Traumatic Brain Injury Outcome Measures Overview

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Introduction

An Outcome Measure is a test used to objectively determine baseline function of an individual at the beginning of treatment. Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy. With the move towards Evidence Based Practice (EBP), objective measures of outcome are important to provide credible and reliable justification for treatment. The instrument should also be convenient to apply for the therapist and comfortable for the individual.

Measuring the effectiveness of interventions is accepted as being central to good practice. An integral part of evaluating clinical practice is to objectively assess the intervention and measure it against a set of outcomes to determine its efficacy. For results to be meaningful, it is imperative that any measures used to assess outcomes in any health care context cover domains (for example pain, physical function, perceived independence) that are relatively specific and appropriate to both the particular context and population that you are working with and have acceptable measurement properties, including: reliability, validity, responsiveness, acceptability and feasibility specific to that population.

TBI EDGE Task Force Recommended Outcome Measures

The TBI EDGE Task Force reviewed 88 outcome measures covering the range of ICF Domains, including body structure and function (15), activities (21), participation (29) and some covering more than 1 ICF domain (29), evaluating each for psychometrics and clinical utility for individuals with moderate to severe traumatic brain injury. Through literature review, analysis, and a modified Delphi Procedure, recommendations were formulated for outcome measures that are highly recommended for use in individuals with Traumatic Injury during each phase of treatment, with a summary for each of these outcome measures updated or added to the Shirley Ryan Ability Lab Rehabilitation Measures Database. [1]

5 measures were recommended or highly recommended for acute setting
17 measures were recommended or highly recommended for inpatient rehabilitation
18 measures were recommended or highly recommended for outpatient rehabilitation
6 measures were recommended for patients mildly dependent to independent in ambulation:
2 measures were recommended for patients moderately to severely dependent in ambulation
19 measures were recommended for use in physiotherapy education
52 measures were recommended for use in traumatic brain injury research

Phase of Treatment Overall 14 measures were recommended or highly recommended for at least 2 levels of acuity providing the ability to compare progress over a longer period of time and covering a number of domains of the International Classification of Functioning, Disability, and Health. The acute spinal cord injury category had a total of 6 “Highly Recommended” Outcome Measures and 7 “Recommended” Outcome Measures in comparison with the chronic spinal cord injury category, which had a total of 6 “Highly Recommended” Outcome Measures and 19 “Recommended” Outcome Measures. Limited research in acute spinal cord injury (0 - 3 months) meant fewer measures could be recommended during this phase of injury. In particular in relation to quality of life and upper limb function were areas in which no recommendations could be made, despite the importance of both areas and have been identified as a need for further research and development.

Phase	Timeframe	Highly Recommended	Recommended
Acute	0-3 Months	6 Minute Walk Test (6MWT) 10 Meter Walk Test (10MWT) Hand Held Myometry Timed Up and Go (TUG) Walking Index for Spinal Cord Injury II (WISCI II) ASIA Impairment Scale	Berg Balance Scale (BBS) Functional Independence Measure (FIM) Manual Muscle Test (MMT) Needs Assessment Checklist Numeric Pain Rating Scale Spinal Cord Independence Measure III (SCIM III) Spinal Cord Injury Functional Ambulation Inventory
Subacute	3-6 Months	6 Minute Walk Test (6MWT) 10 Meter Walk Test (10MWT) Handheld Myometry Timed Up and Go (TUG) ASIA Impairment Scale	Berg Balance Scale (BBS) Functional Independence Measure (FIM) Manual Muscle Test (MMT) Needs Assessment Checklist Numeric Pain Rating Scale Sickness Impact Profile 68 Spinal Cord Injury Functional Ambulation Inventory Spinal Cord Independence Measure III (SCIM III) Walking Index for Spinal Cord Injury II (WISCI II)
Chronic	> 6 Months	6 Minute Walk Test (6MWT) 10 Meter Walk Test (10MWT) Handheld Myometry Numeric Pain Rating Scale (NRS) World Health Organization Quality of Life - BREF (WHOQOL - BREF) ASIA Impairment Scale	Berg Balance Scale (BBS) Capabilities of Upper Extremity Instrument (CUE) Craig Handicap Assessment & Reporting Technique (CHART) Craig Hospital Inventory of Environmental Factors Functional Independence Measure (FIM) Graded and Redefined Assessment of Sensibility, Strength and Prehension (GRASSP) Life Satisfaction Questionnaire 9 Manual Muscle Test (MMT) Multidimensional Pain Inventory, SCI Version Reintegration to Normal Living Index Satisfaction With Life Scale Short Form 36 (SF-36) Sickness Impact Profile 68 Spinal Cord Injury Functional Ambulation Inventory Spinal Cord Injury Functional Ambulation Profile Spinal Cord Injury Independence Measure III (SCIM III) Timed Up and Go (TUG) Walking Index for Spinal Cord Injury II (WISCI II) Wheelchair Skills Test (WST) Wheelchair Users Shoulder Pain Index

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References

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