Understanding paediatric rehabilitation therapists' lack of use of outcome measures

1. In the literature, the most frequently mentioned barriers to the use of outcome measures are:

a) time constraints

b) lack of knowledge / skill

c) reluctance to use measures that fail to meet client need.

Do you feel any of these barriers apply to your practice?

• Therapists agreed that time constraints were an issue across the board.  Many of the outcome measures are inappropriate for the children we follow due to the child's lack of attention and lack of understanding.

2. The article speaks a lot of the importance of collaborative client-practitioner relationships and the relational goal-oriented approach to working with families. They highlighted the need to communicate information that was helpful to families and share it at a time that was sensitive to the family’s circumstances. How do you feel the use of outcome measures may positively or negatively impact your relationship with the family?

•  One positive example we discussed was using the GMFM Motor Growth Curves which gives the child a percentile ranking within their GMFCS level (they will be at approximately the 50th percentile for GMFCS level III kids their age, as opposed to <1st percentile when scored on the Peabody). ***See Tabulated gross motor curves below***
• Homecare therapists talked about using the pictures from the AIMS to show families the new skills that the children were doing, even if the child was too old to officially score the AIMS.

3. The article observes that therapists providing consultation services may be less likely to do formal goal setting or evaluation. Do you agree? What outcome measures, if any, would be appropriate in a consultation setting?

• We discussed outcome measures that could be done quickly in clinic -- the 10 metre walk test, 6 min walk, Timed up and down stairs (TUDS test), items from the PDMS-2 for functional developmental level, AIMS, and the Canadian Occupational Performance Measure.
• The School Function Assessment, PDMS-2, and AIMS are also used regularly for consultation in the community.

4. The article hypothesized four key psychosocial factors that influence therapists lack of use of outcome measures:

a) a primary focus on relationship and family needs: lesser valuing of measurement

b) a focus on understanding and engaging families versus attaining specific outcomes

c) a pragmatic approach to practice and to measurement

d) a focus on celebrating small gains and providing hope: concern that measures will not show change.

Which of these resonate with you? Can you think of any specific examples?

•  The therapists in our discussion group identified with all of these factors.

5.   The article discusses different ways to “reframe” thinking around outcome measures, thereby supporting their use:

a) Viewing measurement as a mutual goal-oriented activity facilitating informed practice and decision making

b) Stressing the educational role of therapists in explaining the usefulness of the measurement process to parents

c) The importance of establishing a collaborative, learning-oriented workplace culture.

Do you think these strategies are in use at your organization?

• Many therapists thought that b) was very important.  They felt it was their responsibility to educate families regarding the GMFCS level in particular. ***See GMFCS family and self report questionaires below***
• Although many workplaces officially state they are 'learning-oriented', many therapists feel that in practice they do not have the support to spend the time using outcome measures and that there are expectations to maintain a high caseload.

Motor growth curves

GMFCS Family and Self report Questionaires