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30 Cards in this Set
- Front
- Back
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tests and measures-general def.
3 components |
Means of gathering (subjective and objective) information from patient/client based on history and systems review to:
Identify and characterize signs and symptoms of pathophysiology, impairments, or functional limitations Establish diagnosis, prognosis, intervention efficacy (tracking or measuring outcomes) Indicates outcomes achievement |
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outcome status
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…is the impact of care on patient/client health over time.”
Outcome measures quantify changes that result from patient/client management. Standardized tests & measures establish a baseline used to develop prognosis, realistic goals and plan of care. |
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measurement
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numeral assigned to an object, event or person or the class (category) to which an object, event or person is assigned according to rules.”
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types of measures in PT
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Self Report Measures
Standardized Patient perceived Subjective Ie. Pain, confidence, satisfaction Performance-Based Measures Standardized Clinically/professionally measured Objective Ie. Standardized walk test |
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why measures
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To identify:
Signs and symptoms Impairments Functional Limitations Disabilities Device & Equipment need and use Barriers To facilitate: Data collection on outcomes Comparisons between outcomes of different interventions To provide: Information regarding progress |
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reliability and validity of measures
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Chosen measures should represent the most reliable and valid test whenever possible
“Gold Standard” measures are considered the best proven in a particular category Must be prepared to defend your measure of choice |
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reliability
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Test-retest-
Consistency of a repeated measure Indicates the stability of a measurement Intrarater- Consistency of the same therapist measuring at different times Interrater- Consistency of the different therapists measuring at different times Parallel form reliability- Measurements obtained using different versions of the same test Internal Consistency- “Homogeneity” Measurements obtained by tests with multiple parts where each part is supposed to measure one concept |
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validity
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The degree to which useful, meaningful, interpretation can be inferred from a measurement
Face Validity- Reflects what is supposed to be measured Content Validity- Establishes the degree to which a measurement reflects a domain of interest (Ie. pain at rest vs. pain with motion) Construct Validity- Theoretical form of validity that a test measures an underlying concept (Ie. motor function) Concurrent Validity- An inferred interpretation is justified by comparing a measurement with supporting evidence obtained at approximately the same time (Ie. new test compared to a gold standard) Predictive Validity- An inferred interpretation is justified by comparing a measurement with supporting evidence obtained at later point in time (Ie. estimates the likelihood of an outcome in the future such as return to work, survival) |
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sensitiveity and specificity
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Sensitivity-
Indicates the proportion of individuals with a positive finding who already do or will have a particular condition/characteristic/outcome Positive Predictive Validity Specificity- Indicates the proportion of individuals with a negative finding who do not or will not have a particular condition/characteristic/outcome Negative Predictive Validity |
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guidence catergories for tests and measures
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Aerobic Capacity/Endurance
Anthropometric Characteristics Arousal, Attention, Cognition Assistive and Adaptive Devices Circulation (Arterial, Venous, Lymphatic) Cranial and peripheral nerve integrity Environment, Home, and Work Barriers Ergonomics and Body Mechanics Gait, Locomotion, and Balance Integumentary Integrity Joint Integrity and Mobility Motor Function (Motor Control and Motor Learning) |
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more guidence categories for tests and measures
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Muscle Performance
Neuromotor development and Sensory Integration Orthotic protective and supportive devices Pain Posture Prosthetic requirements Range of Motion Reflex Integrity Self-care and Home Management Sensory Integrity Ventilation and Respiration/Gas Exchange Work (Job, school, play), Community, and Leisure Integration and re-integration |
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guidence catergories for tests and measures
each category includes--- |
General definition and purpose
Clinical indications Pathology/pathophysiology Impairment categories Functional limitations Disability Risk factors Health, wellness & fitness needs Actual tests and measures Tools used for gathering data Data generated |
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Interventions
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The purposeful interaction of the physical therapist with the patient/client, and when appropriate with other individuals involved in patient/client care, using various physical therapy procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis”
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INtervetion- 3components
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1) Coordination, Documentation and Communication
2) Patient/client related instruction 3) Procedural interventions …encourages functional independence, emphasizes patient or client instruction, and promotes proactive, wellness-oriented lifestyles.” |
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Decisions regarding interventions based on:
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Decisions regarding interventions based on:
1) timely monitoring 2) progress towards goal achievement 3) expected outcomes |
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How do physical therapists select appropriate interventions?
based on what model |
How do physical therapists select appropriate interventions?
Complexity and severity of clinical problems Likelihood of success Differences in highest level of function that a person is capable of vs. level of function that person will habituate to Graphic model= grounded in HOAC organizing patient from initial encounter to outcomes HOAC= Hypothesis Oriented Algorithm for Clinicians clinical hypotheses are generated at each step of the process Then task analysis is uused to examine and analyze problems with performance of functional measures and systematically summarize the problem. Finally disablement and enablement models are applied with particular emphasis on enablement History and Interview= purpose why seeking Pt, patient as individual BEGIN TO FORMUALATE EXAMINATION STRATEGY inTERVIEW= PERSON’S PLACE IN SOCIETY AND HOW IT HAS BEEN AFFECTED BY CURRENT CONDITION Determine patient goals and identified problems, what patient wants to do compared to what they are currently able |
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3 core PT intervention categories
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theraputic excersise
functional training and self care and home management functional training: work school, recreation, community |
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guide format for each type of procedural intervention
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Includes:
Clinical Considerations Possible Intervention Anticipated Goals and Expected Outcomes Therapeutic Exercise Functional training in self-care & home management Functional training in work, community, and leisure Manual Therapy Techniques Prescription, Application, & (as appropriate) fabrication of devices and equipment Airway Clearance techniques Integumentary Repair and protection techniques Electrotherapeutic modalities Physical Agents and Mechanical Modalities |
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Therapeutic Exercise
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Systematic performance or execution of planned physical movements, postures, or activities intended to enable the client to:
Remediate or prevent impairments Enhance function Reduce risk Optimize overall health Enhance fitness and well-being |
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Functional training in self-care and home management
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Intended to improve the ability to perform physical actions, or activities in a efficient, typically expected, or competent manner
Examples? What are ADL’s? What are IADL’s? Activities may include accommodation or modification to environment |
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Functional Training: Work, Leisure, Recreation
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Involves education and training for integration or re-integration into community or work environment
This includes: work hardening or work conditioning, negotiating with school systems, and age-appropriate play activities |
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manual therapy techniques
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Skilled hand movements that are intended to:
Improve muscle extensibility Improve range of motion Induce relaxation Mobilize and/or manipulate soft tissue and joints Modulate pain Reduce soft tissue swelling, inflammation, or restriction. |
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devices
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Prescription, Application, and (sometimes) fabrication of Devices and Equipment:
Assistive Adaptive Orthotic Protective Supportive Prosthetic Select, provide and train to use to: Aid in performing tasks/movement Support weak of ineffective joints of muscles Replace a missing body part Adapt environment to facilitate functional performance |
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Airway Clearance Techniques
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A group of therapeutic activities intended to manage or prevent the consequences of:
Impaired mucociliary transport Inability to protect the airway (impaired cough) |
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Integumentary Repair and protection techniques
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Implementation of therapeutic procedures and modalities that are intended to:
Enhance wound perfusion Manage scarring Promote an optimal wound environment Remove excess exudate from a wound Eliminate non-viable tissue from a wound bed |
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electrotheraputic modalities
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Broad group of agents that use electricity and are intended to:
Assist muscle force generation and contraction Decrease unwanted muscle activity Increase the rate of wound healing Maintain strength after surgery or injury Modulate or decrease pain Reduce or eliminate tissue swelling, inflammation, or restriction Use as a tool in biofeedback Guide p. 118 |
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Physical Agents and Mechanical Modalities
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Group of procedures using various forms of energy that are applied to tissues in a systematic manner.
They are intended to: Increase connective tissue extensibility Increase the healing rate of open wounds Reduce pain Reduce or eliminate swelling, inflammation, or restrictions Remodel scar tissue Treat skin conditions |
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Physical Agents-
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Thermal Agents
Athermal Agents- ie. pulsed electromagnetic fields Crytherapy- ie. cold packs, ice massage, vapocoolant spray Hydrotherapy- ie. contrast baths, whirlpool Light Agents- ie. infrared, laser, ultraviolet Sound Agents- ie. phonophoresis, ultrasound Thermotherapy- ie. diathermy, dry heat, hot packs, paraffin baths |
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mechanical modalities
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Compression Therapies- ie. bandages, garments, taping, total contact casting, vasopneumatic devices
Gravity-assisted compression devices- ie. standing frame, tilt table Mechanical Motion Devices- ie. CPM: Continuous passive motion Traction Devices- ie. intermittent, positional, sustained |
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Challenges of today’s health care systems:
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Challenges of today’s health care systems:
1) Time to spend with client 2) # of visits 3) Who does the treatment 3) Discharge planning- starts at the eval |
