User:Enderbyandjohn/Therapy Outcome Measures in Allied Health Professions

Therapy Outcome Measures for Rehabilitation Professionals

The Therapy Outcome Measures for Rehabilitation Professionals (TOM) (Enderby, John & Petheram 2006) was designed to be a simple, reliable, cross-disciplinary and cross-client group method of gathering information on a broad spectrum of issues associated with therapy/rehabilitation. The TOMs allows the AHP to describe the relative abilities of an individual across four dimensions. These follow the dimensions used by the World Health Organisation International Classification of Disability and Function (WHOICF 2001). The dimensions include impairment, activity, participation and the impact on the individual's well-being.

Impairment is concerned with the integrity of body systems, and includes psychological and physiological structures and functioning and concerns the degree of abnormality observed, in terms of its variance from the norm for a human being (of same age, gender etc). Activity/ Disability is concerned with the limitations on actions or functions for an individual, given their abilities/disabilities. Participation/ Handicap is concerned with the disadvantage experienced by the individual, reflecting circumstances, social participation, interaction, and autonomy. Well-being/ Distress is concerned with emotions, feelings, burden of upset, concern and anxiety, and level of satisfaction with the condition.

On the TOM each of the four TOM dimensions (impairment, activity, participation, and well-being) is rated on a six-point ordinal rating scale, with 0 representing the severe end of the scale and 5 representing normal for a human being given age, sex, culture. The integers are defined with a semantic operational code that identifies the severity of the difficulty experienced on each dimension allowing assessor to indicate whether the person is slightly better or worse than the descriptor, resulting in an 11 point scale and undefined half-points providing an 11 point scale. The ratings are entered at the start and end of an intervention when the goals set have been achieved. Rating can be made at an intermediate point in intervention if required to assess what has changed or been maintained and rated on discharge fro treatment. The scales have been tested for reliability and validity. The procedures for using the TOM requires the therapist to assess the individual referred for treatment using their usual assessment procedures, such as standardised tests, observation, report, and consideration of medical and social history. The information collected leads the therapist to the appropriate dimension of the measure and to judge the appropriate rating to assign. A number of scales have been developed to facilitate rating on the TOMs by providing expanded descriptions by different client groups. The TOM takes a short time to administer, as ratings are only allocated when the individual has been assessed and goals set or reassessed. Once used regularly, therapists can complete a TOM rating in 4-5 minutes including documentation.

The TOM has been used in a number of benchmarking studies (see references)which have been reported in the literature. Benchmarking allows the Allied Health Professional or rehabilitation nurse to compare the outcomes over time and to compare their results against other services in order to benchmark the data. The TOM has been used in benchmarking studies. The TOM has also been used in research studies as one of a number of measures and the results have been used to inform change (Nancarrow et al. 2009).

There is a need to collect information about outcomes of care so the effectiveness of intervention can be assessed. In Allied Health Professions, such as speech and language therapy, occupational therapy, physiotherapy,hearing therapy or in community nursing, collecting information on outcomes and outcome measurement is complex. Individual goals can produce different effects. Altering an environment can affect the ability to complete activities, changing activities and providing strategies can improve both activity and the level of impairment, for example vocal abuse, while work on impairment can impact on activity and levels of participation in life. Therefore, goal based outcome measures do not always reflect the clinical signicance of changes for the individual. Also, it can be difficult to define the effects of care and who contributed to that care especially when team working. Often there is little agreement regarding what health programs are endeavouring to achieve with different client groups. Different client groups may need to report different outcomes, for example, someone with a progressive neurological disorder may value being able to do things for as long as possible despite the progression of their impairment, sustaining their abilities to do things in life and maintaining a level of function. Outcome measurement is needed when trying to understand what is being achieved within a health care program.