Measures Commonly Used in Clinic to Assess Falls Risk
Created by: AJ Francioni, SPT
Background:
I was very fortunate to grow up in a household where my grandmother lived with us and I always appreciated what it meant caring for her. That sparked an interest in spending more time with older adults very early in my life and led me to volunteer at nursing homes and senior care facilities. An important aspect of geriatric care is fall prevention and it immediately became a passion of mine once entering the UNC DPT program. Throughout my time at UNC, I have worked with Senior Fitness Testing to screen for falls, CHAMP in Western North Carolina for fall prevention and the implementation of OTAGO, Free From Falls clinic for adults with Multiple Sclerosis, and I completed a Neurological Integrated Clinical Experience (ICE) rotation.
It was during my ICE rotation that I discovered the need and an interest in developing a tool for students to learn more about neuro-based outcome measures. Even while completing research for the EBP-II course, I found that literature can be very limited for outcome measures, but during ICE, we commonly used five measures that I chose to research while developing this tool for students.
Overview/Purpose:
Falls can occur for a multitude of reasons, especially in older adults where vision, sensation, strength, mobility, and balance can decline.1 Because of this, it is important for physical therapists to have some handy outcome measures to assess risk for falls that can be performed with various levels of mobility and independence. For students specifically, it can be difficult to enter a new clinical and know which outcome measure(s) to select based on the clinical presentation of a patient, so this tool was developed to assist students in selecting appropriate outcome measures for assessing risk for falls. This tool was created to educate students prior to entering their neurological-focused clinical rotations to enlighten and challenge them with commonly used neuro-based outcome measures.
Statement of Need:
During my literature search regarding fall prevention for EBP-II, I was disappointed to see that the popular website Rehab Measures did not provide updated research regarding so many common outcome measures, such as Timed Up and Go.2 Seeing that one of the most common outcome measure’s cut-off score for older adults was not properly cited or updated on a popular outcome measures website is why the development of my neuro-based outcome measure website is such a great tool for students and clinicians.3 It includes the most updated and/or available research regarding scoring, psychometrics, and validation for specific populations.
Products:
Two products were created for this Capstone Project. Initially, the goal was to research five outcome measures: Timed Up and Go, Functional Gait Assessment, 4-stage balance test, 4-square step test, and the Berg Balance Scale. The primary focus of the literature search was to determine the effectiveness, responsiveness, and psychometrics of these outcome measures for assessing risk for falls. With this research, the first product was created. A website was developed with access to a pdf version of each test and their written instructions, video demonstrations of each test with an older adult, equipment and scoring requirements, and the psychometrics and neurological patient populations each test has been validated to assess. The “Neuro-based Outcome Measures Commonly Used in Clinic” website is easily accessible to students during their clinical rotations and provides the most up-to-date scoring and psychometrics compared to other outcome measures websites.
Secondly, a “Lunch and Learn” presentation was created to raise awareness of the website and instruct students on how to navigate the site. It was interactive with questions and participation from the audience. During the presentation, “Clinical Pearls” were provided with common mistakes patients make and how to safely guard patients. Students were able to rehearse giving instructions and guarding a patient for the 4-stage balance test, 4-square step test, and components of the Functional Gait Assessment.
Evaluation:
Throughout the process of completing the website, I worked closely with the capstone committee to improve the functionality of the website and ensure quality information and resources for the students. The website focuses on five outcome measures, so as I completed information for each measure, my capstone committee provided me feedback regarding formatting, more research to include, and proper instructions in the video demonstrations. Once all the information on the website was approved by my advisors, I produced the Lunch and Learn presentation. During that inservice presentation, the students that attended provided me with feedback by filling out a survey after learning about the five neurological outcome measures. The survey included scoring my knowledge of the information, organization, ability to answer questions, and presentation skills, such as eye contact. The survey also tested the students’ learning by asking three objective questions to assess my ability to educate and the quality of my presentation. The majority of students demonstrated full understanding by answering the three objective questions correctly and their feedback was very positive.
Self-Reflection:
This website is very exciting to me because I remember being so confused in clinic trying to determine which task you time versus measure distance and the interpretation of every test for risk for falls varies. As we have learned the names of these outcome measures throughout the DPT program, I saw a need to show the tests as they would be performed and provide updated literature to effectively use them in clinic. This project furthered my understanding of each of these measures and their individual tasks along with challenging me to be in an instructive role for students.
While creating the website, I found the most difficult part was finding the most current research, and sometimes the answer was that there is not any. However, I am very proud of the final product and all that I was able to put into it. It feels great knowing that the students found it useful and plan to use it during their clinical rotations. While preparing for the inservice presentation, I really had to push myself to be confident in my knowledge and provide students with clear, specific information that answered their questions. While that was challenging and intimidating at times, it was also very rewarding to see all my hard work pay off and I feel I presented the information well.
Acknowledgements:
I would like to thank my capstone committee advisor, Prue Plummer, PhD, PT, and the committee members, Vicki Mercer, PT, PhD, and Carol Giuliani, PT, PhD, FAPTA, for their dedication and time commitment toward reviewing my materials and responding to my many questions. I am so grateful for a faculty that nurtures student’s interests and curiosities along with my passion for older adults and fall prevention. The UNC DPT program has instilled the exceptional quality of seeking evidence-based care for all our future patients and I would like to thank the entire staff for their guidance and their role in shaping me into a physical therapist. Lastly, thank you to the DPT students that supported me and found an interest in learning more about neurological outcome measures. Fall prevention is a true passion of mine, and I am so grateful to share it with others.
References:
- What Causes Falls in the Elderly? How Can I Prevent a Fall? Am. Fam. Physician 2000.
- Rehabilitation Measures | Shirley Ryan AbilityLab – Formerly RIC. Available at: https://www.sralab.org/rehabilitation-measures. Accessed January 31, 2019.
- Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys. Ther. 2000;80(9):896-903. doi:10.1093/ptj/80.9.896.
10 Responses to “Neuro Outcome Measures Commonly Used in Clinic”
Kate Kennison
AJ,
Your project has made me wish such a website existed for all outcome measures! The organization, included details, and videos make it extremely user-friendly and feasible for clinical reference. I also think the targeted audience was perfect in combination with the timeline of your presentation delivery. The outcome measures included pertain to so many patients seen during second year clinical rotations, making this information particularly relevant. Excellent job with the planning and execution of your project!
ajfran
Kate,
Thank you for the great feedback regarding my target audience and accessibility of my website. Even though this is the specific population I am most excited about working with, it is definitely true that these are patients everyone will encounter throughout their clinical rotations and eventual career. Falls screenings need to be performed at much greater volume to prevent the injuries and hospitalizations for older adults that occur with a fall, and physical therapists have great opportunity to examine multiple impairments affecting balance and risk for falls. This website provides tests that can be simple screens, tests that examine static and dynamic balance, and tests for gait assessments, which means they are also appropriate for lots of populations and mobility levels.
Thank you,
AJ
Caroline Lynott
AJ,
Wow!! This project is absolutely fantastic and definitely is a window into your passion for fall prevention and working with older adults. The website you have created is extremely user friendly with consistency throughout in order to locate content with ease. Often times when web pages change their formatting from page to page, it can be difficult to find particular details or understand the purpose of the page, however this is not the case for your project. Each page dedicated to an outcome measure is organized exactly the same, making it simple and easy to locate information and follow the same schematic of choosing to use the measure for a specific patient. Throughout this process for my own project, I have engaged in a lot of research regarding creating aesthetic materials and ensuring readability by reducing written content, all of which you have done an outstanding job creating!
I have come across the same qualms with rehab measures in obtaining information of commonly used tests for specific populations, or noticed some faulty research uploaded for psychometric content for a particular population or impairment. I appreciate that the majority of the outcome measures you chose are those that can be used for various groups of patients, thus clouding the evidence on sites like rehab measures. The details you provide regarding the psychometrics of each measure are clear, concise and prove helpful for determining when to use the measure, who with, and how to interpret the results. The videos you incorporated into each measure’s page are well done and enhance the material that you are providing. I also appreciate the quick link to the actual outcome measure, often times it can be hard to locate these, or there are several variations available of the same measure. Additionally, having a script for patient instructions allows for continuity of administering this outcome measure both between patients and at different times for the same patient throughout the rehabilitative process. Especially given that your audience is students or novices, we can tend to provide too much verbal instruction to patients which may impact their performance on any given measure.
I truly believe this will help students immensely in appropriately choosing outcome measures for patients, which will ultimately translate into for effective plans of care for patients at risk of falling.
ajfran
Caroline,
Thanks for great comments regarding my capstone project. I definitely put a lot of thought into the organization of this website because of my difficulties navigating Rehab Measures. I am so glad to hear this is a useful website for outcome measures and at a level that students and novices can appreciate. These were the most commonly used measures during my Neuro ICE rotation for patients at risk for falls with a multitude of diagnoses, so I was happy to perform them with an older adult and provide clear instructions. The frustrating part was some of my research demonstrated that these tests do not have a lot of reliable information, so I included when the research came up bare as a “con” to the specific test. Knowing that, I really hope to see the research being done on the 4-stage balance test in the future. I am really glad you found this useful and I hope others do to.
Thank you,
AJ
Vicki Mercer
Excellent work AJ! I hope that the website will be a helpful resource for many years to come!!
ajfran
Vicki,
Thank you for being such a great resource during this process and also for giving me so much education and confidence during our Neuro ICE rotation together. These measures can be so tough without practice and preparation to know when to grab a stopwatch or when to measure gait deviations, so I wanted to make this website for students to turn to with clear instructions both written and verbally. I am so grateful for your mentorship and hope we can work together again soon.
Sincerely,
AJ
ashley3
AJ,
You did an amazing job on this Capstone project!! I really enjoyed reading through your capstone and thought the website you created was very useful and helpful for all current and future DPT students. I was particularly interested in your project after I listened to your lunch and learn presentation and realized how beneficial this website will be for me to use in the future. I am interested in working in a neuro setting, so having an easily accessible website with the most commonly used outcome measures is extremely beneficial. This will help save time and confusion trying to find the directions and figure out which measure is most appropriate to use with patients. Your passion and enthusiasm for working with older adults was evident in this project, and I’m so glad you were able to create this project on a topic that interests you. This project was a great way for you to develop your clinical practice goals and help students become stronger in their ability to use neuro-based outcome measures. Your project provides an evidence based, applicable, and easy to use website for DPT students and clinicians to use focusing on the five most commonly used outcome measures in neuro.
When looking at your website, I like how you made each outcome measure a separate section that is concise and easy to access/read. I found it extremely hard when using Rehab Measures to find the tests that I was looking for, and then once I found it sometimes the information provided was very detailed and confusing. I would spend excessive amounts of time researching these outcome measures and trying to find the specific data that I was looking for. Your website reduces all of this wasted time spent looking through data and provides concisely the important details of these outcome measures. I wish we would have had this website our first two years of PT school. Your website is also attention grabbing and has a good use of charts/tables and videos, which are all helpful for students to learn how to administer and remember these tests. The videos will be advantageous for future DPT students to see and hear an explanation of how to perform these commonly used measures. I am excited to be able to use this website in future clinicals and jobs and to be able to recommend it to other DPT students and clinicians in the future. Great job AJ, and you will be an amazing DPT working with older adults in the future!
Debbie Thorpe
AJ
Fantastic job on the balance assessments website!! You presented training videos and evidence-based information for DPT students. I am sure your product will get a lot of use in the future by DPT students!!
ajfran
Dr. Thorpe,
Thanks for reviewing my capstone project. I am really excited that I was able to organize a Lunch and Learn before the 2nd Year students left for clinical and that there was such positive feedback. I hope it can be a great resource for all students when working with older adults or any patient at risk for falls.
Thank you,
AJ
kadams17
AJ,
Great job! Your passion for fall prevention and treating patients with neurological deficits is inspiring, and I have no doubt that you will excel in your future career. The work you put into your capstone project is evident. First, the website is very concise and makes it very easy to understand the important aspects of administering and interpreting a patient’s score on these outcome measures. Whenever I do an outcome measure and have to use the Shirley Ryan Ability Lab Rehabilitation Measures site, I feel overwhelmed with information that I have to scroll through and decipher before I find what I’m looking for. This can be time consuming. In addition, a lot of this information is not updated like you mentioned, and some psychometric properties are missing. I then have to go look for studies that include my patient population to find certain cut-off points that are validated and evidence-based (I’m sure you know this process quite well). Your website will be very useful in saving time and being more efficient in clinical practice. I’m excited to refer to it during my upcoming inpatient rehabilitation clinical rotation. Awesome job AJ, and best of luck in all your endeavors!