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presented by Karen L. McCulloch, PhD, PT, MS, NCS(E), FAPTA, FACRM
Financial: Karen L. McCulloch receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.
Nonfinancial: Karen L. McCulloch has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
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This course provides an overview of psychometric properties important for selection of outcome measures, and characteristics of measures that aid in their interpretability and clinical usefulness. The approach of item response theory will be described as a tool to refine developing measures so that they can be shorter and represent a hierarchy of item difficulty. This approach also may facilitate the transition to computer assisted measurement. Consensus-oriented processes and resources will be reviewed that provide therapists with information about ideal measures for different adult neurologic conditions. The application of these principles to cases or practice settings is addressed via knowledge check examples.
Karen L. McCulloch, PhD, PT, MS, NCS(E), FAPTA, FACRM
Karen L. McCulloch is a professor in physical therapy in the Division of Physical Therapy, Department of Health Sciences, School of Medicine at University of North Carolina at Chapel Hill, where she has taught entry-level and advanced-level students in neurorehabilitation since 1993. She has served in multiple roles within the Academy of Neurologic Physical Therapy,…
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1. Why Outcome Measures?
This chapter addresses what we should measure and why, from the standpoint of the ICF framework; purposes for which measures may be chosen; the types of measures that are used in practice; and the challenge of identifying the right measure for the patient and setting.
2. Data Types in Measurement
The types of data used in clinical measures will be reviewed with implications for what types of analyses may be appropriate with this data, and scaling properties that affect psychometrics.
3. Measurement Properties – Reliability and Change Indices
Different types of reliability are reviewed that relate to stability of measurement between and within raters and internal consistency, with review of statistical tests that are used to illustrate these relationships. Minimal detectable change and minimal clinical important difference terms are defined and contrasted as they relate to interpretation of change with a repeated test.
4. Measurement Properties – Validity
Types of validity are reviewed. More critically, consideration of choosing the appropriate measure for the patient in that setting and at that level of function is emphasized. Common statistical analyses used to analyze validity are reviewed. Aspects of reliability and validity are illustrated through various studies conducted in the development of the High-Level Mobility Assessment Tool.
5. Item Response Theory
An overview of the aims of item response theory is provided, with an illustration of its use to refine a measure in development and an example of its use in computer assisted testing from the PROMIS Physical Function subscale. Consensus-based and computer-assisted testing resources that are available for use with neurologic patients are highlighted, including the Common Data Elements website, PROMIS, and NeuroQOL.
6. Diagnosis-Specific Resources
Consensus-based outcome measurement projects conducted by the Academy of Neurologic Physical Therapy EDGE groups and other multidisciplinary, evidence-based projects (StrokEngine, COMBI, ABI-EBR, SCIRE) are shared as resources for considering outcome measure selection.
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