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  • Brad Fentor DPT

Outcome Measures

When starting at our physical therapy clinic (or really any clinic for that matter) there always seems to be a stack of paperwork to fill out. This includes medical history, insurance disclaimers, and questions about one’s pain and reason for coming. Indeed the paperwork seems to never end, with additional requirements over the course of one’s visit. One particular piece of paperwork is called an outcome measure and is usually the most pertinent for the physical therapists. While not an enjoyable part of one’s visit, they are usually necessary for a variety of reasons which often get overlook in the limited time available with the providers.


The main questions people have when given an outcome measure are A) what is this? and B) why am I being asked to fill this out? The first question is fairly simple. An outcome measure is usually a questionnaire pertaining to their pain and dysfunction in a particular area such as the low back or hip. These are not just random questions, and they have been researched and validated over time to ensure they do the best job at capturing the information a physical therapist needs. While these measures can take several forms, this article is primarily about ones that are in the style of a questionnaire. Other outcome measures can include physical tests the patient must perform such as a 5x Sit-To-Stand Test which has a person perform a squatting motion as a proxy for strength and balance.


Now for the second question, as to the why this is being asked. The most common reason is to track changes over time. When a patient fills out a questionnaire at the beginning, the expectation is they will fill out the same thing in the future. The scores can be compared to see if any changes occur. Most of the outcome measures have some type of scale with minimal changes needed in order to conclude the person has, in fact, improved. It’s important for the therapist to place some objectivity into a realm that is inherently subjective. With this objectivity in mind, there is a threshold that needs to be met in order to conclude a person has indeed had some type of actual improvement or change. This is where the idea of a Minimally Clinically Important Difference (MCID for short) comes into play. The MCID is the amount of change needed to conclude that a real and apparent improvement has taken place. Any change in the outcome measure score less than the MCID could just be statistical noise and is not considered significant. To put it another way, the MCID is the amount needed for the patient to notice an actual change in their presentation.


The other reason for filling out these outcome measures is often for insurance purposes. If we are billing for services and saying our patients are getting better, we need to be able to back this up with evidence. We will use the outcome measure score as one way to show improvement. Conversely, if a patient is not improving, it’s important to have actual, objective information that supports this claim, so we can help send them to the most beneficial type of clinic.


Now, what are the primary outcome measures a patient will see in our clinic? There are in fact four measures used most commonly although there are significantly more than this which cover a wide variety of situation. They are the:

- Oswestry Disability index (ODI) – For Lower Back Pain

- Lower Extremity Functional Scale (LEFS) – For hip, knee, ankle, or foot pain

- Neck Disability Index (NDI) – For Neck pain

- Quick DASH – For shoulder, elbow, wrist, or hand pain.


Each of these measures are different and are scored on different scales, but they all involve questions pertaining to a certain area. The ODI is for the low back, the LEFS (as the name implies) is for the legs, the NDI is for the neck, and the Quick DASH is for the shoulder and arm. And yes, there is a normal DASH, but research has pared this down from 30 questions to 11 for the Quick version which still does a good job of capturing all of the most important information.


To put this into context let’s use the Oswestry Disability Index. This is scored as a percentage of disability with 0% being the best, meaning no disability, and 100% being the worst. The MCID we typically use is 10% meaning the score needs to decrease by that much in order to be considered a real change. If a patient originally scored 26% at their 1st visit and then subsequently scored 10% after their 6th visit that would be considered a real and significant change in their back pain.


When in the clinic, you will undoubtedly be asked to fill out many pieces of paperwork. When looking at the outcome measures these are not simply arbitrary questions and are used by the therapist for setting goals and tracking change over time. The therapist may not always have to time to go over the nuance of everything but hopefully this helps shed some light on why patients are always being asked to do paperwork and, how this is used.


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