Outcome Measurement for Complex Seating

Schedule

2.00pm Outcomes Management: The Strive to Prove Complex Seating & Mobility Equipment Really Matters Mark Schmeler and Richard Schein

3.45pm Coffee

4.00pm Outcome Measures in Complex Seating: Using Goal Attainment Scaling (GAS) Clare Wright

4.40pm Discussion

5.00pm Finish

 

 

Mark R. Schmeler
 

Outcomes Management: The Strive to Prove Complex Seating & Mobility Equipment Really Matters

Mark R. Schmeler, PhD, OTR/L, ATP & Richard M. Schein, PhD, MPH, Department of Rehabilitation Science & Technology, University of Pittsburgh

Course Description
Those who use, provide, or pay for goods and services now more than ever want to know what they are getting works and is cost-effective. This is also the case when it comes to healthcare that includes rehabilitation interventions. For decades skilled professionals have provided complex wheeled mobility and seating devices to people with disabilities that have resulted in significant benefit. The problem however is that these benefits have not been reported in a systematic manner. With the advent of evidence-based practice as a primary criteria for coverage policies in an economy of shrinking resources, the field of complex rehab technology is challenged to develop methods to measure and report effectiveness in a uniform manner that has meaning to third party stakeholders. This 2 hour session will review how outcomes and research findings are used in related areas of healthcare to support interventions including; standardized measurement tools, uniform data sets, collective databases, and research methods. Examples of existing and emerging outcomes tools and data sets in the area of wheeled mobility and seating will be discussed with their potential to advance evidence. The potential role of the Rehabilitation Technology Supplier in outcomes management will also be discussed. 

Upon completion of this session, attendees will be able to;

  1. Explain 3 reasons why it is important to measure the outcomes of an intervention
  2. Explain 2 characteristics of a standardized measurement tool
  3. List the 5 levels of research evidence
  4. Give 2 reasons why formalized outcomes have not been implemented in the field of complex rehab technology
  5. Describe one example of a standardized measure used in rehabilitation and it’s relationship to the influence of Medicare policy
  6. Explain 2 reasons why a uniform dataset is necessary to implement an effective outcomes management system
  7. List 2 existing standardized measures that have evolved in the field of wheeled mobility and seating as well as one advantage and disadvantage of each
  8. Explain 2 reasons why the Rehabilitation Technology Supplier has a an active role in measuring outcomes

Mark

Bio
Mark R. Schmeler, Ph.D., OTR/L, ATP
Department of Rehabilitation Science & Technology, School of Health & Rehabilitation Sciences University of Pittsburgh, 6425 Penn Avenue, Suite 401, Pittsburgh, PA 15206 USA Email: schmeler@pitt.edu Web: www.rstce.pitt.edu

Mark is an Assistant Professor, Graduate Faculty, and Director of the Continuing Education Program in the Department of Rehabilitation Science & Technology at the University of Pittsburgh. He is the course director for the International Seating Symposium and directs several other continuing education venues including web-based post-professional education and training. He also directs a national contract to develop Assistive Technology Clinics within the Veterans Administration’s four regional Polytrauma Rehabilitation Centers. He has over 20 years of clinical practice experience and currently practices as an Occupational Therapist and Assistive Technology Professional in the Center for Assistive Technology at the University of Pittsburgh Medical Center which he helped establish and directed until 2005. His graduate teaching responsibilities are in the area of assistive technology funding & policy as well as clinical applications of wheelchair seating and mobility applying case-based and evidence based practice. His area of research is in the development and application of functional outcomes measures, product development, and telerehabilitation. He also works closely with national organizations as an advocate for appropriate coverage policies related to assistive technology. He currently serves on the RESNA Board of Directors.

Post-test True/False Questions

  1. Measuring outcomes helps determine the effectiveness of an intervention TRUE
  2. A measurement tool can be valid but not reliable FALSE
  3. The best evidence as to the effectiveness of an intervention is the opinion of a well-known expert FALSE
  4. The Functional Independence Measure (FIM) is a reliable tool that has shown to be a valid means of comparing the subtle benefits of different seating and mobility interventions FALSE
  5. A uniform means of collecting outcomes data is necessary in order to pool data and increase sample sizes and conduct more robust research analyses TRUE
  6. Questionnaires are a valid means of measuring outcomes as long as they have been systematically developed and tested TRUE
  7. Only researchers have a vested interest and role in outcome measures FALSE
  8. The Rehabilitation Technology Supplier has a role in the development and management of outcomes management systems TRUE
  9. A test has inter-rator reliability if two people can administer the tool and come up with different results FALSE
  10. A test is likely valid if it measures change when if fact a change was actually observed TRUE.

References
Granger CV, Hamilton BB, Linacre JM, Heinemann AW, & Wright BD. Performance profiles of the functional independence measure. Am J Phys Med Rehabil 1993;72:84-89.

Kumar A. Test-retest reliability of the Functional Mobility Assessment (FMA) [master’s thesis]. Pittsburgh: University of Pittsburgh; 2010.

Marino RJ, Huang M, Knight P, Herbison GJ, Ditunno JF, Jr. & Segal M. Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM). Paraplegia1993;31:225-233.

Mills T, Holm MB, Schmeler M. Test-retest reliability and cross validation of the functioning everyday with a wheelchair instrument. Assist Technol 2007;19:61-77.

Ota T, Akaboshi K, Nagata M, Sonoda S, Domen K, Seki M, et al. Functional assessment of patients with spinal cord injury: measured by the motor score and the Functional Independence Measure. Spinal Cord1996;34:531-535.

Portney LG & Watkins MP. (2008). Foundations of clinical research: Applications to practice (3rd ed.). Upper Saddle River, NJ: Prentice Hall.

Schein RM, Schmeler MR, Holm MB, Saptono A, Brienza DM. Telerehabilitation wheeled mobility and seating assessments compared with in person. Arch Phys Med Rehabil 2010;91:874-878.

Schmeler MR. Development and testing of a clinical outcome measurement tool to assess wheeled mobility and seating interventions[dissertation]. Pittsburgh: University of Pittsburgh; 2005.

 

 

Clare Wright, Northern Ireland
 

Outcome Measures in Complex Seating: Using Goal Attainment Scaling (GAS)

Course Description
The field of special seating is known for its complexity. There is wide variation in client presentations and hence subsequent seating configurations, a range of functional goals, and differing environments in which seating systems are used. Often too, our clinical goals may be less important to our clients than their functional and/or social goals. So how can we capture outcomes in a way which is respectful of these complexities, but yet is rigorous enough to demonstrate effectiveness and satisfy funding agencies?

This session will review Goal Attainment Scaling (GAS), as a means of showing outcomes in special seating provision. First used in the late 1960’s to evaluate the outcome of mental health treatment, GAS broadly involves the setting of individual goals based on issues that will be the focus of treatment, selecting indicators for each goal, and specifying the expected level of outcome for each goal1 . As with many clinical interventions, measuring the impact of special seating means recording a change in function, comfort, or ease of use as a result of using special seating. GAS makes room for the inherent variance in individuals but relies on our clinical skills to work with the client and carers to identify the specific issues that the seating system will address for each person.

Participants will have the opportunity to review and discuss the benefits and limitations of the GAS in relation to their own experiences, and practice setting goals, indicators and specifying expected outcomes.

Participants will gain an increased understanding of this standardised outcome measure and the knowledge of when and how to apply it to their own clients.

References

Kiresuk TJ, Smith A, Cardillo JE (Eds) (1994). Goal Attainment Scaling: Applications, Theory and Measurement. Lawrence Erlbaum Associates ISBN 0-89859-889-3.

Bio

Clare graduated with honours in Occupational Therapy from the University of Ulster in 1994.  After 11 years working as a paediatric OT in the National Health Service, Clare took the opportunity to work for James Leckey Design in 2005.  She completed a Master of Clinical Research degree in 2008, and now, as the Clinical Research Manager in the company, undertakes and supervises research projects, as well as providing training and education on a range of clinical and evidence based topics.

 



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