Outcome Measures in Seating & Mobility

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There are many steps to wheelchair provision, as outlined in the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Wheelchair Service Provision Guide (2011).  One of the steps is measuring outcomes.  (For more on all of the steps to wheelchair provision, please refer to the 2015 Clinical Corner article: The Steps to Wheelchair Provision.)   As therapists, we know we should be using outcome measures in our clinical practice but sometimes lack of time or lack of knowledge prevents us from fully incorporating outcome measures into our day-to-day practice.  This month’s Clinical Corner article will address why outcome measures are important and will begin to explore some of the outcome measures used in seating and mobility.
What is an Outcome Measure?
An outcome measure is “a measure of the quality of medical care, the standard against which the end result of the intervention is assessed” (Mosby's Medical Dictionary, 2009).  An outcome measure quantifies the result of an intervention.  If selected at the outset of an intervention, an outcome measure can provide a baseline measurement; when the outcome measurement tool is repeated at the end of the intervention, changes to the value of the outcome can be attributed to the intervention, all other variables being equal. 
Outcome measures are important in evidence-based practice.  Outcome measures help to validate the interventions that are conducted with clients.  In seating and mobility, outcome measures provide evidence regarding the effectiveness of the technology that is selected with clients.  This helps in terms of selecting the most appropriate devices for clients.  It also helps to provide objective measures that can be shown to funders when advocating for certain equipment on behalf of clients.
Examples of Outcome Measures
In seating and mobility, many outcome measures exist.  Many therapists use outcome measures as part of the assessment process to determine the most appropriate equipment for a client, but may not necessarily define the tools as outcome measures.  Some examples are:
  • Client self-report on their level of satisfaction with the equipment
  • Client self-report and/or therapist observation of client’s ability to function with equipment
  • Pain rating scales
  • Pre- and post-intervention photographs and/or measurements documenting postural alignment
  • Pressure mapping of a  seating system
  • Sitting tolerance as measured by time
  • Ability to propel a manual wheelchair as measured by distance/time
In addition, standardized outcome measures exist.  Some examples include:
  • Chailey Levels of Sitting Ability
  • Canadian Occupational Performance Measure – COPM
  • Functioning Everyday with a Wheelchair – FEW
  • Psychosocial Impact of Assistive Devices Scale – PIADS
  • Quebec User Evaluation of Satisfaction with Assistive Technology – QUEST
  • Wheelchair Outcome Measure – WhOM
  • Wheelchair Skills Test – WST
  • Wheelchair Use Confidence Scale – WheelCon
(Specifics on the above outcome measures will be the topic of a future Clinical Corner article.)
When to Use Outcome Measures
Outcome measures can be used at any time along the continuum of wheelchair provision, from assessment to delivery of prescribed equipment to follow-up.  RESNA’s Wheelchair Service Provision Guide (2011) states that
“Standardized and validated measures should be used whenever possible to allow comparison of identified variables before, during and after the process.  Standardized tools also allow for comparisons across clients, types of equipment, and various service delivery models” (p. 12). 
The RESNA Wheelchair Service Provision Guide (2011) further states:
“Professionals involved in the provision of wheelchairs should apply outcome measures to raise the standard of practice, to support evidence-based practice, and to improve the level of accountability.” (p. 12)
Standardized and non-standardized outcome measures in seating and mobility provide information that can be used to improve individual client results.  In addition, with informed consent, the results of standardized outcome measures can be pooled to help to provide a body of evidence that helps to inform evidence-based practice in the area of seating and mobility.  
As always, please provide your comments, questions and suggestions regarding Clinical Corner.  Please email me at Sheilagh.Sherman@sunmed.com.  I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)
Clinical Educator
Sunrise Medical Canada
References and Resources
Outcome measure. (n.d.) Mosby’s Medical Dictionary, 8th ed. (2009). Retrieved from https://medical-dictionary.thefreedictionary.com/outcome+measure
Rehabilitation Engineering and Assistive Technology Society of North America. (2011). RESNA Wheelchair Service Provision Guide. Retrieved from http://www.resna.org/sites/default/files/legacy/resources/position-papers/RESNAWheelchairServiceProvisionGuide.pdf.
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients.  Sheilagh is unable to answer questions from members of the general public.  Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2018 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.

Sheilagh Sherman,
BA, BHScOT, MHM, OT Reg. (Ont.)

Sheilagh joined Sunrise Medical Canada in 2010 as our full-time Clinical Educator. Prior to joining Sunrise, Sheilagh gained extensive clinical experience from working in a variety of settings, including in-patient rehabilitation, complex continuing care, and community rehabilitation. As Clinical Educator, Sheilagh is a clinical resource for therapists across Canada involved in seating and mobility. She teaches in-services and leads workshops and seminars on the clinical aspects of seating and mobility. In addition, Sheilagh hosts monthly webinars for therapists and vendors.

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