Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Publication Date: July 1, 2018
Last Updated: March 14, 2022

SUMMARY OF ACTION STATEMENTS

STATIC AND DYNAMIC SITTING AND STANDING BALANCE ASSESSMENT

Clinicians should use the Berg Balance Scale (BBS) for adults with neurologic conditions who have goals to improve static and dynamic sitting and standing balance and have the capacity to change in this area. The BBS should be administered under the same test conditions using the protocol recommended by the CPG Knowledge Translation (KT) Committee at admission, and discharge, and when feasible, between these periods for patients with:
  • Acute conditions
(I, A)
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  • Chronic stable conditions
(I, A)
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  • Chronic progressive conditions
(I, A)
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WALKING BALANCE ASSESSMENT

Clinicians should use the Functional Gait Assessment (FGA) for adults with neurologic conditions who have goals to improve balance while walking and have the capacity to change in this area. The FGA should be administered under the same test conditions using the protocol recommended by the CPG KT Committee at admission, and discharge, and when feasible, between these periods for patients with:
  • Acute conditions
(I, A)
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  • Chronic stable conditions
(I, A)
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  • Chronic progressive conditions
(I, B)
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BALANCE CONFIDENCE ASSESSMENT

Clinicians should use the Activities-specific Balance Confidence (ABC) Scale to assess self-reported changes in balance confidence in adults with neurologic conditions who have goals and the capacity to change in this area. The ABC should be administered under the same test conditions using the protocol recommended by the CPG KT Committee at admission, discharge, and, when feasible, between these periods for patients with:
  • Acute conditions
(I, A)
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  • Chronic stable conditions
(I, A)
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  • Chronic progressive conditions
(I, A)
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WALKING SPEED ASSESSMENT

Clinicians should use the 10 meter Walk Test (10mWT) for adults with neurologic conditions who have goals to improve walking speed and have the capacity to change in this area. The 10mWT should be administered (per the protocol by Steffen and Seney,10 as adapted by the CPG KT Committee) under the same test conditions at admission, and discharge, and when feasible, between these periods for patients with:
  • Acute conditions
(V, D)
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  • Chronic stable conditions
(I, A)
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  • Chronic progressive conditions
(I, A)
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WALKING DISTANCE ASSESSMENT

Clinicians should use the 6-Minute Walk Test (6MWT) for adults with neurologic conditions who have goals to improve walking distance and the capacity to change in this area. The 6MWT should be administered (per the Quinn et al protocol,11 as adapted by the CPG KT Committee) under the same test conditions at admission, and discharge, and when feasible, between these periods for patients with:
  • Acute conditions
(V, D)
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  • Chronic stable conditions
(I, B)
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  • Chronic progressive conditions
(I, A)
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TRANSFER ASSESSMENT

Clinicians should document the transfer ability of adults with neurologic conditions who have goals to improve transfers and have the capacity to change. Documentation should include the type of transfer, level of required assistance, equipment or context adaptations, and time to complete. In patients who have goals and the capacity to improve sit-tostand transfers, the 5 Times Sit-to-Stand (5TSTS) may be used. The 5TSTS and documentation of other transfers may be administered under the same test conditions using the protocol recommended by the CPG KT Committee at admission, and discharge, and when feasible, between these periods for adult patients with neurologic conditions. (V, D)
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DOCUMENTATION OF PATIENT GOALS

Clinicians should document patient-stated goals and monitor changes in individuals with neurologic conditions, using an outcome measure (OM) such as the Goal Attainment Scale (GAS), reporting the task, the performance conditions, and the time to complete or level of independence desired. Patient goals should be documented at least 2 times, at admission and discharge, and, when feasible, between these testing periods. (V, D)
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USE OF THE CORE SET OF OUTCOME MEASURES

Clinicians should use and document the OMs in the core set to assess changes over time. The core set includes the BBS, FGA, ABC, 10mWT, 6MWT, and 5TSTS, and the recommended patient goal assessment for adults who are undergoing neurologic physical therapy. The core set should be administered with patients who have goals and the capacity to improve transfers, balance, and/or gait. In cases when a patient cannot complete one or more core set OMs (eg, a patient who is unable to walk; thus, cannot complete the 10mWT or the 6MWT), a score of 0 should be documented. The core set should be administered under the same test conditions at least 2 times, at admission and discharge, and when feasible between these periods. (II, B)
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DISCUSS OUTCOME MEASURE RESULTS AND USE COLLABORATIVE/ SHARED DECISION-MAKING WITH PATIENTS

Clinicians should discuss the purpose of OMs, OM results, and how these results influence treatment options with patients undergoing neurologic physical therapy. Collaboratively, the clinician and the patient should decide how these data should inform the plan of care. (V, D)
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Recommendation Grading

Overview

Title

Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Authoring Organization

Publication Month/Year

July 1, 2018

Last Updated Month/Year

June 9, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Describe evidence-based practice, including diagnosis, prognosis, intervention, and assessments of outcomes for musculoskeletal disorders. Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and body structure, activity limitations, and participation restrictions. Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions. Identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure as well as in activity and participation of the individual. Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists and hand rehabilitation. Provide information for payers and claims reviewers regarding the practice of orthopaedic and hand therapy for common musculoskeletal conditions. Create a reference publication for clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy and hand rehabilitation

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care, Outpatient

Intended Users

Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Rehabilitation

Diseases/Conditions (MeSH)

D000066530 - Neurological Rehabilitation, D012046 - Rehabilitation, D020233 - Gait Disorders, Neurologic, D009460 - Neurologic Examination

Keywords

rehabilitation, neurologic conditions

Methodology

Number of Source Documents
144
Literature Search Start Date
April 1, 2015
Literature Search End Date
March 1, 2016