University of Oklahoma
College of Allied Health
Department of Rehabilitation Science

Fall After-Work Series

How to prove your patients are getting better:
Collecting and using clinic records

Dave Johnson, PT, PhD and Dave Thompson, PT, Ph.D.

"Health-related quality of life" (HRQL) scales:

Focusing on HRQL as an outcome of treatment is useful because it accounts for many dimensions of patients' problems, including impairments, functional limitations, and disabilities. These dimensions are the ones addressed in the Nagi model of disablement (the model employed by the Guide to Physical Therapist Practice) and in the NCMRR model (described at http://coph.ouhsc.edu/dthompso/web/ICIDH/ncmrr.htm)

Generic HRQL scales:

Condition-specific or region specific disability indices

Online databases that collect outcome measures:

SF36

A commercial site provides an online version of the SF36's "standard" form, which patients complete at least four weeks following an incident that affects their health.

This site provides automated scoring that is normed (so that an average score is 50 and the standard deviation is 10) to the U.S. general population, but not to a peer group of the patient's gender and age.

Version 2 of the SF-36 Health Survey (Acute Form) from QualityMetric, Inc.

SF-36 is a registered trademark of the Medical Outcomes Trust. SF-36v2 is copyrighted (2000) by QualityMetric Incorporated. For information about obtaining a license to use the SF-36v2, visit the QualityMetric Internet Web site at www.qmetric.com.

Lower extremity functional scale (LEFS)

The LEFS is documented by Binkley, Stratford, Lott, and Riddle (1999, p.383).

Properties:

Error +/- 5 points; an observed score is within 5 points of a patient's 'true' score.

Minimum detectable change (MDC): 9 points; change of more than 9 points on the LEFS represents a true change.

Minimum clinically important difference (MCID): 9 points; "Clinicians can be reasonably confident that a change of greater than 9 points is ... a clinically meaningful functional change" (Binkley, Stratford, Lott, & Riddle, 1999, p. 380).

Reference: Binkley, J.M., Stratford, P.W., Lott, S.A., & Riddle, D.L. (1999). The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. Physical Therapy, 79, 371-383.

Shoulder Pain and Disability Index (SPADI)

The SPADI assesses pain and routine functional skills. A ten point reduction in the score accurately distinguishes between people whose shoulder problems improve and those whose conditions remain stable. Similarly, a ten-point gain in the SPADI score distinguishes between people whose shoulder problems are unchanging and those whose problems are worsening (Williams, Holleman, & Simel, 1995).

The SPADI form is available in a publication by Williams, Holleman, and Simel (1995, Table 1). WorkCoverSA provides a downloadable .pdf version .

Pain scale: How severe is your pain? At its worst?
When lying on the involved side?
Reaching for something on a high shelf?
Touching the back of your neck?
Pushing with the involved arm?

Disability scale: How much difficulty do you have ...
( 0 = no difficulty 10 = unable to do NA = not applicable ) Washing your hair?
Washing your back?
Putting on an undershirt or pullover sweater?
Putting on a shirt that buttons down the front?
Putting on your pants?
Placing an object on a high shelf?
Carrying a heavy object of 10 pounds?
Removing something from your back pocket?

References:

Heald, S.L., Riddle, D.L., & Lamb, R.L. (1997). The shoulder pain and disability index: The construct validity and responsiveness of a region-specific disability measure. Physical Therapy, 77, 1079–1089.

Roach, K.E. (1991). Development of a shoulder pain and disability index. Arthritis Care and Research, 4,:143–149.

Williams, J.W., Holleman, D.R., & Simel, D.L. (1995). Measuring shoulder function with the Shoulder Pain and Disability Index. Journal of Rheumatology, 22, 727-732.

Arthritis Impact Measurement Scale (AIMS2)

Developed at the Boston University Arthritis Center to assess health among patients with rheumatic diseases, the AIMS is now in its second version. It contains nearly 80 items in a 13-page questionnaire. Most questions ask about the person's health and functioning over the previous month.

Download .pdf versions of the users' guide from the public domain portion of the QOLID web page

Reference:

Meenan, R.F., Mason, J.H., Anderson, J.J., Guccione, A.A., Kazis, L.E. (1992). AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis and Rheumatology, 35, 1-10.

Oswestry Low Back Pain Disability Index

Fairbank (1980) and his colleagues originated the Oswestry index. The Chartered Society of Physiotherapy provides background and references on the ODI.

Fritz & Irrgang (2001) provided a version of the index that makes certain items easier for patients to answer and for clinicians to score. They state they did so with permission of The Chartered Society of Physiotherapy. As of 2011, the ODI's original authors and copyright holders encourage users to download and use version 2.1a of the ODI. They are troubled by attempts to rewrite the ODI and are working to reduce the number of downloadable versions that they consider to be poorly validated and, in certain cases, in breach of copyright.

The questionnaire contains six statements (denoted by the letters A through F) in each of ten sections. The sections concern impairments like pain, and abilities like personal care, lifting, reading, driving, and recreation. For each section, subjects choose the statement that best describes their status.

The chosen statements receive scores: statement A=0; statement B=1; C=2; D=3; E=4; F=5. Total scores can range from 0 (highest level of function) to 50 (lowest level of function). To accommodate patients who do not respond to every sections, clinicians can calculate a "percentage of disability" on the basis of the total possible points. Fairbank and his colleagues (1980) interpret "percentage of disability" scores in this manner:

0% to 20% - minimal disability
20% to 40% - moderate disability
40% to 60% - severe disability
60% to 80% - crippled
80% to 100% - bed bound (or exaggerating symptoms)

The instrument is in the public domain, so clinicians can use it without obtaining permission. As a service to colleagues, users can cite one or more of the instrument's source publications.

References:

Fairbank, J.C., Couper, J., Davies, J.B., & O'Brien, J.P. (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66, 271-273.

Fairbank, J.C., & Pynsent, P.B. (2000) The Oswestry disability index. Spine, 25, 2940-2953.

Fritz, J.M., & Irrgang, J.J. (2001). A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy, 81, 776-788.

Neck Disability Index (NDI)

The NDI questionnaire was modeled after the Oswestry index by Vernon and Mior (1991). Just as in the Oswestry, subjects choose the statement that best describes their situation in each of ten sections. The sections concern impairments like pain (including headaches), and abilities like personal care, lifting, reading, driving, and recreation. Clinicians score each statement just as they do the Oswestry. Total scores can range from 0 (highest level of function) to 50 (lowest level of function), and "percentage of disability" scores are calculable.

The Chiropractic Resource Organization offers downloadable .doc and .pdf versions of the questionnaire and scoring methods:

The instrument is in the public domain, so clinicians can use it without obtaining permission. As a service to colleagues, users can cite one or more of the instrument's source publications.

Reference:

Vernon, H., & Mior, S. (1991). The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 409-415.

Last updated 03-07-2010 ©Dave Thompson, Ph.D., P.T.