To enable clinicians to make an informed choice when selecting outcome measures to demonstrate the effectiveness of comprehensive rehabilitation, what objective criteria should be examined? This article considers the importance of the purpose, content, psychometric properties and ease of administration in selecting measures. Several outcome instruments evaluating self-care and mobility, mental health interventions and comprehensive rehabilitation approaches are examined with reference to these selection criteria. Measures that evaluate physical, psychological and social functioning, taking into account the desired outcome of the patient and his/her carers, are highlighted.
Get full access to this article
View all access options for this article.
References
1.
DonabedianA.The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press, 1980.
2.
KeithRA. Functional assessment measures in medical rehabilitation: Current status. Arch Phys Med Rehabil1984; 65: 74–78.
3.
LawMLettsL.A critical review of scales of activities of daily living. Am J Occup Ther1989; 43(8): 522–28.
4.
GrangerCVCotterACHamiltonBSFielderRCHersMN. Functional assessment scales: A study of persons with multiple sclerosis. Arch Phys Med Rehabil1990; 71: 870–75.
5.
JohnstonMVFindleyTWDetuaJKatzRT. Measurement tools with application to brain injury. Am J Phys Med Rehabil1991; 70(1): 40–56.
6.
Wood-DauphineeSLWilliamsJIShapiraSH. Examining outcome measures in a clinical study of stroke. Stroke1990; 21(5): 731–39.
7.
SealeCDaviesP.Outcome measurement in stroke rehabilitation research. Int Disabil Stud1987; 9: 155–60.
WadeDT. Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992.
10.
MirinSMNamerowMJ. Why study treatment outcome?Hosp Commun Psychiatry1991; 42(10): 1007–13.
11.
ApplegateWBBlassJPWilliamsTF. Instruments for the functional assessment of older patients. N Eng J Med1990; 322(17): 1207–14.
12.
CalvaniDLDourisKR. Functional assessment: An holistic approach to rehabilitation of the geriatric client. Rehabil Nurs1991; 16(6): 330–35.
13.
HedrickSCBarrandNDegoR. Measuring outcomes of care in geriatric evaluation and management units. J Am Geriatr Soc1991; 39 (Suppl): 48–52.
14.
PollockNBaptisteSLawMMcCollMAOpzoomerAPolatajkoH.Occupational performance measures. A review based on the guidelines for the client-centred practice of occupational therapy. Can J Occup Ther1990; 57(2): 77–81.
15.
BowlingA.Measuring health; a review of quality of life measurement scales. Milton Keynes: Open University Press, 1991.
16.
World Health Organisation. International classification of impairments, disabilities and handicaps. A manual of classification relating to the consequences of disease. Geneva: WHO, 1980.
17.
GrimbyGFinnstonJJetteA.On the application of the WHO handicap classification in rehabilitation. Scand J Rehabil Med1988; 20: 93–98.
18.
RoyCWHunterJArthursYPrescottRJ. Is ‘handicap’ affected by a hospital based rehabilitation programme?Scand J Rehabil Med1992; 24: 105–12.
19.
LankhorstGJHoppenerMGWCVan der KaaijJE. Preliminary experience with WHO'S ICIDH: A user's report. Int Rehabil Med1985; 7(2): 70–73.
20.
CharpentierP.The benefits of using the International classification of impairments, disabilities and handicaps in rehabilitation: A survey of 950 cases. Int Disabil Stud1989; 11(3): 110–13.
21.
WhiteneckGGCharlifueSWGerhartKAOverholserJPRichardsonGN. Quantifying handicap: A new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil1992; 73: 519–27.
22.
HasselkusBRSafritMJ. Measurement in occupational therapy. Am J Occup Ther1976; 30(7): 429–36.
23.
LawM.Measurement in occupational therapy: Scientific criteria for evaluation. Can J Occup Ther1987; 54(3): 133–38.
24.
FrickeJ.Measuring outcomes in rehabilitation: A review. Br J Occup Ther1993; 56(6): 217–21.
25.
SmithRD. The science of occupational therapy assessment. Occup Ther J Res1992; 12(1): 3–15.
26.
KirshnerBGuyattG.A methodological framework for assessing health indices. J Chron Dis1985; 38(1): 27–36.
27.
HaertleinLeonardelli CA. Ethics in evaluation in occupational therapy. Am J Occup Ther1992; 46(10): 950–53.
28.
FisherAGShort-DeGraffM.Improving functional assessment in occupational therapy: Recommendations and philosophy for change. Am J Occup Ther1993; 47(3): 199–201.
29.
MathiowetzV.Role of physical performance component evaluations in occupational therapy functional assessment. Am J Occup Ther1993; 47(3): 225–30.
30.
TromblyC.Anticipating the future: Assessment of occupational function. Am J Occup Ther1993; 47(3): 253–57.
31.
ChristiansenC.Continuing challenges of functional assessment in rehabilitation: Recommended changes. Am J Occup Ther1993; 47(3): 258–59.
32.
Short-DeGraffMFisherAG. A proposal for diverse research methods and a common research language. Am J Occup Ther1993; 47(4): 295–97.
33.
FisherAG. The assessment of IADL motor skills: An application of many faceted Rasch analysis. Am J Occup Ther1993; 47(4): 319–29.
34.
FisherWP. Measurement-related problems in functional assessment. Am J Occup Ther1993; 47(4): 331–38.
35.
DunnW.Measurement of function: Actions for the future. Am J Occup Ther1993; 47(4): 357–59.
36.
MahoneyRBarthelDW. Functional evaluation: The Barthel Index. Md State Med J1965; 14: 61–65.
37.
KeithRAGrangerCVHamiltonBBSherwinFS. The functional independence measure. A new tool for rehabilitation. Adv Clin Assessments1987; 1: 6–18.
38.
HoustonDWilliamsSLBloomerJMannWC. The Bay Area functional performance evaluation: Development and standardisation. Am J Occup Ther1989; 43(3): 170–83.
39.
AffleckJWMcGuireRJ. The measurement of psychiatric rehabilitation status. Br J Psychiatry1984; 145: 517–25.
40.
Good-EllisMAFineSBSpencerJHDivittisA.Developing a role activity performance scale. Am J Occup Ther1987; 41(4): 232–41.
41.
BergnerMBobbittRACarterWBGilsonBS. The Sickness Impact Profile: Development and final revision of a health status measure. Med Care1981; 19: 787–805.
42.
Wood-DauphineeSLOpzoomerAWilliamsJIMerchardBSpitzerWO. Assessment of global function: The Reintegration to Normal Living Index. Arch Phys Med Rehabil1988; 69: 583–90.
43.
Reintegration to Normal Living as a Proxy to Quality of Life. J Chron Dis1987; 40(6): 491–99.
44.
YerxaEJBurnett-BeaulieuSStockingSAzenSP. Development of the Satisfaction with Performance Scaled Questionnaire (SPSQ). Am J Occup Ther1988; 42(4): 215–21.
45.
LawMBaptisteSMcCollMOpzoomerAPolatajkoHPollockN.The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Can J Occup Ther1990; 57(2): 82–87.
46.
McAvoyE.The use of ADL indices by occupational therapists. Br J Occup Ther1991; 54(10): 383–85.
47.
EakinP.Assessments of activities of daily living: A critical review. Br J Occup Ther1989; 52(1): 11–15.
48.
EakinP.Problems with assessments of activities of daily living. Br J Occup Ther1989; 52(2): 50–54.
49.
LawM.Evaluating activities of daily living: Directions for the future. Am J Occup Ther1993; 47(3): 233–37.
50.
WadeDTCollinC.The Barthel ADL Index: A standard measure of physical disability?Int Disabil Stud1988; 10(2): 64–67.
51.
MattisonPGAitkenRCBPrescottRJ. Rehabilitation status — The relationship between the Edinburgh Rehabilitation Status Scale (ERSS), Barthel Index and Pulses Profile. Int Disabil Stud1991; 13(1): 9–11.
52.
WolfeCDATaubNAWoodrowEJBurneyPGJ. Assessment of scales of disability and handicap for stroke patients. Stroke1991; 22(10): 1242–44.
53.
GrangerCVAlbrechtGLHamiltonBB. Outcome of comprehensive medical rehabilitation measurement by Pulses Profile and the Barthel Index. Arch Phys Med Rehabil1979; 60: 145–54.
54.
MurdockC.A critical evaluation of the Barthel Index, part 1. Br J Occup Ther1992; 55(3): 109–11.
55.
MurdockC.A critical evaluation of the Barthel Index, part 2. Br J Occup Ther1992; 55(4): 153–56.
56.
ShahSCooperB.Commentary on ‘A critical evaluation of the Barthel Index’. Br J Occup Ther1993; 56(2): 70–72.
HamiltonBBLaghlinJAGrangerCVKaytonRM. Inter-rater agreement of the seven level functional independence measure. Arch Phys Med Rehabil1991; 72: 572.
59.
DoddsTAMartinDPStolovWGDegoRA. A valuation of the Functional Independence Measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil1993; 74: 531–36.
60.
FrickeJUnsworthCWorrellD.Reliability of the Functional Independence Measure with occupational therapists. Aust Occup Ther J1993; 40(1): 7–15.
61.
DavidoffGNElliottJRHaughtonJSArdnerMS. Cognitive dysfunction in spinal cord injury patients: Sensitivity of the Functional Independence Measure subscales vs Neuropsychologic Assessment. Arch Phys Med Rehabil1990; 71: 326–29.
62.
EmhoffTAMcCarthyMCushmanMGarbJLValenzianaC.Functional scoring of multi-trauma patients: Who ends up where?J Trauma1991; 31(9): 1227–32.
63.
WilsonDBHouleDMKeithRA. Stroke rehabilitation: A model predicting return home. West J Med1991; 154(5): 587–90.
64.
ByrnesMBPowersFF. FIM: Its use in identifying rehabilitation needs in the head-injured patient. J Neurosci Nurs1989; 21(1): 61–63.
65.
NissenMI. Emphasis placed by Cedar Court Physical Rehabilitation Hospital on the Functional Independence Measure as the overall index for successful rehabilitation. Aust Clin Rev1989; 9: 36–38.
66.
JenkinsR.Towards a system of outcome indicators for mental health care. Br J Psychiatry1990; 157: 550–14.
67.
CookS.A study of the outcomes of occupational therapy in mental health services. University of Sheffield, 1991; (Available from College of Occupational Therapists' Disability Information and Study Centre [DISC], London.)
68.
KielhofnerG, ed. A model of human occupation: Theory and application. Baltimore: Williams & Wilkins, 1985.
69.
KhoosalDIOswaldAGSmithRJ. Practical appraisal of a new rating scale (MRSS) for rehabilitation. J R Soc Med1987; 80: 88–90.
70.
HemphillBJ. The evaluative process in psychiatric occupational therapy. Thorofare, NJ: Slack, 1982.
71.
McCreadieRGAffleckJWRobinsonADT. A comparison of scales for assessing rehabilitation patients. Br J Psychiatry1987; 151: 520–22.
72.
AffleckJWAitkenRCBHunterJAAMcGuireRJRoyCW. Rehabilitation status: A measure of medicosocial dysfunction. Lancet1988; Jan 30: 230–33.
73.
PollardWEBobbittRABergnerMMartinDPGilsonBS. The Sickness Impact Profile: Reliability of a health status measure. Med Care1976; 14(2): 146–55.
74.
GilsonBSGilsonJSBergnerMBobbittRA. The Sickness Impact Profile. Development of an outcome measure of health care. Am J Public Health1975; 65(12): 1304–10.
75.
BergnerMBobbittRAKresselS. The Sickness Impact Profile: Conceptual formulation and methodology for the development of a health status measure. Int J Health Serv1976; 6(3): 393–415.
76.
MacKenzieCRCharlsonMEDigioiaDKelleyK.Can the Sickness Impact Profile measure change? An example of scale assessment. J Chronic Dis1986; 9(6): 429–37.
77.
DeyoRAInuiTS. Toward clinical applications of health status measures: Sensitivity of scales to clinically important changes. Health Serv Res1984; 19(3): 275–89.
78.
BergnerMBobbittRAPollardWEMartinDPGilsonBS. The Sickness Impact Profile: Validation of a health status measure. Med Care1976; 14(1): 57–67.
79.
CarterWBBobbittRABergerMGilsonBJ. Validation of an interval scaling: The Sickness Impact Profile. Health Serv Res1976; 11(4): 516–28.
80.
DeyoRAInuiTSLeiningerJDOvermanSS. Measuring functional outcomes in chronic disease: A comparison of traditional scales and a self-administered health status questionnaire in patients with rheumatoid arthritis. Med Care1983; 21(2): 180–92.
81.
De WitteLP. After the rehabilitation centre. Amsterdam: Swets and Zeitlinger, 1991.
82.
PollockN.Client-centred assessment. Am J Occup Ther1993; 47(4): 298–301.
83.
Department of National Health and Welfare and Canadian Association of Occupational Therapists. Guidelines for the client-centred practice of occupational therapy (H 39-33/198 3E). Ottawa, ON: Department of National Health and Welfare, 1983.
84.
Department of National Health and Welfare and Canadian Association of Occupational Therapists. Towards outcome measures in occupational therapy (H 39-114/198 7E). Ottawa, ON: Department of National Health and Welfare, 1987.
85.
Report of National Health and Welfare and Canadian Association of Occupational Therapists. Towards outcome measures in occupational therapy (H 39-114/198 7E). Ottawa, ON. Department of National Health and Welfare, 1987.
86.
Scottish Office Home and Health Department and Scottish Health Service Advisory Council. Rehabilitation services in Scotland. Edinburgh: HMSO, 1993.
