Skip to main content

Advertisement

SpringerLink
Log in

How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies

  • Outcome Measurement in Rehabilitation (M. E. Kho, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

It is well established that admission to intensive care can result in physical, cognitive and psychological impairments. To assess and treat these impairments competently requires the use of outcome measures in clinical practice. To date, there are no evidence-based recommendations for specific measures to use at different time points on the trajectory of recovery. However, over 33 measures are currently published in research papers. While evidence is scant, the implementation for use of outcomes in daily practice by physiotherapists appears slow and variable. The key aim of this paper is to discuss methods to facilitate clinicians to use outcome measures at the bedside in the ICU. We describe and discuss the barriers and facilitators for use of outcome measures scaffolded in a behaviour change framework and to suggest practical methods by which clinicians may be enabled to use these measures on a daily basis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

References of particular interest, published recently, have been highlighted as: • Of importance and •• Of major importance

  1. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40:502–9.

    Article  PubMed  Google Scholar 

  2. Iwashyna TJ. Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010;153(3):204–5.

    Article  PubMed  Google Scholar 

  3. Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, et al. Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: The RECOVER randomized clinical trial. JAMA Intern Med. 2015;175(6):901–10.

    Article  PubMed  Google Scholar 

  4. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37(9):2499–505.

    Article  PubMed  Google Scholar 

  5. Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months follow up. Crit Care. 2013;17(4):R156.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43.

    Article  PubMed  Google Scholar 

  7. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82.

    Article  PubMed  Google Scholar 

  8. Parry SM, Berney S, Granger C, Koopman R, El-Ansary D, Denehy L. Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med. 2013;41:2406–18.

    Article  PubMed  Google Scholar 

  9. Stiller K. Physiotherapy in intensive care. An updated systematic review. Chest. 2013;144(3):825–47.

    Article  PubMed  Google Scholar 

  10. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41(6):1543–54.

    Article  PubMed  Google Scholar 

  11. Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013;15(4):260–5.

    PubMed  Google Scholar 

  12. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42(5):1178–86.

    Article  PubMed  Google Scholar 

  13. Morris Z, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–20.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89(2):125–35.

    Article  PubMed  Google Scholar 

  15. Skinner E, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian Intensive Care Units. Physiotherapy. 2008;94:220–9.

    Article  Google Scholar 

  16. •Denehy L, Nordon-Craft A, Edbrooke L, Malone D, Berney S, Schenkman M, et al. Outcome measures report different aspects of patient funciton three months following critical care. Intensive Care Med. 2014. Discusses the importance of performance-based tests measuring different constructs to patient-reported measures.

  17. Kramer A, Holthaus DE. Uniform patient assessment for post-acute care. Aurora: Division of Health Care Policy and Research University of Colorado at Denver and Health Sciences Center; 2006.

    Google Scholar 

  18. Stevens JG, Beurskens AJ. Implementation of measurement instruments in physical therapist practice: development of a tailored strategy. Phys Ther. 2010;90(6):953–61.

    Article  PubMed  Google Scholar 

  19. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Francis JJ, Duncan EM, Prior ME, Maclennan GS, Dombrowski S, Bellingan GU, et al. Selective decontamination of the digestive tract in critically ill patients treated in intensive care units: a mixed-methods feasibility study (the SuDDICU study). Health Technol Assess. 2014;18(25):1–170.

    Article  Google Scholar 

  21. •Holdsworth C, Haines KJ, Francis JF, Marshall A, O’Connor D, Skinner EH. Mobilizing ventilated patients in the Intensive Care Unit: an elicitation study using the Theory of Planned Behaviour. J Crit Care. 2015; Revisions under review. One of the few papers in the field discussing an implementation approach to early mobilisation that has relevance to outcome measurement.

  22. Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ (Clinical Research Ed). 2008;337:a1714.

    Article  Google Scholar 

  23. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Health Care. 2005;14:26–33.

    Article  CAS  Google Scholar 

  25. Ajzen I. The theory of planned behaviour. Organ Behav Hum Decis Process. 1991;50(2):179–211.

    Article  Google Scholar 

  26. •Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. 2013;8:28. A recent paper describing an implementation science framework.

  27. Dyson J, Lawton R, Jackson C, Cheater F. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene. J Infect Prev. 2011;12:17–24.

    Article  Google Scholar 

  28. Michie S, Hardeman W, Johnston M, Francis J, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008;57:660–80.

    Article  Google Scholar 

  29. Lipworth W, Taylor N, Braithwaite J. Can the theoretical domains framework account for the implementation of clinical quality interventions? BMC Health Serv Res. 2013;13:530.

    Article  PubMed Central  PubMed  Google Scholar 

  30. French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. Implement Sci. 2012;7:38.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Skinner EH, Williams CM, Haines TP. Embedding research culture and productivity in hospital physiotherapy departments: challenges and opportunities. Aust Health Rev 2015.

  32. Maher C, Williams M. Factors influencing the use of outcome measures in physio-therapy management of lung transplant patients in Australia and New Zealand. Physiotherapy Theory Pract. 2005;21:201–17.

    Article  Google Scholar 

  33. Van Peppen RP, Maissan FJ, Van Genderen FR, Van Dolder R, Van Meeteren NL. Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use. Physiother Res Int. 2008;13(4):255–70.

    Article  PubMed  Google Scholar 

  34. •• Elliott D, Berney S, Harrold M, Skinner EH. Key measurement and feasibility characteristics when selecting outcome measures in rehabilitation. Curr Phys Med Rehabil Rep. 2015;in press (this issue). Relevant associated paper in the same field of outcome measurement.

  35. Hopkins RO, Spuhler VJ, Thomsen GE. Transforming ICU culture to facilitate early mobility. Crit Care Clin. 2007;23(1):81–96.

    Article  PubMed  Google Scholar 

  36. Skinner EH, Warrillow S, Denehy L. Organisation and resource management in the intensive care unit: a critical review. Int J Ther Rehabil. 2015;22(4):187–96.

    Article  Google Scholar 

  37. Lau B, Skinner EH, Lo K, Bearman M. What are the experiences of physiotherapists working in the acute hospital setting? A systematic review. Phys Ther. 2015; in press.

  38. Skinner EH, Haines KJ, Hayes K, Seller D, Toohey JC, Reeve JC, et al. Future of specialised roles in allied health practice: who is responsible? Aust Health Rev 2015.

  39. Beach LJ, Fetterplace K, Edbrooke L, Parry SM, Curtis R, Rechnitzer T, et al. Low physical activity levels and poorer muscle strength are associated with reduced physical function at intensive care unit discharge: an observational study. American Thoracic Society International Conference; 16th–21st May. San Diego: American Journal of Respiratory and Critical Care Medicine; 2014.

  40. Denehy L, de Morton NA, Skinner EH, Edbrooke L, Haines K, Warrillow S, et al. A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther. 2013;93(12):1636–45.

    Article  PubMed  Google Scholar 

  41. Rollnick S, Heather N, Bell A. Negotiating behaviour change in medical settings: the development of brief motivational interviewing. Ment Health. 1992;1(1):25–37.

    Article  Google Scholar 

  42. Prochaska J. Systems of psychotherapy: a transtheoretical approach. Illinois: Dorsey Homeward; 1979.

    Google Scholar 

  43. Haines KJ, Denehy L, Skinner EH, Warrillow S, Berney S. Psychosocial outcomes in informal caregivers of the critically ill: a systematic review. Crit Care Med. 2015;43(5):1112–20.

    Article  PubMed  Google Scholar 

  44. • Michie S, West R, Campbell R, Brown J, Gainforth H. ABC of behaviour change theories. An Essential Resource for Researchers, Policy Makers and Practitioners: Silverback Publishing; 2014. A useful publication explaining behaviour change theories.

  45. Shaw EK, Howard J, West DR, Crabtree BF, Nease DE Jr, Tutt B, et al. The role of the champion in primary care change efforts: from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP). J Am Board Family Med. 2012;25(5):676–85.

    Article  Google Scholar 

  46. Holland R, Meyers D, Hildebrand C, Bridges A, Roach M, Vogelman B. Creating champions for health care quality and safety. Am J Med Quality. 2010;25:102–8.

    Article  Google Scholar 

  47. Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Topics Stroke Rehabil. 2010;17(4):271–81.

    Article  Google Scholar 

  48. Huijbregts MPJ, Myers AM, Kay TM, Gavin TS. Systematic outcome measurement in clinical practice: challenges experienced by physiotherapists. Physiother Canada. 2002;54(1):25–31.

    Google Scholar 

  49. • Parry S, Granger C, Berney S, Jones J, Beach L, El-Ansary D, et al. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med. 2015. A recent systematic review on ICU outcome measures.

Download references

Author information

Authors and Affiliations

  1. Clinical Education Unit, Austin Health, Burgundy St, Heidelberg, VIC, 3081, Australia

    Kimberley J. Haines

  2. Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia

    Elizabeth H. Skinner & Linda Denehy

  3. Department of Physiotherapy, Western Health, Gordon Street, Footscray, VIC, 3011, Australia

    Elizabeth H. Skinner

  4. Division of Physical Therapy, Duke University School of Medicine, Durham, NC, 27708, USA

    Amy Pastva

  5. Department of Physiotherapy, Austin Health, Studley Road, Heidelberg, VIC, 3084, Australia

    Sue Berney

  6. Institute for Breathing and Sleep (IBAS) Austin Health, Heidelberg, VIC, Australia

    Sue Berney & Linda Denehy

Authors
  1. Kimberley J. Haines
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth H. Skinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy Pastva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sue Berney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linda Denehy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda Denehy.

Additional information

This article is part of the Topical Collection on Outcome Measurement in Rehabilitation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haines, K.J., Skinner, E.H., Pastva, A. et al. How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies. Curr Phys Med Rehabil Rep 3, 268–279 (2015). https://doi.org/10.1007/s40141-015-0100-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-015-0100-7

Keywords

Search

Navigation