COLUMN ASKED AND ANSWERED Using your toolkit W What are patient-based outcome assessment instruments, and when should they be used? BY DAWN ARMSTRONG, DC objectively measure a patient’s experi-ence of pain or disability? • Have them give it a number and rank it, relative to other experi-ences • Have them put it into words; choose statements that best reflect their opinion • Have them make a picture of it. These are all strategies that are used to “measure” and document the facts of a patient’s experience. Tools that let us objectively quantify subjective pa-rameters are now being utilized in a variety of healthcare research settings (including pharmacy and physical re-habilitation). Patient-based assessment forms come with many names. You will have heard of the McGill pain questionnaire, or the Vernon-Mior neck disability in-dex or Roland-Morris and Oswestry disability questionnaires. There are nearly 30 different ones being used currently and no doubt more will come. We can use these tools to assess both a patient’s pain and their func-tional abilities, which are often inextri-cably linked. There are dozens of valid question-naires available for use in your office. You will want to ensure that the one(s) you choose will be responsive to the effects of treatment. It should also be valid (it measures what it is supposed to and includes all necessary areas of inquiry) and reliable (can be repro-duced and isn’t influenced by the person administering the test). One of the simplest PBOAIs is the Global Wellbeing Scale, which is a modified visual analog scale. This easy-to-use “tool” lets us objectively document a patient’s subjective re-sponse to care: • Draw a line across the page • At the far left end of the line, place a small vertical line and label it as “Worst you could possibly feel” • At the other end of the line, mark it as “Best you could possibly feel” • Patients are asked to make a verti-cal line along the scale to indicate how they feel today. You will take a ruler and note how far along the horizontal line they have marked. Write this number down along with the date and whether this is a pre-or post-treatment assessment. There is only one rule when it comes to using these special intake forms. The questionnaire must first be adminis-tered before any treatment is given. It is then repeated after a course of care is completed and the results are com-pared. Well-constructed subjective as-sessment forms have sufficient scale width. This allows for meaningful change to be detected. These forms objectively demonstrate the benefits of what you do. Your pa-tients and interested third parties (in-surance companies, lawyers, etc.) all want to know that your particular type of treatment actually helps, and so do you. Patient-based assessment question-naires are an important tool for hands-on health-care professionals who want to document the effective-ness of the treatment they provide and they give patients a chance to accu-rately communicate their suffering to us. Follow us on Linked In: Search “Canadian Chiropractor” hile we are familiar with Practitioner Based Outcomes Assessments (objec-tive measurements of strength or posture or active ranges of motion, useful to document a patient’s baseline physical facts and how they change over time), are we familiar with the patient’s subjective experience? How a patient feels and how they are func-tioning is becoming an equally impor-tant measure of a treatment’s success. Practitioner based tools such as dy-namometres, goniometres and plumb lines have been long regarded as the gold standard of evidence of benefit from treatment because (ideally) objec-tive physical assessment is consistent from one visit to the next and one practitioner to another. The use of instruments to measure (quantify) a patient’s status has been, and still is, valued because objectivity is an impor-tant goal. But there’s a way to objectively measure the subjective experience of a patient, collectively known as patient-based outcome assessment in-struments (PBOAIs). PBOAIs are special intake forms for certain patients – people with chronic/ severe pain and people who have been injured at work or in a motor vehicle accident. They can also be used with everyone who seeks out your care be-cause they are simply questionnaires that give patients an opportunity to answer questions like “how are you feeling?” and “how are you doing?” PBOAIs give us a way to make the subjective objective. How can we DR. DAWN ARMSTRONG is a graduate of CMCC and has been in practice for over 30 years. She is currently focused on promoting life-long learning and professional development and has created a continuing education course – Clinical Record Keeping: A Hands-On Approach. Learn more at auroraeducationservices.ca. 28 Canadian Chiropractor December 2018 www.canadianchiropractor.ca
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