Beth Shelly, PT, DPT, WCS, BCB PMD
6/5/13 Pelvic PT Distance Journal Club
This article is important to read cover to cover. It does a great job at summarizing the
history of outcomes and how you can change outcome results by using a different
outcome measure. Outcomes are very
important and we must be able to choose the correct one for the job.
Definitions - taken from many sources - Outcomes should be reliable and valid
·
Reliability - (Interclass correlation ICC) the extent to which a measurement is
consistent and free from error - statically calculated
o
Inter-rater reliability - assesses the degree to which test
scores are consistent when measurements are taken by different people using the
same methods.
o
Test-retest reliability / intra-rater reliability - assesses the degree to which test
scores are consistent when measurements are gathered from a single rater who
uses the same methods or instruments and the same testing conditions.
·
Validity - ability of a measure to detect or
measure what is indented. Validity is measured in a specific patient population. Measure should be performed according to how
it was validated (patient fills out versus therapist asks the questions)
·
Reproducibility - appears to be the same as
reliability. There is no way to
statistically calculate reproducibility.
·
Responsiveness - ability to detect change
·
Minimally clinically important difference - the
smallest change in a measure that a patient or clinician would care about
Objective outcome - things that you can measure
·
Manual examination of PFM (including MMT)
·
Biofeedback - assessment, EMG, pressure, ultra
sound
·
Pad test
·
POPQ
Subjective outcomes - patient reports
·
Bladder dairy
·
Symptom
questionnaires - PFDI
·
QOL questionnaires - PFIQ
·
Global impression of improvement
o Circle
the one best number which describes how your bladder / bowel / pelvic condition
is now compared to how it was before you began treatment
o 1.
very much better
o 2.
much better
o 3.
a little better
o 4.
no change
o 5.
a little worse
o 6.
much worse
o 7.
very much worse
·
Patients appear to recognize first signs of
meaningful improvements at 50% better and significant improvement at 75%
improvement (according to research)
·
Bother VAS score 0 to 10 MCID 1 to 2
Calculation percentage score
·
value / total possible score
·
28/70 = 40%
·
PFDI and PFIQ both have a possible score total
of 300
Calculation percent change
·
ending value - initial value / initial value
·
33.3 - 89 / 89 = 62.5% change
Typical female PFM dysfunction - PFDI and PFIQ are valid,
reliable and responsive. Have been
tested in many patient populations and cover most of the typical female PFM
dysfunctions seen in the average PT practice.
I also add the ICIQ-SF and ask the patient global impression of change
question at re-evaluation and discharge.
·
ICIQ SF MCID = 2 to 2.5
·
Pelvic floor distress inventory (PFDI)
o CRADI
- bowel dysfunction - MCID 11
o UDI
- urinary dysfunction - MCID 11
o POPDI
- POP dysfunction
·
Pelvic floor impact questionnaire (PFIQ)
o UIQ
- urinary QOL MCID 16
o CRAIQ
- bowel QOL
o POPIQ
- POP QOL
·
Leaking - International prostate symptoms score
(IPSS)
·
Pain - NIH Chronic prostatitis symptom index (NIH CPPS male)
Patients with pelvic pain - I would still encourage use
of the PFDI and PFIQ with the addition of
·
Documentation of function - Oswestry (MCID 10),
Pelvic pain and disability index
·
Paindetect - screening for centralized pain
·
Sexual function scales as needed - FSFI is most
common, VQ can also be used
Most of the questionnaires listed here are available at
SOWH CAPP pelvic common forms - http://www.womenshealthapta.org/credentialing/cappprep.cfm
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