Frances M. Wedge

Use of outcome measures in physical therapy practice is central to evaluating the effectiveness of treatment interventions, providing accountability and addressing quality of physical therapy programs. There is limited discussion on barriers and facilitators to using outcome measures in physical therapy practice. The purpose of this study was to identify factors that influence a physical therapist when deciding to use outcome measures in clinical practice. Participants were 21 physical therapists, seven each from skilled nursing facilities, outpatient clinics, and inpatient rehabilitation facilities. A grounded theory approach was used for interview and data collection. Common themes were determined from the data and a theory developed to explain the rationale behind physical therapists' decisions to use or not use outcome measures in clinical practice. Three overlapping themes related to 1) concepts of time, 2) knowledge, and 3) facility culture were indentified as factors influencing the use of outcome measures. A fourth encompassing theme, professionalism, identified the value placed on the use of outcome measures in practice. Data revealed that therapists require more information on the outcome measures available, and this information needs to be easily accessible within the workplace. Therapists value information generated by using outcome measures in the clinical setting, but need information on what measures are available and psychometric properties. Information must be easily accessible and measures easy to use. Newer graduates and recent learners have a foundation in the use of outcome measures, but more needs to be done in the clinic and through continuing education to promote increased use and understanding.

This case study documents the impact of a resistance-training program on a female patient with Multiple System Atrophy (MSA). A 68-year-old female with a 2-year history of MSA was referred to physical therapy with a history of falls, increasing loss of balance and rapidly progressing lower body Parkinson's like dysfunction. Examination included range of motion, muscle strength, motor control, ambulation with and without assistive device, and determination of postural hypotension. Functional Reach (FR), Timed Up and Go (TUG), timed single limb stance (SLS), and the Performance Oriented Mobility Assessment (POMA) assessed safety, balance, and fall risk. Hypokinesia and festinating gait were observed during ambulation. Transfers sit to stand were functional, but with compromised safety. Impairments of muscle performance were found at ankle, knee, and hip. The patient wanted to be able to live at home to care for herself and disabled spouse. Low to moderate intensity, lower extremity resistance training was added (twice weekly) to an existing program of balance and flexibility exercises. Clinically meaningful gains were achieved in all functional measures, and the patient performed SLS for 10 seconds when previously unable. More importantly, she achieved her goal of remaining at home with her spouse. The addition of resistance training to an existing program of balance and flexibility exercises did not cause any adverse effects and appears to have led to improvements in balance and functional ability.