Laurie's Blogs.

I came across an interesting blog.  It makes some good points and expresses some thoughts that I’ve had myself.  First off, the title is Outcome Measures Suck.  Eek!  We’re not supposed to say that outload or even think that, right?  But I admit, I have thought that!  More than once.  Okay, so let’s dive into it.

The blog was written by Adam Meakins of www.thesports.physio .  He’s a specialist physiotherapist with additional qualifications as a strength and conditioning specialist, and here’s a link to the blog:  https://www.thesports.physio/2020/09/13/outcome-measures-suck/ 

I’ll recap the main points:


•He dislikes and often doesn’t use outcome measures, stating that they offer very little for most patients and clinicians.  

•“I don’t think outcome measures are useful for most day to day regular clinicians in their normal everyday clinical encounters because of three key reasons: a lot of the data collected is rarely used well if at all; most outcome measures create unnecessary barriers between clinicians and patients; and outcome measures don’t actually measure what many think they measure.”

•When a measure has a target to be achieved, bias and error also increase during the recording of the measurement as we attempt to obtain the target. This affects the reliability and accuracy and can skew the results.

•He thinks that most outcome measures are best suited for research purposes and clinical trials and other data gathering purposes such as surveying a populations response to something.

So, just to put this in perspective (as clinicians), have you ever found yourself pushing just a little harder or niggling the arm of the goniometer to get a slightly better read than last time?  Have you re-adjusted the tape measure angle when doing thigh circumference.  Re-positioned the dog on a stance analyzer in different ways to get a better measurement?  (Or… and maybe it’s just me… but gotten on the scale and positioned your feet in different angles just to get 0.2 less pounds on the scale in the morning???)  

It’s true, if we know the goal, we try to achieve it!  Better ROM. Improved thigh circumference.  Increased weight bearing.  And so on!

The author of the blog goes on to recommend a scale / score that he does like and uses day to day; the Patient-Specific Functional Score (PSFS).  (To be honest, I’ve never heard of it on the ‘human side’… but then again, I don’t treat humans anymore.)  However, the PSFS involves asking the patient what are some of the key things that are meaningful to them which they are having difficulty in doing because of their pain or issue currently. They then rate how difficult it is for them to do these things on a simple 1-10 scale which is then recorded and asked at various time points.

This made me realize that there IS such a measure for dogs; The Cincinnati Orthopedic Disability Index.  Here’s the gist if that scale:

It asks the owner what activities seem to be difficult for their dog and allows the owner to list them.   Then it asks what changes or problems is the owner noticing related to arthritis in their dog. The owner then fills in up to 5 items that will be tracked and graded as No problem, A little, Quite a bit, Severe or Impossible.

The Standard Orthopedic Questionnaire is then part of the evaluation and asks specifically about Walking, Running, Jumping, Getting Up, Lying Down, Climbing stairs, or Descending Stairs

Here’s a link to a version of this questionnaire:  

https://www.fourleg.com/media/Cincinnati%20Orthopedic%20Disability%20Index.pdf 

My only critique of the scale is to query whether the categories give enough grades of differentiation to capture smaller changes as compared to a numeric scale and of course, we know that there is owner bias involved when filling out a form.  But, nothing is perfect!

So, all in all, while I don’t want to rain on the Outcome Measures parade, I am like-minded in thinking that our measures need to be functional, relevant, and easy to administer in clinical practice.

I’d love to hear your thoughts on what you feel are the most useful outcome measures from this perspective!  

And, stay tuned for the final installment of the Four Leg Newsletter series on outcome measures.  The Nov-Dec issue will be on Neurologic Function Scales.  

Cheers!



Laurie