Chapter 3: Common Outcomes in Rehabilitation

INTRODUCTION

There are many types of health service outcomes that can be measured. This chapter introduces the more common domains of outcomes that physical therapists find useful as well as examples of how they might be measured. It introduces several outcomes that have not been typically measured by physical therapy practices but for which there is increasing interest. Several medical outcome measures are described that are frequently reported in the literature and that physical therapists may find helpful to understand. This chapter does not describe specific measurement tools or instruments that can be used to generate data for outcome studies, except as examples to illustrate an approach to data collection or as an example from the literature. Because all outcome studies are relative to the questions that are asked and the environments that generate the data, specific measurement tools need to be examined on a case-by-case basis.

COMMON OUTCOME MEASURES IN REHABILITATION

Rehabilitation outcomes can be organized into three categories: patient outcomes, provider outcomes, and service outcomes. Each has its own perspective and uses outcome data for different purposes.

Physical therapy patient outcomes are those changes in the consequences of illness or injury that occur as a result of intervention. Examples of physical therapy patient outcomes include changes in function, social roles, rate of symptom recurrence, and occurrence of complications. Patient outcomes are usually observed or measured by physical therapists during clinical visits or follow-up contacts but are also reported by the patient. The reference point for patient outcomes is the patient; that is, patients will find these measures meaningful.

Provider outcomes are the result of service delivery activities, whether the provider is an individual or a group of clinicians. Provider outcomes include items that can be measured about clinicians, such as service consistency, intervention effectiveness, percentage of satisfied patients on caseload, service cost per provider, provider satisfaction, and knowledge. Impairment changes are also provider outcomes because they are indicators of intervention effectiveness that are meaningful to the clinician and typically have limited relevance to the patient. The reference point for provider outcomes in physical therapy is the physical therapist.

Service outcomes relate to the delivery of services within an institution, among similar institutions or across larger health-care systems. The reference point for service outcomes might be the administrators of a physical therapy practice or group of practices, an accreditation or management group that oversees the quality of care in an institution or type ...