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3 Types of Outcome Measures: Performance-Based, Self-Reported, and Hybrids

How PTs and OTs can balance the use of performance-based outcomes measures, self-reported ones, and hybrids. Learn more about these three measures, here.

Erica McDermott
5 min read
March 14, 2016
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You already know why measuring outcomes data is incredibly important—for your patients, your clinic, and the rehab therapy industry as a whole. Today, let’s discuss how you can use outcome measurement tools to strongly showcase your patients’ progress and the success of your treatments—specifically by balancing the use of performance-based outcomes measures, self-reported ones, and hybrids. We like to call this the outcome measure sweet spot.

What’s the difference between performance-based outcome measures and self-reported ones?

The book Physical Therapy Documentation: From Examination to Outcome defines a performance-based outcome measurement tool as one in which “the patient is required to perform a set of functional tasks, such as the FIM [Functional Independence Measure],” which assesses the patient’s “ability to 1. perform self-care skills (e.g., feeding and dressing), 2. control bowel/bladder function, 3. transfer, 4. move (e.g., gait and stair climbing), 5. communicate, and 6. interact socially, including memory and problem solving.” By contrast, self-reported measures are those that require the patient to complete a questionnaire, “rating his or her overall performance on a predetermined set of functional tasks.”

In chapter four of the Guide to PT Practice, the APTA notes that the difference between these two measure types “reveals a distinction between patient/client perceived or self-measured ability to perform a task or activity and the clinically or professionally measured performance of a task or activity.” In other words, self-reported measures convey what a patient believes he or she is capable of accomplishing, whereas a performance-based outcome measure conveys the actual clinical findings.

And these two scores rarely line up. In fact, according to this University of Delaware training slide deck, there is only “a moderate correlation (r = .48) between patient’s self reported difficulty in performing tasks and observer assessment.” (The correlation increases to r = .78 after the patient actually performs the task.)

Which one is better?

While some measures clearly are only appropriate for self-reporting (e.g., patient satisfaction surveys), tools tend to be most impactful when they include elements of both measure types—a self-reported/performance-based hybrid, if you will. Now, you might be wondering: if self-reported measures are less-than-accurate representations of a patient’s actual abilities, why use them at all? Why not go performance-based all the way? The answer is simple: accuracy is not the only goal here. In order to treat people—whole people—you must have the whole picture. And that includes each individual’s self-perceptions and feelings about his or her progress—clinically accurate or not.

As WebPT’s Brooke Andrus says, “Patients are more than a series of numbers and figures that reflect their functional deficit, which is why it’s important to know how that deficit is impacting patients outside of the clinic.” Plus, asking your patients questions and showing that you care about the answers by listening and responding is just good bedside manner. As a result, patients are more likely to feel actively involved in their care and empowered to share in their treatment decision-making, which—as this Journal of the American Physical Therapy Association article points out—”substantially improves patient satisfaction, treatment adherence, and health outcomes.” That’s not only good for your patient; it’s also good for business.

Now, that doesn’t mean you nix performance-based measures in favor of relying solely on your patients’ perceptions. It simply means you use both types of measuring sticks—together—to maximize effectiveness. While you’re at it, be sure that even your self-reported outcome measurement tools have some kind of objective scoring mechanism built in. That way, you can track the data across your patient base and glean meaningful, actionable insights about your treatments. (That’s actually one of the criteria WebPT has for the outcome measurement tools we include in our application. Check out this article to learn more about the OMTs we’ve added so far.)

What are your favorite outcome measurement tools? Do you gravitate toward performance-based measures, self-reported ones, or hybrids? Share your opinions in the comment section below.


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