What constitutes patient progress? What is the best way to accurately capture the impact of your physical therapy treatment? How has the patient's overall health also improved? These are three essential questions to keep in mind when selecting outcome measures to assess the impact of your physical therapy plan of care. In this article, we discuss various categories of outcome measures and how innovative technology like OneStep can make this data collection convenient and purposeful.
Subjective measures of patient progress
Questionnaires and patient-reported outcome measures are useful because they offer insight into how the patient perceives their current limitations and functional abilities. While there are many well-known and standardized patient-reported outcome measures for common conditions and impairments, there are also a wide variety of questionnaires available that can be useful in determining overall health and wellness status, activity level, patient satisfaction, and more. Implementing a variety of subjective measures that are appropriate for the current patient helps establish a baseline snapshot of not only their primary concern for treatment but also their overall health and wellness. It can be useful in determining if a patient might benefit from a referral to another provider, such as a mental health professional or registered dietician, and observing additional health improvements throughout their physical therapy treatment to truly capture the full magnitude of their progress and value of the treatment.
Document a comparable sign
Decide on a comparable sign with your patient that is meaningful to them and will validate their own progress. A comparable sign should be something that the patient is unable to do at all or without pain at the moment but an activity or movement that they would like to be able to perform with comfort. Like setting any goal, it should be realistic and attainable for their situation. Perhaps your patient is unable to bend down to tie their shoe without pain. This could become their comparable sign – it is an activity that they can perform and self-assess their own progress over time.
Objective measures for strong physical therapy documentation
Every plan of care should incorporate objective measurements to quantify the patient’s impairments and limitations. What sets this category apart is that collecting objective data limits the probability of bias that is sometimes a factor with patient-reported outcome measures and offers quantitative insight into patient status. Using objective data to demonstrate progress strengthens your documentation – which is particularly important when submitting to insurance companies and practicing in value-based care models. Collecting such data may seem daunting, but leveraging new and validated technology within your practice, like OneStep, can help you obtain objective measures for gait analysis, range of motion, and functional mobility tests with ease and in some cases automatically.
Additionally, the American physical Therapy Association (APTA) clinical practice guidelines (CPGs) serve as a great resource for not only the best practices in treatment, but also outcome measure selection. Test clusters, which are groups of tests that have been found to be especially valid and reliable at diagnosing certain impairments when used in combination with each other, are particularly useful and should be part of your evaluation and documentation when possible.
Assess overall fitness levels
While most patients will come to therapy with a specific impairment to address and goals in mind, physical therapists still play a critical role in promoting improved overall fitness levels. It may not seem directly connected, but poor fitness levels at baseline can contribute to the patient’s primary diagnosis and even put them at risk for future problems. For these reasons, it’s useful to establish a baseline physical fitness with some of your patients and understand their current activity levels. This can help you to determine what other lifestyle activities need modifying to help them reach their full health potential. Try using the 6 Minute Walk Test (6MWT) – a valid and reliable assessment that is used to assess endurance and aerobic capacity in various patient populations. As clinicians, there is a lot of emphasis on restoring the patient to prior level of function, but that doesn’t mean you shouldn’t strive for surpassing prior levels for more optimal health and mobility. A great outcome measure is if the patient’s quality of life has not only improved to prior level but that they are continuing on an upward trajectory with the tools they need for ongoing progress.
Using a combination of subjective and objective outcome measures leads to strong documentation that demonstrates the trajectory of patient progress and the value of the care they are receiving. Unfortunately, in actual practice settings, collecting sufficient and accurate data can be cumbersome and time-consuming, taking time away from patient treatment time. Luckily, there are now innovative solutions that leverage technology to help clinicians capture both subjective and objective outcome measures for the most thorough representation of patient progress.
OneStep provides the most comprehensive and innovative platform for digital physical therapy using pioneering science that turns any smartphone into a clinical-grade motion analysis lab. As part of OneStep’s solution, providers can automatically capture objective data throughout the patient’s entire plan of care, from anywhere. Patients are assigned specific outcome measures, both patient-reported and movement assessments, based on their needs – all of which can be completed within the app with detailed instructions for increased convenience. OneStep’s technology is the only of its kind to accurately measure over 40 gait parameters in addition to providing range of motion measurements and scores for functional movement assessments, such as the Timed Up and Go (TUG), Sit to Stand (STS), 6MWT, and more.
Providers can set automatic notifications that will remind the patient when it is time to answer a questionnaire or perform an assessment. Furthermore, providers can create their own customized questionnaires in addition to assigning the standard patient-reported outcome measures such as the Lower Extremity Functional Scale (LEFS) and the Neck Disability Index (NDI) among many others. Using OneStep’s technology also offers insight into patient adherence metrics, changes in functional mobility status, increases in fall risk, and how active a patient is throughout their day based on their recorded walks.
Kyte DG, Calvert M, van der Weesc PJ, et al. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015;101(2): 119-125.
6 Minute Walk Test. Shirley Ryan Ability Lab. Updated April 2013. Accessed September 14, 2022.