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Journal of Neurologic Physical Therapy:
doi: 10.1097/NPT.0b013e31821ba134
Editor's Note

Measures of Evidence in Evidence-Based Practice

Fulk, George PT, PhD; Field-Fote, Edelle C. PT, PhD

Free Access

For every patient we work with as physical therapists, our goal is to identify the best possible interventions that will result in optimal outcomes based on their unique presentation of body structure/function, activities, and participation. But when the literature is replete with various approaches to the same motor dysfunctions, how do we know which is the best possible intervention? The first necessary step in the process of accumulating evidence of the effectiveness of an intervention is to gather sufficient data to support that approach. Comparisons among different intervention are difficult, if not impossible, when different measures are used to assess the outcomes of intervention. The bottom line is that evidence of intervention effectiveness depends on, among other things, the use of a common set ofvalid and reliable measures that are responsive to change and reflect clinically important outcomes.

Imagine a scenario in which you find yourself with a health condition for which surgery is required. When you discuss your options with your surgeon, you are told that a specific approach is indicated on the basis of the outcome of a specific test. Your expectation would be that: (1) the test was a standard test that had been determined to be reliable, valid, and sensitive for this diagnosis and (2) there was evidence in the literature that the outcome of the recommended surgery was beneficial based on results of the postsurgical administration of this test. If you sought a second opinion about whether this approach was warranted, you would hope that the surgeon offering the second opinion would employ the same test and come to the same conclusion about the surgery based on evidence in the literature. However, if the second surgeon decided to use his own criteria to determine the need for the surgery and the outcome of the surgery, then all bets are off regarding what intervention would be recommended and how its effectiveness would be measured.

The use of standardized outcome measures is a critical component of evidence-based, physical therapist practice.1,2 Standardized outcome measures assist with diagnosis, prognosis, developing a plan of care, and assessing patient progress. Outcome measures inform clinical decision-making by guiding the selection of appropriate interventions and evaluating the effectiveness of these interventions.3 Without valid and reliable outcome measures, physical therapist and other rehabilitation professionals would not be able to determine the impact of their interventions. Although the use of standardized outcome measures in the clinic has grown, their use is still limited because of time constraints and lack of knowledge regarding these measures.35

The Neurology Section of the APTA had the foresight to address the need for standardized outcome measures in its 2006–2010 Strategic Plan. Based on this initiative, the Section has supported a number of efforts directed at enhancing the use of outcome measures. In 2008, the Section began development of a continuing education course: Neurologic Practice Essentials: A Measurement Toolbox. More than 300 physical therapists and educators have attended this course at various locations across the country. More recently, the Section developed a task force to make recommendations for outcome measure use in clinical practice and entry-level physical therapist education. Recommendations for the use of stroke-specific outcome measures were presented at the Combined Sections Meeting in New Orleans and are available at http://www.neuropt.org/go/EDGE.

The editors of JNPT have long advocated for the use of standardized outcome measures,6,7 and the journal is pleased to continue these efforts with this special issue on measurement of outcomes in neurologic physical therapy practice. In this issue, members of the task force that developed the Neurologic Practice Essentials: A Measurement Toolbox provide a clinical decision-making model to guide the selection of outcome measures in clinical practice8 and to illustrate the use of this model through a clinical case.9 Beninato and Portney10 provide an overview of the important concepts of responsiveness, minimal detectable change, and minimal clinically important difference and how these may be applied with individual patients to enhance patient-centered, evidence-based practice. Two articles in this issue provide further evidence to support the use of specific outcome measures in people with Parkinson's disease and stroke. Leddy et al11 report on the clinical utility of the miniBEST, an abbreviated version of the Balance Evaluation Systems Test, and its ability to discriminate between fallers and nonfallers in people with Parkinson's disease. Fulk et al12 examine the responsiveness of gait speed in people with stroke who are undergoing outpatient rehabilitation.

JNPT is also excited to implement a number of firsts with this special issue. There are a number of resources on the Internet that provide information on the psychometric properties of specific outcome measures. In our abstracts of current literature, for the first time we review 3 Web sites that provide information on outcome measures for use with people with traumatic brain injury, stroke, and spinal cord injury. The article by Sullivan et al9 has associated supplemental content (available online) that lists available web sites that offer access to standardized outcome measures. We are also planning on holding an open discussion with an author, an editorial board member, and clinician at our Facebook site (http://www.facebook.com/JNeuroPT). Be sure to like JNeuroPT, and join in on the discussion about measuring outcomes in neurologic physical therapy practice.

If you are already consistently using standardized outcome measures in your clinical practice, then you have an excellent basis from to which assess the functional progress of the patients with whom you work. We hope the articles in this issue will offer you insights into whether the measures you use are optimal. If you are not already using standardized outcome measures, then we hope this issue will motivate you to get on board!

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REFERENCES

1. Craik RL. Thirty-sixth Mary McMillan lecture: never satisfied. Phys Ther. 2005;85:1224–1237.

2. Duncan PW, Jorgensen HS, Wade DT. Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke. 2000;31:1429–1438.

3. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89:125–135.

4. Kay TM, Myers AM, Huijbregts MP. How far have we come since 1992? A comparative survey of physiotherapists' use of outcome measures. Physiother Can. 2001;54:268–281.
5. Huijbregts MP, Myers AM, Kay TM. Systematic outcome measurement in clinical practice: challenges experienced by physiotherapists. Physiother Can. 2002;54:25–36.

6. Deutsch J. Standardizing examination of outcomes. J Neurol Phys Ther. 2004;28:57, 108.

7. Field-Fote E. Guest editorial: standardization of outcome measures: the first step toward a classification approach to treatment. J Neurol Phys Ther. 2005;29:114–115.

8. Potter K, Fulk GD, Salem Y, Sullivan J. Outcome measures in neurologic physical therapy practice. Part I: making sound decisions. J Neurol Phys Ther. 2011;35:57–64.

9. Sullivan J, Andrews AW, Lanzino D, Perron A, Potter K. Outcome measures in neurologic physical therapy practice. Part II: a patient-centered process. J Neurol Phys Ther. 2011;35:65–74.

10. Beninato M, Portney LG. Applying concepts of responsiveness to patient management in neurologic physical therapy. J Neurol Phys Ther. 2011;35:75–81.

11. Leddy AL, Crowner BE, Earhart GM. Utility of the Mini-BESTest, BESTest and BESTest Sections for balance assessments in Parkinson disease. J Neurol Phys Ther. 2011;35:90–97.

12. Fulk GD, Ludwig M, Dunning K, Golden S, Boyne P, West T. Estimating clinically important changes in gait speed in people with stroke undergoing outpatient rehabilitation. J Neurol Phys Ther. 2011;35:82–89.

© 2011 Neurology Section, APTA

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