Abstract
Purpose
To be patient-centered, assessment must extract what patients prefer to be able to do along with what they can do now so health care can specifically address the gap between current and preferred abilities. In this project, we compared patient-perceived current–preferred gaps with the assessments and interventions reported by clinicians in a rehabilitation clinic.
Methods
Sixty-two patients in outpatient physical therapy completed a computer-adaptive test version of the patient-reported Movement Ability Measure (MAM-CAT) at initial visit and discharge. The MAM-CAT calculated the gaps between the movement patients perceived that they could do “Now” and what movement ability they “Would Like” to have across six dimensions of movement: flexibility, strength, accuracy, speed, adaptability, and endurance. Physical therapists’ notes regarding assessments and interventions were categorized based on these same six dimensions of movement. Frequency of agreement between the largest patient-perceived gaps and clinician-documented emphases was recorded (kappa analyses), along with MAM-CAT changes at discharge (paired t tests).
Results
Although patient progress was noted in both the MAM-CAT and the clinician notes (p < .05), comparison showed poor or slight agreement (kappa < .05) between the specific movement dimensions patients regarded as having the largest gaps and the dimensions on which clinicians focused.
Conclusion
The MAM-CAT facilitated direct comparison of patients’ current–preferred gaps at initiation and discharge with clinicians’ emphases during episodes of care. While interventions were perceived as effective, collaboration between patients and clinicians using gap data could increase alignment between patient priorities and clinician emphases, potentially resulting in improved patient engagement and rehabilitative outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cott, C. A. (2004). Client-centred rehabilitation: Client perspectives. Disability and Rehabilitation, 26(24), 1411–1422.
Law, M., Baptiste, S., & Mills, J. (1995). Client-centred practice: What does it mean and does it make a difference? Canadian Journal of Occupational Therapy, 62, 250–257.
Crennan, M., & MacRae, A. (2010). Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical & Occupational Therapy in Geriatrics, 28, 33–43.
Gabriel, S. E., & Normand, S.-L. T. (2012). Getting the methods right—The foundation of patient-centered outcomes research. New England Journal of Medicine, 367, 787–789.
Allen, D. D., & Cott, C. A. (2010). Evaluating rehabilitation outcomes from the client’s perspective by identifying the gap between current and preferred movement ability. Disability and Rehabilitation, 32(6), 452–461.
Allen, D. D., & Wagner, J. M. (2011). Assessing the gap between current movement ability and preferred movement ability as a measure of disability. Physical Therapy, 91, 1789–1803. doi:10.2522/ptj.20100393.
Mitra, S. (2006). The capability approach and disability. Journal of Disability Policy Studies, 16, 236–247.
Kiresuk, T., & Sherman, R. (1968). Goal attainment scaling: A general method of evaluating comprehensive mental programs. Community Mental Health Journal, 4, 443–453.
Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: A report of a patient specific measure. Physiotherapy Canada, 47, 258–263.
Allen, D. D. (2007). Validity and reliability of the Movement Ability Measure: A self-report instrument proposed for assessing movement across diagnoses and ability levels. Physical Therapy, 87, 899–916.
Cott, C. A., Finch, E., Gasner, D., Yoshida, K., Thomas, S. G., & Verrier, M. C. M. (1995). The movement continuum theory of physical therapy. Physiotherapy Canada, 47(2), 87–95.
Allen, D. D. (2007). Proposing 6 dimensions within the construct of movement in the Movement Continuum Theory. Physical Therapy, 87, 888–898.
Wilson, M. (2005). Constructing measures: An item response modeling approach. Mahwah, NJ: Erlbaum.
Allen, D. D. (2007). Responsiveness of the Movement Ability Measure: A self-report instrument proposed for assessing the effectiveness of physical therapy intervention. Physical Therapy, 87, 917–924.
Allen, D. D., Ni, P., & Haley, S. M. (2008). Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning. Disability and Rehabilitation, 30(6), 479–484.
Adams, R. J., Wilson, M., & Wang, W. (1997). The multidimensional random coefficients multinomial logit model. Applied Psychological Measurement, 21, 1–23.
Allen, D. D., & Wilson, M. (2006). Introducing multidimensional item response modeling in health behavior and health education research. Health Education Research, 21(Supplement 1), i73–i84.
Allen, D. D. (2010). Using item response modeling methods to test theory related to human performance. Journal of Applied Measurement, 11(2), 99–111.
Sim, J., & Wright, C. C. (2005). The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Physical Therapy, 85, 257–268.
Bohannon, R. W. (2007). Muscle strength and muscle training after stroke. Journal of Rehabilitation Medicine, 39, 14–20.
Acknowledgments
This study was partially funded by Grant R120190 from the Patient-Centered Outcomes Research Institute (PCORI).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Allen, D.D., Talavera, C., Baxter, S. et al. Gaps between patients’ reported current and preferred abilities versus clinicians’ emphases during an episode of care: Any agreement?. Qual Life Res 24, 1137–1143 (2015). https://doi.org/10.1007/s11136-014-0888-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-014-0888-0