ABSTRACT
The clinical assessment of patients involves interpreting information from various sources, such as patients’ reports and therapists’ examinations of function, so that clinical decisions related to patients’ needs and the appropriateness and nature of their therapy can be determined (Laver Fawcett 2007). In many countries, this information also includes data from outcome measures. Indeed, in some countries or in some services, the use of outcome measures is compulsory and related to reimbursement. For example, rehabilitation centers in the United States use the Functional Independence Measure (FIM) as part of their prospective payment system, along with length of stay and discharge destination (Uniform Data System for Medical Rehabilitation 2014). Increasingly, organizations such as the Commission on Accreditation of Rehabilitation Facilities (CARF) promote the quality, value, and optimal outcomes of services through a consultative accreditation process and continuous improvement services that center on enhancing the lives of persons served (CARF International 2014). This organization works around the world. Measuring outcome of rehabilitation is important for such evaluations. In addition, there is evidence to suggest that the use of outcome measures in clinical practice assists
Introduction ......................................................................209 Key Concepts in Outcome Measurement ..................... 211 Outcomes of Interest in Rehabilitation.......................... 212 Outcomes Measurement Development and Use-The State of Play ..................................................... 212 Computer Adaptive Testing ............................................ 218 Conclusions and Thoughts for the Future ..................... 219 References .......................................................................... 221
in “diagnosing” the presence and severity of patients’ problems, communication with patients and the team, treatment and discharge planning, the evaluation and improvement of processes of care or treatment, benchmarking against other services, and informing funding priorities and health policies (ACC 2009; Chartered Society of Physiotherapy 2011; Kayes and McPherson 2010; Laver Fawcett 2007; Tyson et al. 2010). But, as our hypothetical case in Box 11.1 suggests, dealing with the interpretation of outcomes data that are not in accordance with what patients think can be a contentious issue-one familiar to many therapists reading this book. The other struggle for many clinicians is how to choose measures that are appropriate in the clinical arena as opposed to the research arena; consequently, clinicians in different fields of rehabilitation report a wide range of validated and nonvalidated outcome measures that are used in their practice (Alviar et al. 2011; Duncan et al. 2000; Haigh et al. 2001; Jette et al. 2009; Korner-Bitensky et al. 2011; Sivan et al. 2011; Skeat and Perry 2008).
