If you have been following SeekFreaks for awhile now, you probably know how much I love standardized assessments (Top 9 Functional Balance Tests for School-Based PTs, 7 Promising Wheelchair Operation Tests, Top 10 Walking Tests for School-based PTs, 2 Tests of Selective Motor Control – SCALE and SCUES).
You may also know that I teach a 2-day class on standardized assessments. It is always great to have 2 or more therapists attend from the same school district, clinic or organization. By the end of the 2nd day, I often get asked, “how do we start adopting standardized tests within our organization?”
So I was very excited that the Physical Therapy Journal published Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study. McDonnell, B., Stillwell, S., Hart, S., & Davis, R. B. (2018). Physical therapy, 98(6), 528-538.
If I still have to convince you to utilize standardized assessments, here are some reasons cited by the authors:
- Improve patient care
- Evidence-based approach to clinical reasoning
- Quantify observations
- Compare status between examinations
- Facilitate communication
- Efficiency of practice
- Help patients recognize improvements
- Facilitate reimbursement
- Prevent excessive variability, error and bias
Despite these benefits, there are lots of barriers to a system-wide utilization of standardized assessments. I’m not gonna bore you with this list, as I’m sure you are already experiencing them. You can refer to the full article for a list.
Let’s get to the most exciting parts of how this team implemented strategies to achieve consistent use of tests and measures. This study was completed in an acute care setting with 24-34 full-time PTs. At the start of the study, they found only 16% use of standardized measures. A year and a half later, they found 100% use! WOW!
How did they do it? They used seven specific knowledge translation strategies. I will highlight some of them below:
Create a consensus process to select appropriate tests and measures
In the study, a group of therapists chose tests and measures that are appropriate for their setting.
Some of my thoughts:
- Having a consensus group is a way to get buy-in from different members of the team. So include not just those who are gung-ho for a change, but also those who may be unsure about it. Having only “yes” people can give a false illusion that everything’s nice and easy. Including the “unconvinced”s can help the team understand barriers that need to be addressed, plus get their buy-in for implementing the desired change.
- The variety in experience and perspectives can also be helpful in selecting and narrowing down to the most useful tests.
- In my Everything’s Measurable course, I always suggest starting with a small number of easier/shorter tests (in this study, they chose 10 tests). There’s always a learning curve, so starting easy will help you experience success early and be motivated to do more. (Isn’t this true for our clients too? So it should be good for us, as well!)
- Start with functional tests, instead of impairment level tests. I present the argument about this in an earlier SeekFreaks tests and measures article.
Print and laminate test cue cards
In the study, therapists were provided “laminated pocket cards for easy reference.”
My experience:
- We did just that in the New York City public schools. The laminated sheet included 10 tests, with instructions, norms/small group averages, and references.
- Cue cards make it easier to utilize tests with fidelity! Fidelity means using the correct test set-up, administration, scoring and interpretation, as described by manuals and/or research articles. Note that some tests require specific instructional “wording”, and there’s no way you can remember them word-for-word. With a cue card – you just have to read the instructions during testing.
- Cue cards also ensured consistent use of tests among team members.
Conduct educational sessions to practice test administration and interpretation
In the study, therapists attended an educational session which included benefits of tests and measures, as well as psychometric properties, administration and considerations for applying the selected tests and measures.
My take:
- This part is the most fun!
- Organize a meeting where you can discuss and try out tests and measures. Everybody should try every single test. Demonstrate great performance, and not-so-great performance.
- Practice, practice, practice with each other before utilizing the tests with your clients. This is your opportunity to gain some expertise that will make it faster for you to complete the test when it’s time to use them.
- Great questions always come up when therapists try out a test. How would you score this if they do this instead of that? What if the space is too small? What if the client cannot follow instructions? How many trials are allowed? This test looks complicated…are demonstrations allowed?
- Often you can find the answers from the test manual or from the reference article that describes the test.
- Sometimes the manual/article does not answer your question. The educational session is a great time for your team to decide how you as a group would like to address the question to ensure that the test is being administered consistently within your organization.
- Do follow-up sessions. This is not just for review, but also a way to assess how useful the tests have been. Did anybody find a practical way of using the test or interpreting the test? Are there tests that have not been as effective? Should you modify your list of tests?
Require system-wide use of tests and measures | Include tests and measures in your documentation template
In the study, the therapy department required the use of tests and measures concurrent with their adoption of new billing guidelines.
What I think:
- Unfortunately, at times it requires stringent rules and regulations for change to occur. Mandating tests and measures mean everybody has to use it. (Disclaimer: not everybody will be happy about this – I experienced this myself – see next bullet point.)
- Back to my experience as Director of PT in New York City, every therapist was asked to include scores for Part I – Participation of the School Functional Assessment (SFA) in every single reevaluation report. We added a table for these scores. There were 2 columns, one for the last evaluation, and the 2nd for the current reevaluation. This format provided an easy quantification and comparison of performance/progress.
- Find what test(s) is really essential for your setting/clients that needs to be mandatory. You may require different tests for different conditions. Or just ask that every report should have at least 1, 2 or whatever number of tests.
- Be careful that members do not just report scores for the sake of reporting numbers. When documenting in the assessment report, test results need to be related back to the client’s needs, goals and/or expected level of participation/function.
For other great strategies, read the article by McDonnell, et al (2018).
Let us know how it goes. Or share below, how you have successfully implemented the consistent use of tests and measures within your practice.
