an assessment of clinically relevant pediatric physical therapy outcome tools regis university sept...
Post on 20-Jan-2016
216 Views
Preview:
TRANSCRIPT
An Assessment of An Assessment of Clinically Relevant Clinically Relevant Pediatric Physical Pediatric Physical
Therapy Outcome ToolsTherapy Outcome ToolsRegis UniversityRegis UniversitySept 29, 2010Sept 29, 2010Cody Butler, SPTCody Butler, SPT
Courtney Haia, SPTCourtney Haia, SPTSydney Stan, SPTSydney Stan, SPT
ObjectivesObjectives
At the end of this presentation, each clinician should be able to:
Accurately identify Sn, Sp, MCID, & MDD when selecting an outcome tool
Compare and contrast the psychometric properties of Pediatric PT outcome tools
Describe the effectiveness of the PEDI as an outcome tool in the pediatric setting
Examine the psychometric properties of the PEDI based on evidence-based literature
Accurately search and critically appraise literature for high quality and clinically relevant research regarding outcome measures
Benefits of Outcome Benefits of Outcome MeasurementMeasurement
Information about developmental progress
Ensure continuation of funding
Improve program planning
Inform decision making
Improve guidance in goal development
ChallengeChallenge
The use of measures that are sensitive to small changes in children with differing developmental and functional disabilities.
StakeholdersStakeholders
The Children’s Hospital
Department of Rehabilitation
Individual Physical Therapists
Patients and Families
Recommendations for Recommendations for Outcome Measure Outcome Measure
SystemsSystems Ask Questions
Purpose If purpose is for comparing performance to same age peer then
you need a scale that can give a normative standard score. (PEDI, Peabody, TIMP, AIMS)
If purpose is to measure progress along a continuum of difficulty then you need a measure that can give you a scaled score.(GMFM, PEDI)
Consider validity, reliability, sensitivity to change and responsiveness of the measure
Consider the group or individual of interest: homogenous, heterogeneous, dx, age, severity of functional challenges, rate of change
Specificity and Specificity and SensitivitySensitivity
A test’s ability to obtain a negative result when the condition actually is absent. A true negative. “SpIN”
When a test is positive, you can rule in the disease/ condition
The ability to obtain a positive test when the target condition is actually present. “SnOUT”
If the test is negative, you can rule the condition out. Overestimates
the amount of people who have it.
Clinically Significant DifferenceClinically Significant Difference
1. Responsiveness
“The power of a test to detect a clinically important difference.”
1. Sensitivity to Change “Accurate detection of change when it has occurred.”
Minimal detectable Minimal detectable difference (MDD)difference (MDD)
Defines the amount of change in a variable that must be achieved in order to reflect a true difference The smallest amount of change that passes the
threshold of error.
Minimal clinically-Minimal clinically-important difference important difference
(MCID)(MCID)Smallest difference in a measured variable
that signifies and important rather than trivial differences in patients’ conditions. Smallest difference a patient or clinician would
perceive as beneficial & would result in a change in the management of the pt.
Psychometric Properties
TIMP GMFM PEDI
Responsive-ness
Discriminates between children
with various conditions
Discriminates between GMFCS
levels I-II and II-III3
Greater responsiveness to change with children > 4yo
Sensitivity to change
Age-related changes in motor
performance (r = .83)1
ES and SRM > 0.54 ES and SRM > 0.84
Reliability ICC: 0.89-0.95 Inter-rater: 0.077 and 0.885
ICC: 0.95-0.996
Inter-respondent reliability: 0.64-0.746
Validity Concurrent validity with
AIMS2
Children with CP and Down’s
Syndrome (66)
Construct: strong correlation between mean scale scores and child’s age for functional skills
and care giver assistance scales7
Patient population
34 weeks – 4 months
5mo – 16 yrs < 7yo
InternationalInternational Classification of Classification of Functioning, Disability and Health (ICF)Functioning, Disability and Health (ICF)
Body Function: physiological function
Activity: execution of an action
Participation: places activities in to life situations
ICF
Level8-10 TIMP
Wee
FIM GMFM PEDI
Health Condition
NO NO NO NO
Body Function
NO NO NO NO
Activity YES YES YES YES
Participation NO NO NO YES
Environment NO NO NO YESEnv mod, caregiver
asst
We started with the We started with the QuestionQuestion
What outcome tool effectively measures change in activity level and participation for children with a wide variety of neurological disorders?
PEDI (CP or children) AND physical PEDI (CP or children) AND physical therapy AND responsiveness to change therapy AND responsiveness to change
AND assessmentAND assessment
Pub-med 1 result (Ketelaar 200811)
Conclusion “Only two evaluative assessment measures, the
Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), fulfill the criteria of reliability and validity with respect to responsiveness to change.”
What is the PEDI?What is the PEDI?
Pediatric Evaluation of Disability Inventory (1990)
Discriminative device Detects functional limitations and participation
Self-care, mobility, social function, caregiver assistance, modifications
Evaluative Tracks progress in individual children with disabilities;
Sensitive to small increments of change Examples: Cerebral Palsy, hemiplegia, spina bifida,
TBI, Down’s syndrome
PEDIPEDI
Number of items/questions 197
Time to complete 30-60 minutes
Age range <1-7 years
Score range 0-100
Administered by clinician/guardian
Usefulness to everyday Usefulness to everyday practicepractice
Engelen 2007Engelen 20071212
CONCLUSION Individual goals set in a physical therapy
practice for children with cerebral palsy can be linked, to a large extent, to items and activities of 2 standardized measures. GMFM-88 and PEDI
Identifying quality Identifying quality evidence in the evidence in the
literatureliteratureWhen asking a question based on gaps in the
literature, use the PICO format: Person/patient population Intervention Comparison Outcome
Databases: PubMed, CINAHL, Cochrane Library
Future EndeavorsFuture Endeavors
Standardized format for documenting pediatric interventions (PPTIA)13
PEDI Multidimensional PEDI Multidimensional Computer adaptive testing Computer adaptive testing (PEDI-MCAT)(PEDI-MCAT)14
ConclusionConclusion
No one assessment tool is able to capture the impact of pediatric physical therapy and the use of environmental modifications/adaptive equipment on the multiple dimensions of the ICF (body function, activity, participation).
Questions?Questions?
ReferencesReferences1.1. Campbell, S. K., & Hedeker, D. (2001). Validity of the Test of Infant Motor Performance for discriminating Campbell, S. K., & Hedeker, D. (2001). Validity of the Test of Infant Motor Performance for discriminating
among infants with varying risk for poor motor outcome. among infants with varying risk for poor motor outcome. Journal of Pediatrics, 139, 546-551Journal of Pediatrics, 139, 546-5512.2. Barbosa VM, Campbell SK, Barbosa VM, Campbell SK, Jaidep Singh DS, et al. Longitudinal Performance of Infants with Cerebral Palsy on Jaidep Singh DS, et al. Longitudinal Performance of Infants with Cerebral Palsy on
the Test of Infant Motor Performance and on the Alberta Infant Motor Scale. the Test of Infant Motor Performance and on the Alberta Infant Motor Scale. Physical & Occupational Physical & Occupational Therapy in Pediatrics.Therapy in Pediatrics. 2003; 23: 3. 2003; 23: 3.
3.3. Bagley AM, Gorton G, Oeffinger D, Barnes D, et al. Outcome assessments in children with cerebral palsy, Bagley AM, Gorton G, Oeffinger D, Barnes D, et al. Outcome assessments in children with cerebral palsy, Part II: discriminatory ability of outcome tools. Part II: discriminatory ability of outcome tools. Developmental Medicine & Child Neurology. Developmental Medicine & Child Neurology. 2007, 49: 181–2007, 49: 181–186.186.
4.4. Vos-Vromans DCWM, Ketelaar M, and Gorter JW. Responsiveness of evaluative measures for children with Vos-Vromans DCWM, Ketelaar M, and Gorter JW. Responsiveness of evaluative measures for children with cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. Disability and Rehabilitation.Disability and Rehabilitation. 2005; 27(20): 1245 – 1252. 2005; 27(20): 1245 – 1252.
5.5. Nordmark E, Hagglund G, Jarnlo GB. Reliability of the gross motor function measure in cerebral palsy. Scand Nordmark E, Hagglund G, Jarnlo GB. Reliability of the gross motor function measure in cerebral palsy. Scand J Rehabil Med 1997;29(1):25-8.J Rehabil Med 1997;29(1):25-8.
6.6. Berg M, Jahnsen R, Frøslie K, Hussain A. Reliability of the pediatric evaluation of disability inventory (PEDI). Berg M, Jahnsen R, Frøslie K, Hussain A. Reliability of the pediatric evaluation of disability inventory (PEDI). Physical & Occupational Therapy in Pediatrics.Physical & Occupational Therapy in Pediatrics. 2004;24:61-77 2004;24:61-77
7.7. Haley S, Coster, W, Ludlow L, Haltiwanger J, Andrellos J. Haley S, Coster, W, Ludlow L, Haltiwanger J, Andrellos J. Pediatric Evaluation of Disability Inventory (PEDI).Pediatric Evaluation of Disability Inventory (PEDI). Boston: Trustees of Boston Univeristy, 1998.Boston: Trustees of Boston Univeristy, 1998.
8.8. McCarthy ML, Silberstein CE, Atkins EA, et al. Comparing reliability and validity of pediatric instruments for McCarthy ML, Silberstein CE, Atkins EA, et al. Comparing reliability and validity of pediatric instruments for measuring health and well-being of children with spastic cerebral palsy. measuring health and well-being of children with spastic cerebral palsy. Developmental Medicine & Child Developmental Medicine & Child Neurology.Neurology. 2002, 44:468–476. 2002, 44:468–476.
9.9. Oeffinger D, Gorton G, Nicholson D, et al. Outcome assessments in children with cerebral palsy, Part I: Oeffinger D, Gorton G, Nicholson D, et al. Outcome assessments in children with cerebral palsy, Part I: descriptive characteristics of GMFCS Levels I to III. descriptive characteristics of GMFCS Levels I to III. Developmental Medicine & Child Neurology.Developmental Medicine & Child Neurology. 2007, 49: 2007, 49: 172–180.172–180.
10.10. Lollar DJ, Simeonsson RJ, and Nanda U. Measures of Outcomes for Children and Youth. Lollar DJ, Simeonsson RJ, and Nanda U. Measures of Outcomes for Children and Youth. Arch Phys Med Arch Phys Med Rehabil.Rehabil. 2000;81. 2000;81.
11.11. Ketelaar M, Vermeer A, Helders PJ. Functional motor abilities of children with cerebral palsy: a systematic Ketelaar M, Vermeer A, Helders PJ. Functional motor abilities of children with cerebral palsy: a systematic literature review of assessment measures. literature review of assessment measures. Clin RehabilClin Rehabil. 1998; 12(5):369-80.. 1998; 12(5):369-80.
12.12. Engelen V, Ketelaar M, Gorter JW. Selecting the appropriate outcome in pediatric physical therapy: how Engelen V, Ketelaar M, Gorter JW. Selecting the appropriate outcome in pediatric physical therapy: how individual treatment goals of children with cerebral palsy are reflected in GMFM-88 and PEDI. individual treatment goals of children with cerebral palsy are reflected in GMFM-88 and PEDI. J Rehabil MedJ Rehabil Med. . 2007; 39(3):225-31. 2007; 39(3):225-31.
13.13. Hashimoto M and Westcott McCoy S.Hashimoto M and Westcott McCoy S. Validation of an Activity-Based Data Form Developed to Reflect Validation of an Activity-Based Data Form Developed to Reflect Interventions Used by Pediatric Physical Therapists. Interventions Used by Pediatric Physical Therapists. Pediatr Phys Ther.Pediatr Phys Ther. 2009;21:53–61. 2009;21:53–61.
14.14. Hayley SM, Coster WI, Kao YC, Dumas HM et al. Lessons from use of the pediatric evaluation of disability Hayley SM, Coster WI, Kao YC, Dumas HM et al. Lessons from use of the pediatric evaluation of disability inventory: where do we go from here? inventory: where do we go from here? Ped. Phys. Ther. Ped. Phys. Ther. 2010.2010.
top related