"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, April 27, 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.

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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