Physio Facts - The Importance of Measuring Outcomes with Patients
Healthcare is expensive in every sense of the word – it’s expensive in terms of time, commitment, effort and, of course, financially. In the UK, we are fortunate to have a National Health Service, free at the point of delivery from cradle to grave, but there is a cost to healthcare, whether we use the NHS or private systems. Those that hold the purse strings to our health requirements have a very important job. In the NHS, they have to consider the most cost-effective use of taxpayer’s money. In private healthcare, the fund holders may be insurance companies, a legal team, or the patient themselves. Everyone wants value for money – the best outcome for the least outlay.
Measuring the effectiveness of an intervention in primary healthcare is relatively simple: patients have an illness or injury of sorts, they go to hospital or their GP, they get treated and generally get better. There may be a patient satisfaction questionnaire to complete and data on various surgeries are collated for reference and future planning. Occasionally, patients are referred to a secondary healthcare provider such as ourselves for non-emergent treatment. These types of treatments are often expensive and complicated and the costs and time taken need to be justified to the fund holder using outcome measures.
Outcome measures take many different forms but all will take data at the beginning of a course of treatment and then again at the end of treatment. Sometimes data will also be taken during treatment to check that improvements have occurred and the health intervention is “on the right track”. There are many outcome measures available in the areas of prosthetics and orthotics. Some take the form of simple patient questionnaires, such as socket comfort, perception of balance and functional ability. Others are more objective, such as timed walking or stair climbing tests, or balance testing. For the more athletic patient, we may use actual athletic tests which include running and jumping.
Having a range of outcome measures allows us to show the fund holder functional, objective and subjective gains made during the fitting of a new prosthesis or following an episode of rehabilitation. This is also useful if we feel that a patient has not yet reached their full potential and we would like to continue further with their rehab or provide more advanced prosthetics.
We have also found outcome measures to be useful when comparing different prosthetic components, such as the more advanced microprocessor knees or feet that are now available. In cases such as these, we take a range of outcome measures on the patient’s current prosthesis and then compare them after a short trial period with a loaner knee or foot. Along with a statement from the user, we can then present these measures within a report which allows the patient, prosthetist and fund holder to then make an informed decision on the most appropriate prosthetic device for the user.
Aside from demonstrating the effectiveness of treatment to the fund holder, outcome measures are also very encouraging to the individual patient. Pointing out increases in walking speed and balance ability, or noting improvements in certain gait indicators can be a powerful motivator for continuing to exercise. Alongside outcome measures, we also discuss patient-specific goals, such as being able to return to a leisure or sport activity, or being able to manage a flight of stairs. The outcome measures we chose to do may incorporate these goals by giving them a score and monitoring patient progress towards them. So for instance, we may ask a patient to score themselves on a 0-10 scale for how close to achieving their goal they feel they are. Having a number of separate goals, all scored in this way, gives us a compounded score of achievement in a person-centred way. After all, a good outcome should relate 100% to what that patient actually wants to achieve and not what the treating clinician thinks is best for them!
Lastly, when outcome measures are used consistently, this fosters improvement and adoption of best practices within the clinic situation, therefore improving outcomes further still for everybody involved in patient care and the patients themselves.