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5.2 – Why should rehabilitation providers use outcome measures?

Evidence-based practice is now a well-accepted component of health and medical care in many parts of the world.

What is evidence-based practice?

  • "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients"1

What is the goal of evidence-based rehabilitation?

  • To incorporate research findings with clinical wisdom and clients' preferences to inform rehabilitation assessment and treatment.2

Research questions addressed in rehabilitation include:

  • the effectiveness and safety of interventions;
  • the frequency of diseases and disability;
  • aetiology and risk factors;
  • prediction and diagnosis;
  • diagnostic accuracy and other phenomena including hypothesis generation.3

The evidence base in rehabilitation is growing rapidly, but translating these findings into practice remains a challenge.4,5,6,7,8 The goal of this resource is to provide evidence-informed guidance on rehabilitation for adults and children living with HIV.

Rycroft-Malone et al (2004)9 describe four types of evidence that can contribute to the delivery of care: 1) research, 2) clinical experience, 3) patient experience, and 4) information from the local context.

Research: The strongest type of research evidence is a blinded, randomized controlled trial (RCT) for testing an intervention.10 However, other types of quantitative and qualitative research are valuable when used appropriately.

Clinical experience: Knowledge from clinical experience is a crucial component of evidence-based practice to achieve client-centred care. This perspective allows clinicians to work according to their skills and experiences.

Patient experience: Knowledge from clients, family members and carers regarding what works for the client is crucial. Communication of desires and goals are necessary to apply the research-based evidence appropriately.

Information from the local context: Finally, practice can be improved by incorporating knowledge from the local context, including knowledge of an organization's culture and the local health system.

Why use outcome measures?

  • As evidence-based practice and initiatives to improve healthcare have grown around the world, there has been increased recognition of the need to measure outcomes.
  • Using outcome measures in practice is important because it helps rehabilitation providers:
  • compare a client’s function to other people living with HIV, or the general population
  • determine whether changes in a client's health status occur over time
  • facilitate communication about a client's health status among members of the health care team
    • e.g., when a client is transferred from acute to rehabilitation care, the rehabilitation provider in acute care can indicate scores on a symptom index in the chart and the rehabilitation provider in the rehabilitation department will be able to know what they mean
  • determine whether a change in health status occurs in response to a particular intervention.

Why are using outcome measures in rehabilitation with people living with HIV important in Sub-Saharan Africa?

  • HIV management can be complex, which demands a comprehensive continuum of care.
  • Given the complexity of care associated with rehabilitation of people living with HIV, key issues to be addressed include: ‘what works?’, ‘how can it be measured?’, ‘what can be used to measure that which works?

Table 5.2: Purpose of outcome measures

Purpose Description

Descriptive

Describes the state of a health construct at a point in time.

This description can be used to compare the client to other clients, or the general population.

For example, measuring activities of daily living or symptom severity at one point in time.

Predictive

Used to predict outcome or make a prognosis, helps clinicians set treatment goals or discharge plans, and anticipate the need for home adjustments or community support.11,12

For example, using a balance scale to predict whether someone is at risk of falling.

Evaluative

Useful for detecting the magnitude of change over time in an individual or group.13, 14

For example, measuring health-related quality of life (HRQL) at two time points, such as before and after a six week rehabilitation program to see if there are changes (improvement or worsening) in HRQL. 

Discriminative

Differentiates between patient groups and identifies differences in patients’ abilities15

What would rehabilitation providers measure in people living with HIV?

There are many "things" (otherwise referred to as constructs or concepts) that health professionals might measure with clients. These health-related concepts exist at multiple levels:

 

 

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