Background and Purpose: The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work.
Methods: An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided.
Results: The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain.
Discussion and Conclusions: Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.
Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).
The use of standardized outcome measures (OMs) in physical therapy (PT) practice is growing and becoming the standard of practice. Evidence of intervention effectiveness depends on, among other things, common use of valid and reliable tests and measures, which reflect clinically important outcomes and are responsive to change. An important initial step toward best practice is the identification and selection of the most appropriate OMs for patients whom therapists treat. However, clinicians may be uncertain in how to select the best OM based on an individual’s specific limitations.1,2 Common barriers to using OMs include the time required to learn or use them, perceptions that OMs are too difficult for patients to understand, and the time burden for clinicians to score and analyze test results.3 The ability to track patient progress during recovery from a neurologic condition improves with the use of standardized OMs that are employed across settings. In addition, the use of common OMs may facilitate ongoing clinical research.
To address some of these issues, the Academy of Neurologic Physical Therapy of the American Physical Therapy Association (APTA) began a process to develop recommendations for the identification of core sets of OMs in 2009. A Research Section of APTA task force, the Evaluation Database to Guide Effectiveness (EDGE), was developed to make recommendations for OM utilization in PT practice. Building on recommendations from that group, members of the Academy of Neurologic Physical Therapy initiated what was described as an “EDGE group” focusing on the stroke population. This group established a yearlong process for rating and evaluating OMs, which culminated in the StrokEDGE report.4 The following year, the process was followed by a group focused on OMs for patients with Multiple Sclerosis.5 In the fall of 2011, the Academy of Neurologic Physical Therapy initiated task forces to evaluate OM use in traumatic brain injury (TBI) and spinal cord injury. Task forces looking at vestibular dysfunction and Parkinson disease measures were conducted the following year.
The choice of appropriate OMs for use with TBI can be a challenge. Traumatic brain injury is a chronic health condition that affects physical, cognitive, and behavioral function, often in heterogenous ways. Outcome measures must accommodate a large range of physical and cognitive strengths and limitations. Clinicians must be aware of the complexity of this diagnosis to determine which OMs are most appropriate.6 After TBI, individuals are treated in a wide variety of settings, including intensive care units, acute care, in- and outpatient rehabilitation settings, long-term care facilities, and in the home. The environment, available space and equipment, as well as the individual’s cognitive and physical limitations, all influence which OMs are feasible and appropriate.
The objectives of the TBI EDGE task force were:
- to develop recommendations for clinicians, educators, and researchers for the use of standardized OMs to utilize throughout the continuum of care of the TBI population and span the domains of the International Classification of Functioning, Disability, and Health (ICF) and,
- following the Academy of Neurologic Physical Therapy Board of Directors approval, to disseminate recommendations through available avenues such as the section Web site, conference presentations, and publications.
The work of each EDGE task force had traditionally been completed in a year period, requiring a scope sufficiently focused to be feasible with a limited volunteer workforce. It is the goal of this article to describe the yearlong processes that were used to create recommendations for OM utilization in the TBI patient population in clinical practice, as well as additional recommendations for inclusion into entry-level PT curricula and for use in research.[…]