Why is there a need for ICF framework?
Diagnosis alone is not enough to understand the health status and needs of the patient. ICF framework reflects the interaction between the health condition, environmental and personal factors. Even with the same diagnosis, treatment approach can be very different for different patients.
List the components of the ICF framework.
Impairments in body structure and function, Activity limitation, Participation restrictions, Personal factors, Environmental factors.
Why do we use ICF framework in the clinical setting?
- provides a common language to improve communication between healthcare professionals.
- used to monitor the impact/outcome of health interventions.
- improves data comparability across the world using international standard for recording.
- provide systemic coding scheme for each health condition/ disability.
How is goal setting beneficial for patients?
- enhanced motivation and autonomy
- improved satisfaction with recovery
- Regain valued activities
How is goal setting beneficial for clinicians?
- promote patient-centre care
- promote adherence
- improve outcome
- promote team work and collaboration
- able to evaluate the progress and outcome
Describe some of the strategies used in goal setting.
- patient education to increase the awareness of goal setting process
- breaking down goals into smaller goals.
- linking therapy to goals
- facilitating self-monitoring and self-management
- enabling experiential learning
- flexibility in goal setting
Describe the process of goal setting.
- Goal negotiation (discuss problems & potential goals)
- Goal setting
- Goal planning (what, when, how)
- Appraisal and feedback (evaluate performance and progress)
List some of the factors that can influence behaviour.
- self-efficacy
- outcome expectations
- goal attributes
- evaluation & progress
What is SMART?
Specificity (consider activity and participation limitations, social and environmental context)
Measurable (consider quantity and frequency)
Achievable (realistic and reachable)
Relevant (reflect needs and interest of patient)
Time
Tools used for goal setting
- Goals Attainment Scaling (GAS)
- Canadian Occupation Performance Measure (COPM)
- SMART (informal)
What is the purpose of predicting functional outcomes for post-stroke patients?
- inform patient on prognosis
- make decision on therapy goals, discharge planning, and use of resources
- identify patients for clinical trials and group them in prognosically comparable groups.
What can be used to predict patient’s outcome?
- clinical experience (e.g. common factors seen in patients)
- research evidence (prediction modelling studies and prognostic studies)
What are some of the key predictors for arm and leg recovert after stroke (based on prediction modelling studies)?
Arm: - arm motor function (using FMA-UE) - arm activity (e.g. pour water from glass, place hand on top of head) - age - severity of stroke (NIHSS) - movement of finger extension, shoulder abduction Leg: - leg motor function (using FMA-LE) - Age - severity of stroke (NIHSS) - sitting ability (trunk control test) - muscle strength (motricity index)
What are the effective predictors used to predict walking ability at 6 months?
- patients with indepedent sitting balance (TCT 30s)
- strength of hemiparetic leg (Motricity index - visible contraction)
What are the effective predictors used to predict arm function at 6 months post-stroke?
- exhibit some voluntary extension at the fingers and abduction of hemiparetic shoulder on day 2.
Role of physiotherapist in discharge planning.
- ensure patient get the best care to optimise recovery
- ensure healthcare resources are allocated to the right people, at the right place and at the right time.
(efficient care and effective care)
List some of the discharge destinations available.
Home, nursing home, respite, community hospitals, acute hospitals.
List some of the services available for stroke patients after discharge.
private services, home-based services, centre-based services, outpatient services, inpatient (subacute/acute)
In the acute stage, what is the role of physiotherapist?
- determine if patient requires inpatient rehabilitation
- determine discharge goals, destination and timeframes.
Common assessments used in stroke.
- National Institute of Health Stroke Scale (NIHSS)
- Motor Assessment Scale (MAS)
- Berg Balance Scale (BBS)
- Timed-up and go (TUG)
- 10m Walk Test (10MWT)
What are some of the key psychometric properties of an assessment that you need to consider before choosing them?
- Validity (criterion, construct validity –> does it measure what it is supposed to measure?)
- Reliability (intra/inter-rater reliability)
- Minimally Clinically Important Difference (MCID)
- Responsiveness to Change (RC)
Others:
- Correlation statistics (ICC, r, kappa)
- Floor and ceiling effect
Define reliability of an assessment.
extent to which a test is consistent and produces similar results when administered repeatedly by the same rater or different raters.
Define validity of an assessment.
extent to which a test measures what it says it measure.
What is Minimally clinically important difference (MCID) ?
smallest beneficial/significant effect of treatment that justifies its costs, harms, and inconveniences. obtained via stated preference methods, benefit-harm trade off method and discrete choice methods.
