Some say they use it because it's 'recommended' by Medicare, not because it's a good outcomes scale.
Some of the problems with the OPTIMAL scale that physical therapists relate to me are:
- Too general
- No descriptors of the activities (eg: long distance walking)
- Inappropriate for elderly persons (eg: running, hopping and jumping)
- Too long (21 activities)
This is just a short list...
Additionally, the American Physical Therapy Association has gone on record saying the OPTIMAL has not fulfilled its intended mission:
...to be the single, disease-specific treatment planning and goal-setting tool for outpatient physical therapy Medicare compliance and outcomes measurement. (my emphasis)
Nevertheless, the APTA maintains the OPTIMAL page on its website and offers free licensing for clinical physical therapy use until a superior alternative is found.
What are the alternatives?
Now, be aware that these are commercial (NOT free) alternatives that offer some enhancement over a pen-and-paper tool like the OPTIMAL.
CARE tool (May 2009)
AM-PAC (required by 2012?)
FOTO
There may be others, like the following:
...and others, that are acceptable overall outcomes measures but are not recommended by Medicare.
Acceptable outcome measures have usually gone through the peer review process and are published in a professional journal and are accepted by a consensus.
What is the trade-off?
The trade-off for comprehensiveness is time.
A tool that is disease-specific requires multiple templates for different body parts or regions (eg: Neck and Back Index).
A tool that is more comprehensive is longer and harder for the patient to complete.
A longer tool may be more difficult for the clinician to score.
A commercial tool, today, offer few benefits over the free tool.
The OPTIMAL is brief and simple to score.
My own recommendation, today, is for the clinician to use the OPTIMAL.
What is the time frame?
In May 2009, Research Triangle International (RTI) will begin a pilot project to develop a new measurement tool to find
"...better information tied to patient need and the effectiveness of outpatient therapy services."Between 2012 and 2014 the pilot project will wrap up and, presumably, physical therapists will have a needs-based, risk-adjusted tool to assess their patients, in acute, hospital-based and outpatient clinics.
What if you do nothing?
Even if you don't adopt a commercial tool today that, realistically, will segue into the recommended tool by 2012 you should be using the free tool.
Doing nothing is not an option.
A Medicare auditor looking at your files may consider the absence of any outcomes tool as 'blatant disregard' of published recommendations.
Get your systems in place now.
The easiest, simplest system today is the OPTIMAL baseline and follow-up scale.
Use outcomes measures to measure your effectiveness because it's good physical therapy.
Use outcomes measures to improve your Medicare compliance because you can't afford not to do so.
