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p.m.enderby@sheffield.ac.uk

Outcomes

‘address the effects, not the process, of particular interventions’ (Hesketh & Sage, 1999)

“ results or visible effects of interventions…. forms part of the quality cycle….. provides information on the impact of interventions….identifies the effectiveness of practices….” (Enderby, John & Petheram, 2006)

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Rehabilitation/Habilitation/Enablement

• The process of trying to help people who have suffered some injury/disease or developmental delay to maximise psychological well being, functional ability and social integration (Wade, 1992)

• An often complex process which enables individuals after impairment by illness, developmental delay or injury to regain as far as possible control over their own lives (King’s Fund, 1999) 3

What For?

• Impairment/disorder reduction

• Improved Function

• Psycho social gain

• Wellbeing4

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Therapy treatment goals

• to identify and reduce the disorder/ dysfunction

• to improve or maintain the function and ability

• to assist to achieve potential or integration

• and to alleviate anxiety or frustration.

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Choosing an Outcome Measure

• Relevance• Validity• Reliability

Other considerations• Ease of use• Communication

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The Therapy Outcome Measure

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Note

Therapy Outcome Measures for Rehabilitation Professionals

Pamela Enderby and Alexandra John (2015) ISBN 978-1-907826-29-0 PUBLISHED BY J&R

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End of episode of care

Intervention

Aim/Goal

Referral /case history/ assessment

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“So when do we do it?”

What is the International Classification of Function, Disability and Health (ICF)?

An international classification developed by the WHOof function and disability and its effects on the individual:

• Classifies body structure and function• Classifies activity/independence• Classifies social participation• Classifies how the environment impacts upon the

disabled individual

We have added wellbeing as a domain10

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Impairment

Disease/Disorder/Developmental Delay

Physical Mental/ cognitive

An injury, illness, or congenital condition that causes or is likely to cause a loss or difference of physiological or psychological function as compared to those without such.

Activity

Limitation

Abilities Person

Difficulties an individual may have in the performance of activities/level of independence.

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Participation

Disadvantages

Circumstances Society

Disadvantages an individual may have in the manner or extent of involvement in life situations.

Well-being

Upset

SatisfactionFeelings

Degree of upset, distress, or satisfaction with status

Incorporates frequency and severity

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Carer Well-being

Upset

SatisfactionFeelings

Emotional effect resulting in an upset, distress, or satisfaction with status

THERAPY OUTCOME MEASURE (TOM)

• Based on:World Health Organisation Classification –

ICF.

11 point ordinal scale with 6 defined points

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The Core SCale

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adapTed SCaleS1. Anorexia Nervosa and Bulimia Nervosa-scale under development2. Augmentative and Alternative Communication (AAC)3. Autistic Spectrum Disorder4. Cardiac Rehabilitation5. Cerebral Palsy6. Child Language Impairment7. Challenging Behaviour and Forensic Mental Health8. Chronic Pain9. Cleft Lip and Palate10.Cognition11.Complex and Multiple Difficulty12.Dementia13.Diabetes14.Dietetic Intervention for the Prevention of Cardiovascular Disease15.Dietetic intervention for Enteral Feeding – Paediatrics

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adapTed SCaleS 216.Dietetic intervention for Home Enteral Feeding – Adult17.Dietetic intervention for Irritable Bowel Syndrome18.Dietetic intervention for Obesity – Paediatric19.Dietetic intervention for Obesity – Adult20.Dietetic intervention for Undernutrition – Paediatrics21.Dietetic intervention for Undernutrition – Adults22.Dysarthria23.Dysfluency24.Dysphagia25.Dysphasia26.Dysphonia27.Dyspraxia –Developmental Co-Ordination Difficulties28.Equipment Services29.Head Injury30.Hearing Therapy/ Aural Rehabilitation

adapTed SCaleS 332. Laryngectomy33. Learning Disability – Communication34. Mental Health35. Mental Health – Anxiety36. Multi-Factorial Conditions37. Musculo-Skeletal38. Neurological Disorders (Inc Progressive Neuro Disorders)39. Palliative Care40. Phonological Disorder41. Podiatric Conditions - scale under development42. Post Natal Depression43. Respiratory Care- (COPD)44. Schizophrenia45. Stroke46. Tracheostomy47. Wound Care

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Scales in Development• ADHD• Selective Mutism• Erratum for AAC• Acquired Apraxia• Paediatric Dysphagia• Sensory Processing Disorder• Paediatric Podiatry• Chronic Fatigue Syndrome/ME• Selective Mutism• Prefeeding/ parent infant engagement• Oral Hygiene• Oral Aversion• Orthopaedic -Hip and knee surgery • Transgender – Communication• Trismus• Cognitive Impairment-- Communication Disorder• Velopharyngeal Dysfunction• Vocal Tract Discomfort• Auditory impairment /deafness/ partially hearing• Acute Enteral Feeding-

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Normal limits0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

MildProfound Severe Severe/ Moderate Moderate

Therapy Outcome Measure

Ordinal Rating Scale

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Impairment Mrs PR has had multiple sclerosis for 15 years. She is severely ataxic and has increased tone in all limbs. Her sitting balance is poor.

Activity Mrs PR uses an adapted wheelchair and all aids and appliances in the home effectively. She is in an adapted accommodation and can get to the local shops. She is able to care for the house, provide meals for the family and communicate effectively.

Participation Mrs PR plays an active social role: she is a school governor as well as a volunteer for a local charity. She enjoys her garden and wheelchair dancing.

Wellbeing/distress Mrs PR is a determined, resourceful lady who, not surprisingly, becomes concerned and frustrated on occasion, but is generally positive and uses good emotional support strategies.

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Mrs PR

• Summary Mrs PR has a severe level of impairment but overcomes most functional restrictions by being resourceful and using appropriate aids. Thus, she is only partially limited in activity and is not socially disadvantaged in any specific way.

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All Data from One Service

All Scales and Diagnosis

Total number of clients

Total number of episodes of care

Positive change in zero domains of the TOMs

Positive change in one domain of the TOMs

Positive change in two domains of the TOMs

Positive change in three domains of the TOMs

Positive change in four domains of the TOMs

Numbers of subjects 1611 12529

2995 1945 2399 1705 3485

23.9% 15.5% 19.1% 13.6% 27.8%

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449 Children with Language DisorderHaving received speech and language therapy

Impairment Activity Participation Wellbeing

Down 0.4% 0.4% 1.1% 1.1%Same 9.3% 11.8% 19.7% 21.7%Up 90.2% 87.8% 79.1% 77.1%

Does a good wedding predict a good marriage?

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