Clinical Bottom Line
“How should I apply this information?”
The use of a blended model of both qualitative- and quantitative-data collection to guide clinical decision making is the strength of the paradigm underlying this research. Information in this article is relevant for all pediatric physical therapists working with children who use wheelchairs and also for those participating in the wheelchair selection process. This article reminds us that as rehabilitation professionals, relying on our expertise in evaluation and assessment of a child's physical function is not sufficient. In addition to clinical expertise of pediatric physical therapists, a child's self-reported outcome measure can be a useful method for children to actively engage in their own health care decision making and effective self-advocacy. The challenge is finding an appropriate outcome measure that allows self-reporting to be relayed accurately. This is especially true in the case of assessing physical function in children who use wheelchairs, since the research in this area is limited.1 The Patient Reported Outcomes Measurement Information System pediatric physical function related to mobility appears to be easily applied for children who use wheelchairs to assess their physical function.
“What should I be mindful about in applying this information?”
Although the physical function related to mobility was easily applied in this study and the children were able to respond to the test items, the individual test items might not have adequately reflected their true capabilities. The authors indicated that the children revealed that some items were vague, with multiple ways of interpreting the question, and the questions were based on the assumption that the child was ambulatory. In addition, the Patient Reported Outcomes Measurement Information System pediatric physical function related to mobility item bank was developed through focus groups and cognitive interview of children with asthma and children without medical conditions or disabilities.
Although the sample size is small, with a limited age range (8-12 years), and is also limited in diagnostic categories addressed, the importance of refinement and expansion of this outcome measure for the pediatric population is encouraged. Outcome measures greatly enhance documentation. As precision of clinical documentation is increasingly requested by third-party payers, the use of reliable outcomes instruments is emerging as a necessary part of clinical practice decision making.
Ana Carolina Mieres, PT, PhD
Jennifer Lam, PT, DPT
All Children's Hospital, eQHealth Solutions-Florida
St Petersburg, Florida
1. Meyers AR, Anderson EM. Enabling our instruments: accommodation, universal design, and access to participation in research. Arch Phys Med Rehabil. 2008;81(suppl 2)(12):S5–S9