated meniscal tears, or knee OA. MDC of 11.5 necessary to distinguish b/w those how perceive themselves as improved vs. not improved, overall MDC for knee disorders was 12.8

originally designed for f/u eval of knee ligt surgery. 8 items of sx & fxn, scored 0-100 pts. Instability and pain weighted most havily. Arbitrarily graded w/ 95-100 as excellent, 84-94 as good, 65-83 as fair, <65 as poor. Research on validity, Sn and reliability is inconclusive. May be more meaningful w/ combined w/ an activity rating scale

clinician-based and pt-reported outcome measure. assesses subjective sx and fxnl activities. 6 dimension scale based on total of 100pts: sx (20pts), PE (25 pts), knee stability testing (20pts), radiographic findings (10pts) and fxnl testing (10pts). portions of it haven't been validated. MDC for pain 2.45, swelling 2.86, partial giving-way 2.82, and full giving-way 2.30. Effect size for responsiveness to change in pain 1.40, swelling 1.18, partial giving-way 1.87, full giving-way 1.49, sx avg 1.74, ACL fxn avg 0.69, sports fxn avg 1.91, and overal rating score 3.49

score of activity level from 0-10pts. grades activity level were 0 is "on sick leave/disability) and 10 is "participation in competitive sports at national elite level". commonly used in combo w/ Lysholm

pt reported activity assessment. 4 questions evaluating high-level fxnl activities scored 0-4 based on frequency per week each item is performed. designed to assess pts highest peak activity over the past year. Is validated, but responsiveness is unknown.

FAAM. The only PT setting validated foot functional outcome measure. 21-tim ADL's and 8-item sports questions. MCID is 8 points for the ADL subscale and 9 points for the sports.