Functional Assessment and Outcome Measures

Functional Assessment Basics - Motion Metrics Mission

• Purpose: Quantify patient's functional status & monitor changes over time.
• Key Elements:
  • History: Focus on Activities of Daily Living (ADLs) & Instrumental ADLs (IADLs).
  • Clinical Exam: Range of Motion (ROM), Manual Muscle Testing (MMT), gait, balance.
  • Standardized Tools: Validated outcome measures (e.g., WOMAC, DASH score).
• Importance: Informs diagnosis, guides rehabilitation, predicts outcomes, assesses treatment effectiveness.

⭐ The International Classification of Functioning, Disability and Health (ICF) model provides a biopsychosocial framework for understanding health and disability, crucial for holistic functional assessment.

Outcome Measure Properties - Reliability Rodeo

• Reliability: Consistency of a measure.
  • Test-Retest: Stability over time.
  • Inter-Rater: Agreement between different raters.
  • Intra-Rater: Agreement of one rater on multiple occasions.
• Internal Consistency: Items measure same construct (Cronbach’s Alpha > 0.7).
• Standard Error of Measurement (SEM): Precision of scores. $SEM = SD \sqrt{(1 - \text{Reliability Coefficient})}$. Smaller SEM = ↑ precision.
• Minimal Detectable Change (MDC): Smallest real change beyond error. $MDC = SEM \times 1.96 \times \sqrt{2}$.

⭐ Minimal Clinically Important Difference (MCID) represents the smallest change in an outcome measure score that a patient perceives as beneficial, guiding interpretation of treatment effects.

Key Orthopaedic Scales - Scale Stars Shine

• HHS (Harris Hip Score): Hip arthroplasty. Clinician-rated. Pain, function, ROM. Max: 100.
• OHS/OKS (Oxford Hip/Knee Score): Hip/knee arthroplasty. PROM. Pain, function. Score: 0-48 (↑better).
• KOOS/HOOS: Knee/Hip OA & injury. PROM. Pain, symptoms, ADL, sport, QoL.
• DASH/QuickDASH: Upper limb disorders. PROM. Function, symptoms.
• SPADI: Shoulder pain/disability. PROM. Pain, disability subscales.
• ASES Score: Shoulder. Patient (pain, function) & clinician parts.
• CMS (Constant-Murley Score): Shoulder. Clinician-rated. Pain, ADL, ROM, strength. Max: 100.

⭐ The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) is a widely used patient-reported outcome measure specifically for hip and knee osteoarthritis, assessing pain, stiffness, and physical function.

Applying Measures Clinically - Data Drives Recovery

• Core: Objective data from outcome measures drives rehab strategies.
• Rehabilitation Cycle:

• Impact:
  • Better plans & outcomes.
  • Supports EBP.

⭐ The Timed Up and Go (TUG) test, requiring a patient to stand from a chair, walk 3 meters, turn, walk back, and sit, is a quick, reliable measure of functional mobility and fall risk, with >13.5 seconds indicating high fall risk in community-dwelling older adults.

High‑Yield Points - ⚡ Biggest Takeaways

• FIM (Functional Independence Measure): Assesses 18 items (motor & cognitive) for disability.
• Barthel Index: Measures independence in 10 basic ADLs.
• Katz Index of ADL: Evaluates functional status in 6 fundamental ADLs.
• SF-36: Generic patient-reported survey, 8 health domains.
• WOMAC: Specific for hip/knee OA; measures pain, stiffness, physical function.
• DASH/QuickDASH: Assesses upper limb disability and symptoms.
• VAS (Visual Analogue Scale): Commonly used for quantifying pain intensity.