Keeping It All in Balance: The Role of Outcome Measures in Clinical Decision-Making

Purpose/Hypothesis: The purpose of this study is to understand how physical therapists use the results of balance assessments in individuals with a history of acquired brain injury. The secondary purpose is to understand how therapists believe the interaction between balance assessments and clinical decisions impacts patient outcomes. Number of Subjects: 23 Materials and Methods: Qualitative study using semi-structured phone conference interviews with an interview guide technique. Maximum variation sampling was used to recruit participants from diverse practice settings and geographic regions. All interviews were audio recorded, transcribed verbatim, and coded with a computer-assisted open technique. An inductive approach with a priori determined focus on emic phrases and indigenous patterns and themes was used. Results: Participants included 9 inpatient rehabilitation/skilled nursing, 7 acute, and 7 outpatient therapists. Major themes that emerged from analysis were the process of assessing balance, factors in choosing a standard outcome measure (OM), use of results of OM, and impact of OM selection. Among the process of assessing balance, categories that were revealed were progressive functional assessment, hypothesis driven exam, continued flexible assessment, assessing types of balance, and standardized OMs. Twenty-seven distinct OMs were identified by therapists, with the Berg Balance Scale, Functional Gait Assessment, and Timed Up and Go most commonly cited. The factors in choosing a standard measure were categorized into institutional, patient, therapist, and tool factors with additional influence from professional organization recommendations. There were seventeen discreet uses for the results of balance OMs as reported by participants. The most commonly reported uses were educating patient and families, guiding treatment interventions, communicating with other health care providers, and guiding discharge decisions. Most interviewees indicated that using OM was important in their practice and impacted their decisions. Many reported which OM was selected did not have an impact on their decision-making or their patient outcomes. Conversely, some acute care therapists purported that use of a robust OM could increase the likelihood of an individual being admitted to inpatient rehabilitation while inpatient and outpatient therapists theorized that selection of a sufficiently challenging OM was important for selecting the appropriate intervention intensity. Conclusions: Since the focus on using OMs began in physical therapy thirty years ago, much research and public policy has pushed for their consistent use to properly quantify patient’s deficits and progress. Little research has investigated the impact of this focus on standardized assessments on therapists’ practice and patient outcomes. This study explores the complex relationship between balance assessment, therapist decision-making, and patient outcomes. Balance OM were used more frequently and were reported to be more important than in past research. Clinical Relevance: Balance OMs play an important role in various areas of decision-making and practice, far beyond quantifying deficits and change.

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  • Control #: 24084
  • Type: Poster
  • Event/Year: CSM 2020
  • Authors: Marissa Lyon
  • Keywords:

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