Review of Therapeutic Outcome measures: Clinical Case

Measurement is a fundamental component of good physiotherapist practices. The purpose of this “Outcome Measures” essay is to critically appraise the use of therapeutic measures for the physical rehabilitation of a patient. 

A 34 year old man with multiple fractures (pelvic and lower limb’s bones), 4 years ago was submitted to multiple surgery interventions, 4 months ago all plates were removed, it presents lesion of the right peroneal nerve (SPE) with drop foot. For physiotherapy intervention (evaluation & rehabilitation) of body structure and function (impairments) of this patient the Lower Extremity Functional Scale (LEFS), Foot and Ankle Disability Index (FADI), and walkway system will be considered. The professional autonomy of the physiotherapists stands in exercising his professional judgment within limits of knowledge and competence, both in health promotion and provision of care. They should assume the responsibility of their professional practice and decisions, notably by making independent judgments, where they have knowledge and skills and for which they can be held responsible. However, it needs to be recognized that only the ability to collect, select and interpreting relevant information enables them to substantiate the judgments and solutions advocated, which is closely linked to measurements and evaluation. On patient care, evidence-based practice corresponds to a conscious use of the best available evidence in clinical decision making. 

For the purpose of this essay, a systematic search was performed on selected databases (PubMed, Physiopedia, Google Scholar & PM&RKnowledge) to appraisal the evidence regarding the measurement properties of the LEFS, FADI and walkway, and related scores. Particularly, this literature review intended to assess the validity, reliability, and sensitivity to change of the chosen outcome measures, across different lower extremity impairments, and discuss the application of evidence to the presented clinical case. 

The Lower Extremity Functional Scale (LEFS), may be used to evaluate the impairment of patients with lower extremity functional conditions or to measure patient’s progress for an extensive range of lower-extremity disorders. This tool was chosen to evaluate the overall condition of our patient since impairments were observed at hip, knee, foot and ankle levels. Easy to administer, no training is required. It’s a self-report 20 item questionnaire that assesses the current ability to undertake normal daily activities, the LEFS score range goes from 0‐80, with higher scores representing the better function. Since the creation of the LEFS original English version, it has been modified and validated in multiple language studies across the world, such as Greek, Persian, Indian, Malayan, Chinese. In all of these studies, the cross-culturally adapted LEFS remains to possess a good profile in terms of reliability and validity. The reliability scores of LEFS were found excellent among several studies and considered as a valid tool compared with other patient-rated questionnaires, with a sensitivity to change superior to those. 

The MCID allows clinicians to evaluate pre‐ and post‐treatment outcome scores to determine if the amount of change that occurred would be perceived as meaningful. The MCID is defined as the smallest change on a scale that would be considered important to a patient. The MCID for the LEFS has been previously reported as 9 points and was established for patients with a variety of lower extremity conditions. 

For a more specific evaluation of the right foot dorsiflexion deficits the Foot and Ankle Disability Index (FADI) was chosen as evaluation tool. Measurement and evaluation are intrinsic components of physical therapist exercise. To measure is to quantify, to evaluate is to interpret. Both actions are required to diagnose, examine and/or detect the presence of health problems, get a complete picture of patients, identify treatment needs and determine the care outcomes. However, it’s of significate importance to be aware, when possible, about the normative data of a PROM while looking for practice evidence. A combination of patient-rated and performance (instrumental) measures is necessary, to incorporate essential and diverse functional activities in order to well capture a wide range of data and be able to correlate the change over time. Thus the applicability of outcome measures as LEFS, FADI and walkway would be adequate in this clinical case.