Traumatic Brain Injury Outcome Measures Overview

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Uchechukwu Chukwuemeka, Simisola Ajeyalemi, Tarina van der Stockt, Nicole Hills and Rachael Lowe  

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.

• 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 and Setting 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		Agitated Behavior Scale Coma Recovery Scale-Revised Moss Attention Rating Scale Rancho Levels of Cognitive Functioning
Inpatient		Coma Recovery Scale-Revised Moss Attention Rating Scale	6 minute walk 10 meter walk Berg Balance Scale Community Balance and Mobility Scale Disability Rating Scale Functional Assessment Measure Modified Ashworth Scale Patient Health Questionnaire Quality of Life after Brain Injury Rancho Levels of Cognitive Function
Outpatient		High Level Mobility Assessment	Action Research Arm Test Apathy Evaluation Scale Balance Error Scoring Scale Community Integration Questionnaire Dizziness Handicap Inventory Global Fatigue Index Sydney Psychosocial Re-integration Scale 6 minute walk 10 meter walk Berg Balance Scale Community Balance and Mobility Scale Disability Rating Scale Functional Assessment Measure Modified Ashworth Scale Patient Health Questionnaire Quality of Life after Brain Injury Rancho Levels of Cognitive Function

Ambulatory Level

Phase	Recommended
Mildly Dependent to Independent in Ambulation	6 minute walk 10 meter walk Balance Error Scoring System Community Mobility and Balance Scale Functional Assessment Measure High Level Mobility Assessment Test
Moderately to Severely Dependent in Ambulation	Functional Assessment Measure FIM
Note: Recommendations based on ambulatory level were made without consideration of treatment settings, therefore therapists must use clinical judgment to determine appropriateness of recommendations for individual cases.

International Classification of Functioning, Disability, and Health Component

ICF Area	Clinical Area	Outcome Measure
Body Structure and Function	Neurological and Autonomic	International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Surface Electromyography
	Strength	Hand-Held Myometer
	Spasticity	Ashworth and Modified Ashworth Penn Spasm Frequency Scale Pendulum Test
	Sensory - Pain	Brief Pain Inventory Classification System for Chronic Pain in Spinal Cord Injury
	Skin Health	Braden Scale Spinal Cord Injury Pressure Ulcer Scale (SCIPUS)
	Mental Health	CAGE Questionnaire Depression Anxiety Stress Scale - 21 Patient Health Questionnaire - 9
Activities	Lower Limb and Walking	6 Minute Walk Test (6MWT) 10 Meter Walk Test (10MWT) Berg Balance Scale (BBS) Timed Up and Go Test (TUG) Walking Index for Spinal Cord Injury (WISCI) Standing and Walking Toolkit
	Wheeled Mobility	Wheelchair Skills Test (WST)
	Upper Limb	Capabilities of Upper Extremity Instrument (CUE) Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) Jebsen Hand Function Test Sollerman Hand Function Test Box and Block Test
	Self Care	Frenchay Activities Index (FAI) Lawton Instrumental Activities of Daily Living Scale (IADL) Spinal Cord Independence Measure (SCIM)
Participation	Community Reintegration	Craig Handicap Assessment & Reporting Technique (CHART) Reintegration to Normal Living Index
	Quality of Life	Short Form-36 (SF-36) World Health Organization Quality of Life - BREF (WHOQOL-BREF)
Environment	Assistive Technology	Assistive Technology Device Predisposition Assessment (ATD-PA) Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)

Conclusion

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Resources

The Center for Outcome Measurement in Brain Injury (COMBI)

Shirley Ryan Ability Lab Rehabilitation Measures Database

References