Senin, 27 April 2009

When should you use the OPTIMAL Scale?

The Case of Mr. Spooner

Some readers of this blog have posited that you should never, ever use the OPTIMAL scale because it is "crap" and not a useful tool for clinical decision-making.

The shortcomimgs of the OPTIMAL have been previously discussed here and are well-known.

OPTIMAL is a 'setting-specific' tool for activity limitations affecting the upper body, lower body and trunk.

That is, OPTIMAL is appropriate for patients who can ambulate into your clinic, irrespective of wheter their conditions affect their knees, hips, spine, shoulder, etc.

OPTIMAL might not be appropriate for patients in acute care or in long term care.

The Case of Mr. Spooner

The reason I bring this up is because Mr. Spooner (see above) came into my clinic today.

Mr. Spooner had the following physician's diagnoses:

  1. Gait Disorder
  2. Post-op lumbar laminectomy
  3. Cervical herniated disc
  4. Leg weakness
Normally, for these diagnoses, I would, provisionally - based upon the findings, decide to use these outcome scales, respectively:
  1. Modified Falls Efficacy Scale
  2. Oswestry Scale
  3. Neck Disability Index
  4. Lower Extremity Functional Scale
These outcome measures are "condition specific" - that is, the physical therapist chooses the scale based on how well she feels the scale reflects the activity limitations discovered in the initial evaluation.

Widespread Panic

But, poor Mr. Spooner - he was a mess!

I didn't want to have him fill out four separate pages of data. He just wanted to feel better - not write a book!

Fortunately, our clinic has been using the OPTIMAL scale for almost three years - we have only recently started using the condition-specific measures for single-diagnosis cases.

Mr. Spooner was done with his questionnaire in 3-4 minutes and on his way.

We had valid, reliable data for use as an outcomes baseline. If, at some point, one of his conditions becomes more acute or refractory to treatment we may ask him to fill out one of the condition-specific measures.

Is OPTIMAL a last resort?

Better than a last resort OPTIMAL is a tool for clinical decision-making.

Not the best tool you have - and certainly not the worst.

Like any craftsman, you may choose to use your tools to gain the best patient outcomes you can.

You decide.

When should you use the OPTIMAL Scale? Rating: 4.5 Diposkan Oleh: Elvina dara

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