When we practice in seating and mobility, are we measuring outcomes when working with clients? Or are we describing outcomes? What do our fellow therapists consider when prescribing seating and mobility for individuals? This month, Clinical Corner will distinguish between outcomes and outcome measures. In addition, Clinical Corner will highlight some of the results of a survey that was conducted regarding the use of outcomes and outcome measures with therapists practicing in seating and mobility in Canada.
According to Mosby's Medical Dictionary (2009), an outcome is "The condition of a patient at the end of therapy or a disease process, including the degree of wellness and the need for continuing care, medication, support, counseling, or education." An outcome can be considered the end result or the consequence of an intervention. It implies a description, which may or may not be quantifiable.
Mosby's Medical Dictionary (2009) defines an outcome measure as "A measure of the quality of medical care, the standard against which the end result of the intervention is assessed." An outcome measure implies a tool that can be used to provide an objective measurement that may quantify and validate the result of an intervention.
If you are a clinician who participated in my Cyber Series of webinars recently, you will know that I asked participants to complete one of two on-line surveys of open-ended questions, asking about the use of outcomes and outcome measures. Response was limited, making generalization difficult; however, there was representation from across the country – from British Columbia to Newfoundland to the Yukon. Occupational therapists and physiotherapists who participated in the surveys reported working in a variety of clinical settings, including community, long term care, acute care, Veterans Affairs, in-patient rehab and a seating clinic. Only one respondent reported currently using standardized outcome measures and drew from a list of multiple outcome measures, depending upon what was relevant to evaluate for a given client. The remainder of the respondents described using outcomes to know that the wheelchair and/or seating they were trialing (or prescribed) was appropriate or working for a client. Most therapists reported they considered multiple outcomes for each client. Let's review the outcomes the therapists from the survey most commonly reported using.
Survey Results – Outcomes Used in Seating and Mobility
Most therapists from the survey reported that they set targeted goals with their clients at the outset of service delivery. Some therapists used wording such as ensuring the goals of the client, goals of the intervention, or goals of the referral have been met. Whatever language was used, establishing SMART (specific, measurable, attainable, realistic, and within a time-frame) goals with clients helped therapists to set parameters to know whether or not the goals had been met.
Ensuring proper fit/set-up/programming of wheelchair and/or seating
The next most common response to the survey was regarding the theme of equipment set-up for the client. This included ensuring the proper fit and set up of the wheelchair and seating system and ensuring the programming parameters of a power wheelchair were appropriate for a particular client.
Ensuring correct positioning/anatomical position/good or tolerated posture
The next theme that emerged from the survey results was regarding positioning. Many therapists reported that they ensure correct positioning for an individual client as an outcome of the intervention. The terms anatomical position and good or tolerated posture also were used.
Function is maintained or improved in environment
Some therapists commented on addressing function as an outcome of seating and mobility. Therapists identified specific outcomes, such as propulsion in a manual wheelchair, operation of a power device, transfers, access to tables, and physiological function.
Reported comfort/sitting tolerance/pain level
Therapists commented that the client's reported level of comfort or pain is taken into account when addressing seating and mobility needs. Other therapists used the language of sitting tolerance, which provides a quantifiable measure.
Client satisfaction/perceived issues/feedback
Other therapists reported that they take into account the client's reported satisfaction with the equipment and any feedback, including any perceived issues the client identifies, as part of the outcomes that are assessed to determine if the prescription is appropriate for a client. One therapist noted that she pays attention to the body language and gestures of her clients to gain feedback when the client is unable to communicate in other ways.
Feedback from staff and family
Therapists also seek and pay attention to feedback they receive from staff and from family members of clients.
Subjective quality of life
The client's report on their quality of life with the use of the prescribed device was listed as another outcome that a therapist considers in seating and mobility.
Some therapists reported that they assess skin integrity to ensure that the prescription is appropriate for the client. One therapist commented that she uses pressure mapping, which quantifies the magnitude of pressure on the seated surface.
There is a subtle difference between outcomes and outcome measures in seating and mobility. Whereas outcomes may include subjective descriptions, outcome measures can be objective, quantifiable means of validating interventions. The results of an on-line survey suggest that many therapists involved in seating and mobility in Canada consider outcomes when working with clients. Some outcomes, such as pressure mapping, sitting tolerance and using SMART goals, allow for some aspect of measurement to occur. A future Clinical Corner article will provide additional details on outcome measures that help to provide objective quantification of outcomes such as those mentioned in this month's article.
- Outcome. (2009) Mosby's Medical Dictionary, 8th edition. Retrieved from https://medical-dictionary.thefreedictionary.com/outcome
- Outcome measure. (2009). Mosby's Medical Dictionary, 8th edition. Retrieved from https://medical-dictionary.thefreedictionary.com/outcome+measure