Understand the importance of measuring outcomes, the different types of measures and ways of finding suitable measures.
There is undeniable positive motivation in recognising and celebrating the results of a person’s efforts. In relation to rehabilitation, this becomes part of the drive for ongoing effort to continue to progress. When the person can see and understand the progress being made, their trust and commitment to their program increases.
Any method of recognising an outcome that has been achieved through practise and hard work adds value to the rehabilitation plan and provides an opportunity to celebrate the success.
The importance of tracking progress and achievement
While the celebration of progress (and the associated motivation) is a clear reason for measuring outcomes, there are other reasons too.
- Identify when strategies and actions aren’t working, so that other options to achieve the goal may be considered.
- Develop the person’s self-awareness of what is realistic and help them to adjust their own goals.
- Identify when progress has plateaued or ended so decisions about future rehabilitation or therapeutic investment are objective and based on value-add principles.
- Report to funders on the success of their investment. Justify any further requests for funding.
- Identify when a short-term goal has been achieved. Give the person the opportunity to consider bigger, more ambitious goals.
- At the service and system levels, consolidate outcome measures across clients to identify the most effective therapeutic strategies and interventions for specific client groups.
Outcomes in the health context
According to the International Consortium for Health Outcomes Measurement, outcomes are the results of treatment that patients care about most.1
Outcomes are not outputs; they are not lab results; they are not technical details. They’re real-world results, like physical functioning or level of pain. For example, how soon after treatment can a patient with low-back pain expect to return to work? How likely is a man to experience incontinence or sexual dysfunction after treatment for prostate cancer?
Formal measures are required for comparative and collective strategies. In rehabilitation, for example, the Functional Independence Measure (FIM)TM measures progress during the person’s rehabilitation episode of care, and collectively, shows that the service is producing gains for the population group.2
Complete measures at the beginning of the program and at regular or pre-determined intervals to inform rehabilitation planning and track progress.
Intermittent reassessment demonstrates progress to the person. It helps you assess if your intervention strategies are having the desired outcomes. Lack of progress may mean you need to change treatment strategies, review goals, or acknowledge that plateau has been achieved and rehabilitation intervention is no longer indicated.
Measurement tools
There are many standardised tools available to measure outcomes across the full range of functional domains.
When selecting which tools to use, consider what outcome measures will be most useful in tracking the person’s progress and outcomes. This will largely be influenced by the nature of their impairments and the nature of their goals. Some outcome measures may be more relevant at different stages of rehabilitation. For example, community integration may not be appropriate early in an inpatient admission, but relevant in community-based rehabilitation.
Goal attainment scaling (GAS) is often used as a formal outcome measure.3 When using GAS, including unrealistic or aspirational goals may mean goal attainment scores appear negative, when in fact the non-achievement of a goal has a positive effect on the person’s disability awareness and adjustment.
When using participation-level goals it is important that periodic outcome measurement captures progress towards the goal. This may involve clinical outcomes at the body functions and/or activity levels as steps towards the participation goal.
Patient-reported measures
The person reporting on their own level of achievement can provide valuable information into their insight, perceived progress, compensatory strategies and adjustment. Patient-reported measures can include outcome and experience measures.
An example of a patient-reported experience measure is the Australian Modification of the Client Centred Rehabilitation Questionnaire (AM-CCRQ).4 This explores the person’s perspective of client-centredness across several sub-scales, including decision making, education and family involvement.5
An example of a patient-reported outcome measure is the Patient-Reported Outcomes Measurement Information System (PROMIS) 29. PROMIS includes a wide range of measures you can choose from.
Support resources
Use these sites to find more information about outcome measures and how to select those most suited to your context.
Patient-reported measures used by NSW Health
Source: Agency for Clinical Innovation
Rehabilitation measures database
Source: Shirley Ryan AbilityLab
Outcome measures
Source: Physiopedia
Measuring adult outcomes from traumatic brain injury
Source: Moving Ahead (UNSW)
References
- ICHOM. Frequently asked questions. ICHOM [cited 2 Jul 2024]
- Uniform Data Set for Medical Rehabilitation. Functional Independence Measure. UDSMR: 1996.
- Kiresuk T, Sherman R. Goal attainment scaling: a general method of evaluating comprehensive mental health programmes. Community Ment Health J. 1968;4(6):443-53. DOI: 0.1007/BF01530764
- Capell J, Pryor J, Fisher M, et al. Person-centred rehabilitation: Implementation and evaluation of a rehabilitation specific patient experience survey. Wollongong: University of Wollongong; 2016 [cited 28 Feb 2020].
- Cott CA, Teare G, McGilton KS, et al. Reliability and construct validity of the client-centred rehabilitation questionnaire. Disabil Rehab. 2006; 28(22):1287-97. DOI:10.1080/09638280600638398