Case Report: Overcoming Barriers to the Use of Outcome Measures Through Faculty, Student and Clinician Collaboration

Purpose/Hypothesis : While physical therapy clinicians recognize the benefits of using standardized outcome measures (OMs), they may encounter barriers to the implementation of OMs One such barrier may be related to clinicians ability to clinically use outcome measure instructions as described in psychometric studies. The purpose of this case report is to describe the collaborative effort between Doctor of Physical Therapy (DPT) faculty members, students and clinicians to overcome clinician concerns regarding the implementation of the Berg Balance Scale (BBS) in a hospital outpatient physical therapy department.Number of Subjects : 10 physical therapy cliniciansMaterials/Methods : Case Description: The physical therapy department selected the BBS as an outcome measure to meet a quality benchmark. Soon after its implementation, clinicians raised the concern that no one performed all items on the BBS in the same manner nor scored it consistently across patient types; leading to concerns regarding the fidelity of the data. To address this barrier, DPT faculty members and students were asked to assist with the development of a strategy to overcome the barrier. DPT faculty and students designed a tailored and cost-effective intervention that included consensus development for administration of the BBS and reliability measurements to address individual and group confidence in scoring the BBS. Consensus development was used to standardize administration and scoring of the BBS. To assess scoring reliability, each clinician viewed a DVD of an expert performing the BBS with 3 patients with balance deficits on two separate occasions two weeks apart. Feedback was provided to the group on inter-rater reliability and each clinician on intra-rater reliability.Results : Outcomes: DPT students facilitated the clinician review of instructions for each BBS item. This resulted in standardization of 11 of 14 items in the administration and scoring of the BBS. Clinician intrarater reliability (ICC = 0.84; 95%C I: 0.64, 0.97) and interrater reliability (ICC = 0.93; 95% CI: 0.87, 0.97) were good to excellent.Conclusions : These findings underscore the challenges faced by clinicians when implementing a known reliable outcome measure to clinical practice. Engaging academic faculty, students and clinicians can result in the development of strategies to successfully increase clinical reliability and improve confidence in the use of newly adopted outcome measures that may be used to benchmark quality improvement initiatives. DPT students were given the opportunity to critically think and problem solve through a real world problem.Clinical Relevance : While outcome measures may be reliable and valid under research conditions, clinicians may have difficulty using instructions associated with standardized outcome measures in practice. DPT faculty and students may facilitate the adoption of outcome measures through innovative and tailored strategies that increase clinician confidence in the use of OMs.

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  • Control #: 1726658
  • Type: Poster
  • Event/Year: CSM2014
  • Authors: Diane E. Clark, Donald H. Lein
  • Keywords: Outcome measure|faculty/student collaboration|clinician reliability

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