Abstract
Purpose: We examined physiotherapists’ use of functional outcome measures in their practice to compare the frequency of use of functional outcome measures and impairment-based measures and to explore policies and practices related to the use of functional outcome measures in Colombia. Method: Eligible participants were licensed physiotherapists actively practising in Colombia. They were recruited by means of a survey link sent via email by a continuing education organization to all the physiotherapists in its database and through snowball sampling. The survey was adapted from questionnaires previously used in similar research in other countries. We used descriptive statistics to describe the use of 14 functional outcome measures and 4 impairment-based measures that have been translated into Spanish and to compare the demographics of the participants who used and did not use the listed functional outcome measures. Results: Of the 606 respondents, 87% used 1–14 of the listed functional outcome measures regularly or sometimes in their practice. The most commonly used functional outcome measures were the Borg Rating of Perceived Exertion (59%), the Barthel Index (56%), and the Berg Balance Scale (53%). In addition, 60% of respondents reported their workplace does charting electronically, 66% stated that their practice mandates or regularly uses functional outcome measures, and 59% indicated that they can independently select which outcome measures to use. Conclusions: The majority of Colombian physiotherapists surveyed are using outcome measures in their practice, which indicates that they are engaged in evidence-based practice. Study findings may stimulate more sharing of information on patient outcomes among Colombian physiotherapists, promote further research, and contribute to advancing practice in Colombia.
Key Words: disability, evidence-based practice, outcome measures, health care systems, impairment, physical functional performance
Abstract
Objectif : examiner l’utilisation que les physiothérapeutes font des mesures de résultats fonctionnels dans leur pratique pour en comparer la fréquence d’utilisation avec les mesures fondées sur les incapacités et explorer les politiques et les pratiques liées à l’utilisation des mesures de résultats fonctionnels en Colombie. Méthodologie : les participants admissibles étaient des physiothérapeutes autorisés en exercice actif en Colombie. Les chercheurs les ont recrutés par l’entremise d’une organisation de formation continue qui a transmis un lien vers un sondage à tous les physiothérapeutes de sa base de données et par des sondages cumulatifs (en boule de neige). Ils ont adapté le sondage à partir de questionnaires utilisés dans des recherches réalisées dans d’autres pays. Ils ont utilisé des statistiques descriptives pour dépeindre l’utilisation de 14 mesures de résultats fonctionnels et de quatre mesures fondées sur des incapacités traduites en espagnol et pour comparer les caractéristiques démographiques des participants qui utilisaient ou non les mesures de résultats fonctionnels énumérées. Résultats : des 606 répondants, 87 % utilisaient entre une et 14 des mesures de résultats fonctionnels énumérées régulièrement ou parfois dans leur pratique. L’échelle d’évaluation de la perception de l’effort de Borg (59 %), l’indice de Barthel (56 %) et l’échelle d’évaluation de l’équilibre de Berg (53 %) étaient les plus utilisés. De plus, 60 % des répondants ont déclaré que le classement était fait électroniquement à leur lieu de travail, 66 % ont affirmé que les mesures de résultats fonctionnels sont obligatoires ou utilisées régulièrement dans leur pratique et 59 % ont indiqué qu’ils peuvent sélectionner en toute indépendance les mesures de résultats à utiliser. Conclusion : la majorité des physiothérapeutes colombiens sondés utilisent les mesures de résultats dans leur pratique, ce qui démontre qu’ils participent à une pratique fondée sur des données probantes. Les résultats de l’étude pourraient stimuler un meilleur échange d’information sur les résultats cliniques des patients entre les physiothérapeutes colombiens, promouvoir des recherches plus approfondies et contribuer à faire progresser la pratique en Colombie.
Mots-clés : handicap, incapacité, mesure des résultats, pratique fondée sur des données probantes, rendement physique fonctionnel, systèmes de santé
Evidence-based practice (EBP) is defined as clinicians’ ability to integrate their expertise, their patients’ values, and the best available evidence into their practice.1 Physiotherapists consider outcome measures to be important tools in the process of integrating EBP into their profession because these measures indicate prognosis, assess the effectiveness of treatments, and justify the value of interventions.2 Documenting treatment outcomes with valid measures not only enhances the knowledge base but also addresses the need to be accountable to patients, employers, and payers.3 The dual goals of EBP and accountability have incentivized clinicians to develop multiple outcome measures, which are defined as tests or scales that have been shown to accurately measure a particular attribute of interest to patients and clinicians, while this attribute is expected to be influenced by intervention.4
The World Health Organization, through its International Classification of Functioning, Disability and Health,5 has advocated that goals for patient improvement consider the traditionally measured limitations related to body function but also address a patient’s ability to perform regular activities and participate in normal life situations.2,5 In this study, we focus on functional outcome measures – those related to activities of daily living (ADLs) and constructs such as gait or balance, which can be assessed by observing performance.
The first documented report exploring the use of outcome measures by physiotherapists was the Canadian survey completed by Mayo and colleagues in 1993.4 That study and its follow-up in 1998 were the basis for the two versions of the book Physical Rehabilitation Outcome Measures.6,7 Since 1992, several studies examining the use of outcome measures by physiotherapists have been completed in other countries.1,2,8–13
These studies have served to start or continue the conversation about the importance of using outcome measures in physiotherapy. They have encouraged the use of outcome measures as best practice and advocated that the profession use strategies to address the barriers to their implementation. Consequently, regulatory bodies and professional organizations have taken initiatives to promote their use.2 For example, “the Commission on Accreditation in Physical Therapy Education in the United States require[s] all university programs to demonstrate that their graduates have experience in using and interpreting outcome measures during their entry-level education.”2(p. 126)
Despite the fact that outcome measures are being more widely adopted, cultural differences and language barriers prevent research findings from being easily transferred from one country to another.10,11 Moreover, several outcome measures have been developed in countries with advanced health care systems, and in English,10,11 which has become the most common language used in research.14 Fortunately, the increasing need to incorporate evidence into the practice of physiotherapy has promoted the translation and cross-cultural validation of several outcome measures into other languages, including Spanish. Recent literature shows that translated and validated functional outcome measures are being used in countries such as Spain and Chile.15,16
History of Physiotherapy in Columbia
The first physiotherapy programme opened in Colombia in 1952. Two years later, the profession officially started by mean of Decree No. 1056, which allowed physiotherapists to start practising in the country. Accordingly, the Colombian Association of Physiotherapy (Asociación Colombiana de Fisioterapia, or ASCOFI) was created that year as well.17
In 2007, Law 1164 came into force, delegating public functions to professional associations; thus, the Colombian College of Physiotherapists (Colegio Colombiano de Fisioterapeutas, or COLFI) was created on April 30, 2011. Nowadays, physiotherapists practising in Colombia are licensed by the Ministry of Health and Social Protection through COLFI.17
Data from the Ministry of Education, the Ministry of Health and Social Protection, and some physiotherapy programmes have indicated that the number of physiotherapists practising in Colombia from 2001 to 2012 ranged from 11,000 to 25,000.17 To have a clearer picture of the country’s physiotherapist population, ASCOFI conducted the National Study on Health and Work Conditions of Physiotherapists of Colombia17 between 2013 and 2015 with the support of 17 universities. This study, with 1,751 participants, showed that 73% of the respondents worked in direct patient care (musculoskeletal, cardiopulmonary, occupational health, neurology, geriatrics, public health, sports, and other areas), 42% in higher education, 37% in administration, and 24% in consulting and formal research. Of note, because participants could work in more than one of these areas, percentages total more than 100. In terms of practice setting, 33% of the participants worked in home care; 21% in private clinics; 17% in first-, second-, and third-level hospitals; 17% in occupational health; 11% in private, non-clinical settings; 10% in sports; and 12% in other settings;17 percentages total more than 100. When the study was published, the country had 33 undergraduate (entry-level) physiotherapy programmes, 12 specialization programmes at the postgraduate level, and 11 master of physiotherapy programmes.17
A study published by Ramírez-Vélez and colleagues in 2015 examined Colombian physiotherapists’ perception of the benefits of and barriers to implementing EBP,18 concluding that most of them had a positive opinion about it. Nevertheless, their participants believed they needed to improve their knowledge of, their skills in, and their attitudes toward EBP.18
The use of outcome measures could be considered an indicator of engagement in EBP,1 and no previous studies have explored the use of functional outcome measures in Colombia. Hence, the objectives of our research were to determine whether physiotherapists were using functional outcome measures in their practice; to compare the frequency of use of functional outcome measures and impairment-based measures; and to explore the policies, beliefs, and practices related to the use of functional outcome measures in Colombia.
Methods
Ethics approval was received from the Health Science Research Ethics Board of the University of Toronto on December 15, 2016.
Survey design
This was a cross-sectional study adapted from a survey conducted by Mehta and Grafton in India,10 based on a questionnaire by Jette and colleagues.2
Our 20-item questionnaire was administered electronically through SurveyMonkey (SurveyMonkey, San Mateo, CA), in collaboration with ES Educación en Salud, a continuing education company located in Cali, Colombia. ES Educación en Salud sent an email to all the physiotherapists in its database (roughly 4,000 practising physiotherapists or physiotherapy students) that included a link to the Spanish version of the survey. Recipients of the email were encouraged to share the link with other colleagues (a technique known as snowball sampling).
Sample
Eligible participants were licensed physiotherapists, actively practising in Colombia. On January 11, 2017, ES Educación en Salud sent an invitation email. On January 30, 2017, the invitation email was sent by ASCOFI to an undisclosed number of potential participants. The closing date for data collection was March 12, 2017.
Survey
The nature and purpose of the study were explained on the first page of the survey, and submission of the questionnaire implied consent. The first two questions filtered out professionally inactive physiotherapists, physiotherapy students, and physiotherapists practising outside Colombia. In the next five questions, participants were asked to pick their location from among the 33 official Colombian territories (32 departments and Bogotá, DC), and they were asked for their age, sex, years of experience, and practice setting.
The survey provided a list of 18 outcome measures from Physical Rehabilitation Outcome Measures7 that have been validated in Spanish. Given that there is no formal classification of outcome measures, we defined, a priori, two types of outcome measures to compare their frequency of use: (1) functional outcome measures, or those related to ADL performance and measuring constructs such as gait and balance, and (2) impairment-based measures, or those measuring the impairment of body functions such as range of motion, strength, and level of pain.
The 14 functional outcome measures included were the Borg Rating of Perceived Exertion,19 Barthel Index,15 Berg Balance Scale,20 Disabilities of Arm Shoulder and Hand,21 FIM,22 gait speed,23 timed up-and-go test,16 Tinetti Performance Oriented Mobility Assessment,24 2-minute walk test,25 6-minute walk test,25 Fugl–Meyer Assessment,26 Fibromyalgia Impact Questionnaire,27 Oswestry Low Back Pain Disability Questionnaire,28 and Roland Morris Disability Questionnaire.29 The four impairment-based measures included were range of motion,30 manual muscle testing,30 Numeric Pain Rating Scale,31 and pain visual analogue scale.32 These four impairment-based measures were also included in the study conducted by Mehta and Grafton.10 Participants were asked to identify which outcome measures they used regularly, sometimes, or never. They also had the option of adding other, non-listed, validated outcome measures.
In the subsequent questions, participants were asked about policies and practices implemented at their workplace, the challenges and perceived benefits of using functional outcome measures, and the criteria they used when selecting outcome measures for their clients. They were also asked about their highest level of education, phase of their education or professional life in which they learned to use outcome measures (undergraduate, postgraduate, or other), and their willingness to learn more about them. At the end of the survey, participants were given the opportunity to make additional comments.
The questionnaire was pretested in English by five physiotherapists who did not speak Spanish, then translated into Spanish by one of the authors (CR). It was translated back into English and then into Spanish by a bilingual physiotherapist and subsequently revised for language clarity by a bilingual non-physiotherapist. The final Spanish version was pretested by five Spanish-speaking physiotherapists.
Data analysis
At the end of the survey period, we exported data from SurveyMonkey to Microsoft Excel 2016 (Microsoft Corporation, Redmond, WA). Initially, we examined the frequency and distribution of use of each outcome measure, workplace policies and practices, and the distribution of responses related to the benefits and challenges of using functional outcome measures. We also calculated the proportion of participants using each outcome measure on the basis of frequency of use (regularly, sometimes, never). Because our variable of interest was based on a yes-or-no dichotomy – whether Colombian physiotherapists used functional outcome measures – we collapsed the initial three-category ordinal scale into a two-category scale: regularly and sometimes represented yes, and never represented no.
The data were then exported to IBM SPSS Statistics, Version 24.0 (IBM Corporation, Armonk, NY) for statistical analysis. Chi-square tests were performed to identify statistically significant differences (p < 0.05) between the demographics of the participants who used and those who did not use functional outcome measures in their practice.
Results
A total of 1,085 respondents clicked on the SurveyMonkey link, but 479 respondents could not continue, either because of their status (inactive physiotherapist or student) or their location (outside Colombia). Of the 606 participants, 84% were female, 14% were male, and 2% did not share their gender. In addition, 48% were aged 20–30 years, 36% were aged 31–40 years, 15% were aged 41 years or older, and 1% did not respond. In terms of professional experience, 29% had practised for 2 or more years, 17% had practised for 3–5 years, 34% had practised for 6–14 years, 19% had practised for 15 or more years, and 1% did not reply. Participants came from diverse regions of Colombia. The largest number came from Valle del Cauca (27%) and Bogotá (25%); the others came from 26 of the other 31 territories (48%). No one reported working in the departments of Amazonas, Choco, Guainía, Vaupés, or Vichada. (Participants’ demographic characteristics are shown in Table 1).
Table 1.
Demographic Characteristic of Functional Outcome Measure Users and Non-Users
| No. (%) of participants |
|||
|---|---|---|---|
| Characteristic | Users (n = 528) | Non-users (n = 78) | All (N = 606) |
| Age group, y | |||
| 20–30 | 290 (48) | 32 (41) | 290 (48) |
| 31–40 | 190 (36) | 28 (35) | 218 (36) |
| ≥ 41 | 80 (15) | 15 (18) | 95 (15) |
| Not reported | 0 (0) | 3 (6) | 3 (1) |
| Experience, y | |||
| 0–2 | 154 (29) | 19 (25) | 173 (29) |
| 3–5 | 97 (18) | 8 (10) | 105 (17) |
| 6–14 | 181 (34) | 26 (33) | 207 (34) |
| ≥ 15 | 94 (18) | 20 (25) | 114 (19) |
| Missing | 2 (1) | 5 (7) | 7 (1) |
| Sex | |||
| Male | 76 (14) | 6 (8) | 82 (14) |
| Female | 452 (86) | 66 (84) | 518 (84) |
| Missing | 0 (0) | 6 (8) | 6 (2) |
| Location | |||
| Valle del Cauca | 139 (26) | 26 (33) | 165 (27) |
| Bogota | 142 (27) | 12 (16) | 154 (25) |
| Other | 247 (47) | 40 (51) | 287 (48) |
Note: χ2 analysis demonstrated no significant difference among functional outcome measure users and non-users by age group (p = 0.523), years of experience (p = 0.164), sex (p = 0.142), or location (p = 0.925).
In terms of practice setting, 33% of participants worked in home care, 28% in facility-based outpatient clinics, 24% in private outpatient clinics, 16% in education, 14% in occupational health, 13% in acute care, 12% in sport centres, 10% in intensive care units, and 4% in nursing homes. In addition, 66% worked in only one setting, whereas 25% worked in two, 6% in three, and 3% in four settings.
The majority of physiotherapists reported treating patients with diverse conditions: orthopedic (64%), neurological (49%), and cardiopulmonary (25%) diagnoses. One-third stated that they practised in geriatrics, 30% worked in paediatrics, 21% worked primarily with athletes, and 19% worked in occupational health.
Use of outcome measures
Of the 606 participants, we considered 87% to be functional outcome measure users because they reported using 1–14 of the functional outcome measures, whereas 13% were considered non-users because they reported using only impairment-based measures (n = 33) or no measures at all (n = 45). Figure 1 shows the number of participants using functional outcome measures. The percentage of participants who reported using each of the listed outcome measures can be seen in Figure 2.
Figure 1.
Number of participants using functional outcome measures.
Figure 2.
Percentage of participants who reported using each listed outcome measure regularly, sometimes, or never.
Many participants (n = 50) added 40 valid outcome measures that were not included in the questionnaire (these measures are listed in the Appendix). The most frequently added scale was the Modified Ashworth Scale (n = 11). Another 25 therapists added seven paediatric scales to the survey, of which the most common were the Gross Motor Function Measure (n = 9) and the Alberta Infant Motor Scale (n = 5). Participants who added non-listed outcome measures also used at least one of our listed functional outcome measures.
Policies, beliefs, and practices related to functional outcome measures
We asked our participants six questions about the frequency and the rigorousness of the use of functional outcome measures in their workplace; 19% reported that their workplace mandated the use of functional outcome measures for all patients, and 13% were mandated only for certain types of conditions. Likewise, 18% indicated that functional outcome measures were not mandated but were regularly used for all patients, and 15% responded that they were regularly used only for patients with certain conditions. Of the remaining participants, 12% reported sporadic use of functional outcome measures, and 17% said that they rarely used functional outcome measures.
For the next question, most of the participants (59%) reported that they independently choose the functional outcome measures they use at their workplace, and 38% reported that they use the same ones as their counterparts. The majority (60%) replied that charting (recordkeeping) is done electronically, and the rest indicated that recordkeeping is done on paper (37%).
The majority of participants generally agreed with the potential benefits of using functional outcome measures, with responses ranging from 83% to 63% (see Figure 3). A lower percentage acknowledged the challenges of using functional outcome measures; their responses ranged from 46% to 10% (see Figure 4). These percentages should be interpreted with caution because approximately 20% of participants did not respond to questions related to challenges and potential applications.
Figure 3.
Responses to eight questions about the potential benefits of using functional outcome measures.
Figure 4.
Responses to seven questions about the potential challenges of using functional outcome measures.
We asked the participants to choose among statements describing how they selected functional outcome measures; they cited the following criteria: appropriate for types of patient (74%); easy to interpret (73%); commonly used by other therapists (70%); reliable and valid (69%); suitable for research, quality improvement, and patient evaluation purposes (68%); takes little time to complete (67%); and easily understood by patients (65%).
We requested respondents choose from statements describing research or administrative benefits of using functional outcome measures: 74% considered that functional scales evaluated a change in patients’ health status for treating physiotherapists to determine the effectiveness of interventions; 73% responded that they compared average functional outcomes among patients with different diagnoses and helped to determine the case mix (complexity) of patients; 72% believed that they improved communication with other health professionals; 70% answered that they evaluated the average improvement in patients as an indicator of the effectiveness of a physiotherapist’s performance; 66% indicated that they answered clinical questions using a traditional research approach; and 64% replied that they compared performance across physiotherapists in terms of patient outcomes.
Overall, 97% of the participants replied that they had started their career in an undergraduate bachelor programme, and 81% replied that they had learned how to use functional outcome measures in their undergraduate studies. An overwhelming majority (93%) of respondents stated that they were interested in learning more about functional outcome measures.
Discussion
This is the first study to examine the use of outcome measures by physiotherapists in Colombia. On the basis of our results, we conclude that the majority of Colombian physiotherapists we surveyed are using outcome measures in their practice, thereby supporting their engagement in EBP.18 Respondents commonly reported using more than 1 functional outcome measure on the list provided, and they added 40 unlisted outcome measures.
The responses indicated that the participants are considering measurement properties and selecting validated outcome measures that are appropriate to their practice settings. Moreover, many respondents work in more than one practice setting, a situation that may contribute to variability in the use of functional outcome measures
The study conducted by ASCOFI in 2015 described progress in the evolution of physiotherapy in Colombia. Of those participants, 32% based their intervention on their own physiotherapy diagnosis rather than a pre-established medical diagnosis, and 51% reported accepting patients directly without medical referral. However, they reported factors that challenged their autonomy to practice: (1) the beginning and the end of a physiotherapy treatment was frequently determined by physicians or the health care insurer (Empresas Prestadoras de Salud, or EPS), (2) the physiotherapy diagnosis was generally not recognized by EPS, and (3) the provision of services was governed by rigid contractual clauses from the EPS that defined the duration, the frequency, and the number of pre-authorized sessions.17 A lack of autonomy could be associated with less frequent use of the latest evidence in clinical practice.18
Despite these potential challenges, it was encouraging for us to find that 59% of the participants indicated that they could independently choose the functional outcome measures they preferred to use with their patients; moreover, 60% reported that charting at their workplace was done electronically. Two-thirds of the participants indicated that functional outcome measures were either mandated or regularly used at their workplace.
Mehta and Grafton in India reported that more physiotherapists regularly used impairment-based measures than functional outcome measures.10 A higher proportion of respondents in our study reported using impairment-based measures, but most nevertheless used functional outcome measures. We hypothesize that the more frequent use of impairment-based measures could be attributed to their generic nature (measures that can be used in different diagnoses); thus, they apply to patients with a wider range of diagnoses and to a broader variety of practice settings. Likewise, functional outcome measures that were more generic were reported more frequently than those that were more diagnosis specific (e.g., the Berg Balance Scale vs. the Roland Morris Disability Questionnaire).
The components of our survey that inquired about physiotherapists’ perceptions of using functional outcome measures were based on the format used in preceding studies.1,2,8–13,18 Similarly, our participants’ responses were consistent with those obtained in previous research. The most commonly identified challenges of using functional outcome measures were lack of time, lack of familiarity, lack of knowledge, and lack of training. Regarding their benefits, most participants had a positive perception of using functional outcome measures. Unfortunately, 20% of participants did not respond to this section of the questionnaire. These may have been the participants who were not using functional measures or those who were less interested in non-clinical applications of functional outcome measures.
Ramírez-Vélez and colleagues18 reported that 43% of their participants indicated “insufficient time to improve the knowledge, skill and attitudes” as their main barrier to implementing EBP.18(p. 9) Similarly, 46% of our respondents identified “time to analyze and quantify results” as the greatest barrier to using functional outcome measures.
Our study has a number of limitations. First, our results may not be generalizable to the overall population of actively practising physiotherapists in Colombia. The reasons for this are that we did not have access to a reliable database of the population of practising physiotherapists in Colombia; we did not have a clear response rate because we worked with an unknown population sample that was non-random; and we do not know how much snowball sampling took place to broaden recruitment. Nevertheless, we recruited a heterogeneous sample of participants working in a variety of practice settings and specialties throughout the country, and we received responses from 28 of the 33 Colombian territories (85%). Indeed, the percentage of physiotherapists working in different practice settings is similar to that in the ASCOFI study, which found that 33% were working in home care, 21% in private clinics, and 17% in occupational health.17
Next, our results are potentially biased toward overestimation because participants were recruited from the database of a continuing education company. These individuals may have more education, could be more predisposed to using or familiar with EBP, and may potentially be biased in their perceptions of the benefits of, and barriers to, using outcome measures. This version of the questionnaire has not been formally validated, and collected data are based on self-report and not on independent, external observation of practice. Individuals who did not use functional outcome measures and who thus had the most challenges and negative perceptions may not have answered the questions in the second half of the survey, thus inflating the estimates of how positively functional outcome measures are regarded.
Conclusion
The majority of Colombian physiotherapists we surveyed are using outcome measures in their practice, thus showing their engagement in EBP. The results of this study could help to build awareness of the functional outcome measures available in Spanish and spark a conversation among Colombian physiotherapists about which ones are used across different settings, and in different regions, to begin comparing outcomes. Sharing information about practices that encourage better outcomes informs education strategies and advances the practice of physiotherapy.
Key Messages
What is already known on this topic
Outcome measures are important tools in the process of integrating EBP into the physiotherapy profession because they help clinicians to indicate prognosis, assess the effectiveness of treatments, justify the value of interventions, and maintain their accountability to patients, employers, and payers.2–3 Thus, several studies examining the use of outcome measures by physiotherapists have been completed in different countries since 1992.1,2,8–13 The most recent literature reporting on the integration of EBP in physiotherapy in Colombia was the study by Ramírez-Vélez and colleagues in 2015.18
What this study adds
We expect that this study will encourage the Colombian physiotherapy community to explore opportunities to promote best practice by sharing data and information about commonly used outcome measures, thereby generating new research in the country. Likewise, we advocate that future research determine the best strategies for facilitating innovation and the adoption of additional measures – that is, integrating the use of functional outcome measures into electronic charting or examining the need to translate and validate other functional outcome measures not listed in this study.
We encourage physiotherapists working in Colombia to enlighten the public and stakeholders who may be interested in this area about the benefits of using functional outcome measures and the importance of integrating them into the health care system.
Appendix: Non-Listed Outcome Measures Added by Participants
| Outcome Measure | No. of participants |
|---|---|
| Modified Ashworth Scale | 11 |
| Gross Motor Function Measure | 9 |
| Alberta Infant Motor Scale | 5 |
| Abbreviated Scale of Development | 5 |
| Glasgow Coma Scale | 3 |
| Functional Mobility Scale | 3 |
| 36-Item Short Form Survey (Quality of Life) | 3 |
| Susan Campbell Scale | 2 |
| Infant Neurological International Battery | 3 |
| Karnofsky Performance Status Scale | 2 |
| Behavioral Pain Scale | 1 |
| Beighton Scale | 1 |
| Balance Evaluation Systems Test | 1 |
| Denver Developmental Screening Test | 1 |
| ECOG Performance Status | 1 |
| Escala de Norton | 1 |
| Gilbert Scale (hemophilia) | 1 |
| House-Brackmann Score | 1 |
| J.H. Downton Scale | 1 |
| Katz Index of Independence in Activities of Daily Living | 1 |
| Lawton Instrumental Activities of Daily Living Scale | 2 |
| Mini-Mental State Examination | 1 |
| Motor Function Measure | 1 |
| Nordic Musculoskeletal Questionnaire | 1 |
| Occupational Repetitive Actions (ergonomics) | 1 |
| Ovako Working Posture Assessment System | 1 |
| Pediatric Evaluation of Disability Inventory | 1 |
| Penn shoulder score | 1 |
| Perme ICU Mobility Score | 1 |
| Rapid Entire Body Assessment | 1 |
| Richmond Agitation-Sedation Scale | 1 |
| Rapid Upper Limb Assessment | 1 |
| Ruffier Test | 1 |
| Rivermead Behavioural Memory Test | 1 |
| Test of Infant Motor Performance | 1 |
| Victorian Institute of Sport Assessments - Achilles | 1 |
| Victorian Institute of Sport Assessments - Patellar | |
| tendon | 1 |
| WeeFIM | 1 |
| Well's criteria for DVT/PE | 1 |
| World Health Organization Disability Assessment | |
| Schedule 2.0 | 1 |
| Total | 77 |
ICU = intensive care unit; DVT = deep vein thrombosis; PE = pulmonary embolism.
References
- 1. Van Peppen RPS, Maissan FJF, Van Genderen FR, et al. 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. 10.1002/pri.417. Medline:18972323 [DOI] [PubMed] [Google Scholar]
- 2. Jette DU, Halbert J, Iverson C, et al. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Therapy. 2009;89(2):125–35. 10.2522/ptj.20080234. Medline:19074618 [DOI] [PubMed] [Google Scholar]
- 3. Herbert R, Jamtvedt G, Hagen KB, et al. Practical evidence-based physiotherapy. 2nd ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2011. [Google Scholar]
- 4. Mayo N, Cole B, Dowler J, et al. Use of outcome measures in physiotherapy: survey of current practice. Can J Reh. 1993;7:81–2. [Google Scholar]
- 5. World Health Organization. International classification of functioning, disability and health. Geneva: World Health Organization; 2001. [Google Scholar]
- 6. Kay T, Myers A, Huijbregts M. How far have we come since 1992? A comparative survey of physiotherapists’ use of outcome measures. Phys Can. 2001;53(4):268–75. [Google Scholar]
- 7. Finch E, Brooks D, Stratford PW. Physical rehabilitation outcome measures: a guide to enhanced clinical decision making. 2nd ed. Hamilton (ON): BC Decker; 2002. [Google Scholar]
- 8. Stokes EK, O’Neill D. Use of outcome measures in physiotherapy practice in Ireland from 1998 to 2003 and comparison to Canadian trends. Phys Can. 2008;60(2):109–16. 10.3138/physio.60.2.109. Medline:20145774 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Swinkels RAHM, van Peppen RPS, Wittink H, et al. Current use and barriers and facilitators for implementation of standardized measures in physical therapy in the Netherlands. BMC Musculoskelet Disord. 2011;12:106 10.1186/1471-2474-12-106. Medline:21600045 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Mehta S, Grafton K. A survey on the use of outcome measures by musculoskeletal physiotherapist’s in India. Physiother Theory Pract. 2014;30(2):110–22. 10.3109/09593985.2013.826313. Medline:23957527 [DOI] [PubMed] [Google Scholar]
- 11. Akinpelu AO, Eluchie NC. Familiarity with, knowledge, and utilization of standardized outcome measures among physiotherapists in Nigeria. Physiother Theory Pract. 2006;22(2):61–72. 10.1080/09593980600564469. Medline:16703815 [DOI] [PubMed] [Google Scholar]
- 12. Turner-Stokes L, Turner-Stokes T. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil. 1997;11(4):306–13. 10.1177/026921559701100407. Medline:9408671 [DOI] [PubMed] [Google Scholar]
- 13. Haigh R, Tennant A, Biering-Sørensen F, et al. The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med. 2001;33(6):273–8. Medline:11766957 [DOI] [PubMed] [Google Scholar]
- 14. Brutt-Griffler J. Languages of wider communication In: Brown K, editor in chief. Encyclopedia of language and linguistics; 2nd ed. Amsterdam: Elsevier Science; 2005. p. 690–7. [Google Scholar]
- 15. Cid-Ruzafa J, Damián-Moreno J. Valoración de la discapacidad física: el Indice de Barthel. Re Esn Salud Púhhca. 1997;71(2):177–37. Medline:9546856 [PubMed] [Google Scholar]
- 16. Mancilla SE, Valenzuela HJ, Escobar CM. Rendimiento en las pruebas Timed Up and Go y Estación Unipodal en adultos mayores chilenos entre 60 y 89 años. Rev Med Chil. 2015;143(1):39–46. 10.4067/S0034-98872015000100005. Medline:25860267 [DOI] [PubMed] [Google Scholar]
- 17. Molina V, Molina N, Alvis K, et al. Perfil profesional y competencias del fisioterapeuta en Colombia [Internet]. Bogotá, DC (Colombia): Ministerio de Salud y Protección Social Dirección de Desarrollo de Talento Humano en Salud; 2015. Available from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/TH/Perfil-profesional-competencias-Fisioterapeuta-Colombia.pdf. [Google Scholar]
- 18. Ramírez-Vélez R, Bagur-Calafat MC, Correa-Bautista JE, et al. Barriers against incorporating evidence-based practice in physical therapy in Colombia: current state and factors associated. BMC Med Educ. 2015;15:220 10.1186/s12909-015-0502-3. Medline:26655253 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Burkhalter N. Evaluación de la escala Borg de esfuerzo percibido aplicada a la rehabilitación cardiaca. Rev latino-am enfermagem, Ribeirão Preto. 1996;4(3):65–73. Spanish 10.1590/S0104-11691996000300006. Medline:9070794 [DOI] [PubMed] [Google Scholar]
- 20. Baydal-Bertomeu JM, Viosca-Herrero E, Ortuño-Cortés MA, et al. Estudio de la eficacia y fiabilidad de un sistema de posturografía en comparación con la escala de Berg. Rehabilitación. 2010;44(4):304–10. Spanish 10.1016/j.rh.2010.06.010. [DOI] [Google Scholar]
- 21. Teresa Hervás M, Navarro Collado MJ, Peiró S, et al. Versión española del cuestionario DASH. Adaptación transcultural, fiabilidad, validez y sensibilidad a los cambios. Med Clin (Barc). 2006;127(12):441–7. Spanish 10.1157/13093053. [DOI] [PubMed] [Google Scholar]
- 22. Rodríguez LP. Medida de la Independencia Funcional (MIF): guía para la utilización del sistema de datos uniformes para medicina física y de rehabilitación. Terapia ocupacional; 1991;13: 4–15. Spanish. [Google Scholar]
- 23. Varela Pinedo L, Ortiz Saavedra PJ, Chávez Jimeno H. Velocidad de la marcha como indicador de fragilidad en adultos mayores de la comunidad en Lima, Perú. Rev Esp Geriatr Gerontol. 2010;45(1):22–5. Spanish 10.1016/j.regg.2009.07.011. Medline:20044176 [DOI] [PubMed] [Google Scholar]
- 24. Rodríguez Guevara C, Helena Lugo L. Validity and reliability of Tinetti Scale for Colombian people. Rev Colomb Reumatol. 2012;19(4):218–33. Spanish. [Google Scholar]
- 25. Jorquera Guillén M, Salcedo Posadas A, Villa Asensi J, et al. Reproductibilidad del test de la marcha (walking test) en pacientes afectos de fibrosis quística. An Esp Pediatr. 1999;51(5):475–8. Spanish. Medline:10652797 [PubMed] [Google Scholar]
- 26. Ferrer González BM. Adaptación y validación al español de la escala Fugl-Meyer en el manejo de la rehabilitación de pacientes con ictus [doctoral thesis]. Seville (Spain): Universidad de Sevilla; 2016. o. [Google Scholar]
- 27. Monterde S, Salvat I, Montull S, et al. Validación de la versión española del Fibromyalgia Impact Questionnaire. Rev Esp Reumatol. 2004;31(9):507–13. Spanish. [Google Scholar]
- 28. Payares K, Lugo LH, Morales V, et al. Validation in Colombia of the Oswestry Disability Questionnaire in patients with low back pain. Spine (Phila Pa 1976). 2011;36(26):E1730–5. 10.1097/BRS.0b013e318219d184. Medline:22138784 [DOI] [PubMed] [Google Scholar]
- 29. Kovacs FM, Llobera J, Teresa M, et al. Validation of the Spanish version of the Roland-Morris Questionnaire. Spine (Phila Pa 1976). 2001;27(5):538–42. Medline:11880841 [DOI] [PubMed] [Google Scholar]
- 30. Daniels L, Worthingham C, Hislop H, et al. Pruebas funcionales musculares: te´cnicas de exploracio´n manual. 6th ed. Madrid: Marba´n; 1997. Spanish. [Google Scholar]
- 31. Registered Nurses’ Association Ontario. Guía de buenas prácticas clínicas Valoración y manejo del dolor. 10th ed. Toronto: The Association; 2013. Spanish. [Google Scholar]
- 32. Montero Ibáñez R, Briega AM. Escalas de valoración del dolor. Madrid: Centro de Salud Villa de Vallecas; 2005. Spanish. [Google Scholar]