More about Outcome Measures

The focus of Clinical Corner for the past 2 months has been on outcomes and outcome measures. The June 2019 article, Outcomes and Outcome Measures in Seating and Mobility: Current Practice, distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding their use of outcomes and outcome measures. The July 2019 article, From Outcomes to Outcome Measures: Next Steps, reviewed the relevance of outcome measures and the key considerations when selecting outcome measures. Clinical Corner will continue the theme on outcome measures this month with a focus on specific outcome measures that can be used in seating and mobility.

There are several outcome measures that can be used in seating and mobility. Some are specific to seating and mobility, while others are not. It is important to have an understanding of what is to be measured and how effectively the outcome measure provides the required information. In addition, it is important to consider that: "No single outcome measure captures all necessary information; trade-offs are inevitable. When choosing an outcome measure, the specific goals of the service evaluation and the resources available need to be considered within context." (Kenny & Gowran, 2014, p. 67).

Let's briefly look at some objective measures that may be used in seating and mobility.

• Goal Attainment Scale (GAS): Although this measure is not specific to seating and mobility, it can be used in this context. Goals are identified with a client and weighted according to their importance and difficulty. The expected outcome is defined clearly. Each goal is then rated on a 5-point scale and an overall GAS score is calculated. (Turner Stokes, 2009).
• Measuring standardized body segment angles: Using standardized measurements for body segment angles helps to objectively quantify posture. This can be used to document postural outcomes before and after seating intervention and measuring postural changes over time. This is an improvement over measuring joint range of motion (ROM) as joint terms, such as hip extension, may not be used accurately in sitting and do not correspond to orientation in space or to corresponding angles in seating support surface. (Waugh and Crane in Lange and Minkel, 2018, p. 87).
• Manual muscle testing: Obtaining an objective measure of muscle strength through manual muscle testing helps to provide a quantifiable measure, rather than reporting "decreased muscle strength", for example. Manual muscle testing may have a possible correlation to manual wheelchair propulsion. (Schmeler et al., 2018).
• Wheelchair Propulsion Test (WPT): The WPT is a 10 metre timed assessment of wheeling either by hand and/or foot propulsion. The method of propulsion is recorded, as is the number of cycles of propulsion required for 10 metres. From this, other measurements can be derived, such as speed (m/s), push frequency (cycles per second) and effectiveness (metres per cycle). (Askari et al, 2013).
• Borg Exertion Scale: This self-report may be used in conjunction with the WPT, or alone, to provide a measure of perceived exertion for manual propulsion. (Chen & Moe, 2002, as cited in Schmeler et al., 2018).
• Tool for Assessing Wheelchair Discomfort (TAWC): This measure is intended for those who have intact sensation and who use a wheelchair for more than 8 hours per day. (Crane et al, 2007, as cited in Pearson, 2009).
• Pain Disability Index. Although this measure is not specific to seating and mobility, it does provide a measure through self-report. (Tait et al, 1990, as cited in Schmeler et al., 2018).
• Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST): This is a 24 item, self-report questionnaire that measures satisfaction with the assistive device and with the service delivery. (Demers et al, 1999, as cited in Kenny and Gowran, 2014).
• Psychosocial Impact of Assistive Devices Scales (PIADS): This 26-item self-report questionnaire measures the impact of assistive technology on functional independence, quality of life and well-being. (Jutai & Day, 2002, as cited in Kenny and Gowran, 2014).
• Wheelchair Outcome Measure (WhOM): This is a 2-part questionnaire that includes both structured and semi-structured questions which identifies "desired outcomes at a participation level while acknowledging concerns about body structure and function." (University of British Columbia, n.d.).
• Wheelchair Use Confidence Scale (WheelCon): There are several versions of this scale, including for manual wheelchair users, power wheelchair users, and for caregivers. A short form exists for manual wheelchair users. Wheelchair confidence is measured in managing several aspects of physical and social environments. (University of British Columbia, n.d.).
• Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q): Both the WST and the WST-Q have versions for manual wheelchair use and for power wheelchair use. The WST assesses an individual's capacity to perform a number of individual skills needed for wheelchair use. The WST-Q is a self-report questionnaire that scores an individual's capacity, confidence and performance in completing individual skills and asks whether or not individual skills are goals of the person completing the questionnaire. (Kirby et al., 2018).

The above list is not exhaustive of all of the outcome measures that can be used in seating and mobility, but it does provide a start for thinking about using outcome measures to provide evidence and objectivity to one's practice in seating and mobility.

As always, please provide your comments, questions and suggestions regarding Clinical Corner. Please email me at Sheilagh.Sherman@sunmed.com. I look forward to hearing from you!

Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)
Clinical Education Manager
Sunrise Medical Canada

References

1. Askari, S., Kirby, R., Parker, K., Thompson, K., & O'Neil, J. (2013). Wheelchair propulsion test: Development and measurement properties of a new test for manual wheelchair users. Archives of Physical Medicine and Rehabilitation, 94, 1660-1698.
2. Kenny, S. & Gowran, R.J. (2014). Outcome measures for wheelchair and seating provision: A critical appraisal. British Journal of Occupational Therapy, 77(2), 67-77.
3. Kirby RL, Rushton PW, Smith C, Routhier F, Best KL, Cowan R, Giesbrecht E, Koontz A, MacKenzie D, Mortenson B, Parker K, Smith E, Sonenblum S, Tawashy A, Toro M, Worobey, L. The Wheelchair Skills Program Manual. Published electronically at Dalhousie University, Halifax, Nova Scotia, Canada. https://wheelchairskillsprogram.ca/en/skills-manual-forms/
4. Pearson, EJM. (2009). Comfort and its measurement – A literature review. Disability and Rehabilitation: Assistive Technology, 4(5), 301-310.
5. Schmeler, M., Schiappa, V., Straatman, J., Arrendondo, J.M. & Semancik, B. (2018). Addressing issues of vagueness in clinical documentation for wheeled mobility and seating: A scoping review of tools for more objective information. Proceedings of the 34th International Seating Symposium.
6. Turner Stokes, L. (2009). Goal attainment scaling (GAS) in rehabilitation. A practical guide. Retrieved from https://www.kcl.ac.uk/cicelysaunders/attachments/tools-gas-practical-guide.pdf
7. University of British Columbia. (n.d.) Mobility Outcome Tools. Retrieved from https://millerresearch.osot.ubc.ca/tools/mobility-outcome-tools-2/
8. Waugh, K. & Crane, B. A. (2018). Standardized measures of the person, seating system, and wheelchair. In M.L. Lange & J.L. Minkel. (Eds.) Seating and Wheeled Mobility. A clinical resource guide (pp. 85-119). Thorofare, NJ: Slack Inc.

Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.

This article is © Sunrise Medical, Inc., 2019 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.