What do these outcomes measures have in common?
- The Step Activity Monitor (SAM)
- Barrow Neurological Institute (BNI) Fatigue Scale
- The Postural Assessment Scale for Stroke (PASS)
- And the Hierarchical Assessment of Balance and Mobility (HABAM)
Yes, they do all suffer from the same urge to give every outcomes measure an acronyms. (Although it has to be said that the people who invented the Physiotherapy Functional Mobility Profile Questionnaire (PFMP-Q), had no desire to give their outcome measure a memorable name or acronym). But that’s not the right answer.
The answer is that they are all outcome measures developed in the last 20 years that are widely used in rehabilitation.
Now this may seem an insipid answer I know, but hopefully it does prompt some interesting thoughts.
Outcome measures are one of the biggest subjects in physiotherapy today, and there are now dozens of new measures being developed each year. The rhetoric for developing sensitive, reliable and valid measures is well known: outcome measures allow us to tell which treatments work and which don’t, and they allow us to assess the effect of our therapy. But they don’t, in themselves, ask more critical questions, like ‘why is it that outcome measures have become so remarkably popular (and suddenly necessary) in the last 25 years?’
Physiotherapists have used outcomes measures since the birth of the modern rehabilitation movement in World War I. Muscle strength testing, range of movement and, most importantly, return to active duty/work rates, were frequently used to assess our treatments.
These few rudimentary tests remained the backbone of physiotherapy measurements for the next 60 years. But when physiotherapists became first contact professionals, moved into universities, and adopted evidence-based medicine’s hierarchy of evidence, everything changed.
But this still doesn’t explain why outcome measures have become so important lately.
To answer this question, we need to dig a little deeper.
Consider this statement from Jonathan Hill, Senior Lecturer in physiotherapy at Keele University, commenting recently on the new Musculoskeletal Health Questionnaire (MSK-HQ).
A key reason for using the tool, according to Dr Hill, was that…models of commissioning typically require physiotherapists to engage with service evaluation and improvement. There had been a strong demand from physios for a more appropriate, discrete and easy to use MSK outcome tool (link).
Whatever else we might think, the real power of outcome measures is in their ability to allow us to say that our treatments are better than theirs; that our evidence is stronger; that if there is any spare social capital left for orthodox health professionals after doctors and nurses have vacuumed up all of the hero-worship and angel dust, then we should get it rather than them.
One only has to look at the changing economy of health care over the last quarter century to realise why outcome measures have become so important.
The outcome measures that survive our newfound critical scrutiny, will not be those that are necessarily the easiest to use, nor the most valid or reliable. It will be the measures that most convincingly show that we are better than them that will endure. And so, perhaps the only outcome measure that really matters, when all is said and done, is the fact that we will still be here tomorrow fighting for our right to design more outcome measures.