Interactive Training Increased Confidence in Administering Performance-Based Measures

Prosthetists who had interactive training in the Timed Up and Go and Amputee Mobility Predictor were more confident in administering the performance-based measures to amputees, according to study results.

Recently, CMS has required providers of physical, occupational and speech-language therapies to provide enhanced documentation that demonstrates the functional value of treatment for patients. According to researchers, “practitioners’ lack of familiarity and experience with standardized outcome measures may be a barrier to their routine use in prosthetics practice.”

Ignacio Gaunaurd, PT, PhD, MSTP

Ignacio Gaunaurd

“The purpose of the study was to investigate if certified and licensed prosthetists are using outcome measures in their clinical practice, which outcome measures they are using among a list of the most common outcome measures used, how frequently do they use them and for what purpose are they used,” Ignacio Gaunaurd, PT, PhD, MSTP, research associate and physical therapist of the Miami Veterans Affairs Healthcare System, told O&P Business News. “We also wanted to determine if a training program that included both didactic and interactive instruction methods helped to improve their confidence in administering two of the most commonly used performance-based outcome measures available, the Amputee Mobility Predictor and Timed Up and Go (TUG).”

Use and confidence

Gaunaurd and his research colleagues from the University of Washington surveyed 79 certified prosthetists in the United States about their experiences with 20 standardized outcome measures before formally training them to administer the TUG and AMP performance-based measures. Prosthetists completed pre-training surveys to assess the use of outcome measures in clinical practice, while pre-training and post-training surveys measured confidence in administering the TUG and AMP.

According to study results, 62% of prosthetists were categorized as non-routine users, who reported never, rarely or sometimes using the 20 surveyed outcome measures in their daily clinical practices. Among routine users, 22% commonly administered the AMP, 17% administered the Patient Assessment Validation Evaluation Test and 10% administered the Distance Walk Test. Researchers found outcome measures were routinely used to justify selection of prosthetic interventions and least often used to predict patient outcomes.

Study results

Compared with non-routine users, study results showed routine users had significantly higher pre-training confidence administering the TUG and AMP. After formal training, confidence in administering the TUG and AMP increased significantly among both groups, according to the Wilcoxon signed-rank test. After receiving TUG training, 64% of prosthetists improved two or more confidence categories, while 21% reported a one-category improvement in confidence and 16% reported no change, according to study results. Similarly, 52% of prosthetists improved two or more confidence categories after AMP training, 26% reported a one-category improvement and 20% reported no change. Researchers found 3% of prosthetists reported worse confidence after AMP training.

“The results of the study emphasize the need to educate current and future prosthetists in the use of standardized outcome measures to evaluate and justify clinical decisions,” Gaunaurd, who is also an assistant professor in the Department of Physical Therapy at the University of Miami, said. “It also supports the mixed method training program and that evidence-based clinical information can be effectively disseminated in multiple ways using various forms of feedback.”

Importance of outcome measures

According to Gaunaurd, this study emphasizes the importance of practitioners using outcome measures in their clinical practice. Soon, CMS may require prosthetists to also “provide objective pre- and post-intervention documentation of patients’ function and condition in order to receive reimbursement for prosthetic services.” Knowing how to use standardized outcome measures could help prosthetists demonstrate the change in function or condition of their patient.

The study results also can allow researchers to better address why standardized outcome measures are not being regularly used, he said. Gaunaurd and his colleagues plan to continue this study by reassessing prosthetists’ confidence after 12 months to 18 months. Comparing the mixed-method training program with another method of training could also help determine ideal continuing education training approaches.

“With this information in hand, we want to answer the question: how can we, as researchers, educators and clinicians, improve their use? Existing evidence suggests that mixed (didactic/interactive) sessions are more successful at training clinicians as compared to didactic or interactive alone,” Gaunaurd said. “In addition, we felt that providing a training program that included didactic and interactive instructional methods would be the best way to teach prosthetists to use performance based outcome measures. This method, if found to be successful, could provide further evidence for the development of mixed-methods training sessions at scientific conference and educational programs to educate current and future prosthetists how to administer and interpret outcome measures in clinical practice.” — by Casey Tingle

For more information:
Gaunaurd I. Prosthet Orthot Int. 2014;doi:10.1177/0309364614532865.

Disclosure: Gaunaurd has no relevant financial disclosures.

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