Traumatic Brain Injury Outcome Measures Overview
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Kim Jackson, Uchechukwu Chukwuemeka, Simisola Ajeyalemi, Rachael Lowe, Tarina van der Stockt and Nicole Hills
Introduction[edit | edit source]
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[edit | edit source]
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 of Treatment[edit | edit source]
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. [1]
| Phase | Timeframe | Highly Recommended | Recommended |
|---|---|---|---|
| Acute | 0-3 Months | ||
| Subacute | 3-6 Months | ||
| Chronic | > 6 Months |
Treatment Setting[edit | edit source]
Overall 8 measures were recommended or highly recommended for at both settings 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. [1]
| Phase | Timeframe | Highly Recommended | Recommended |
|---|---|---|---|
| Inpatient | 0-3 Months | 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 | 3-6 Months | 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 |
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