5.1 What are outcome measures?

Evidence-based practice is now a well-accepted component of health and medical care in many parts of the world.

What is evidence-based practice?

• “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients“¹

What is the goal of evidence-based rehabilitation?

• To incorporate research findings with clinical wisdom and clients’ preferences to inform rehabilitation assessment and treatment. ²

Research questions addressed in rehabilitation include:

• the effectiveness and safety of interventions;
• the frequency of diseases and disability;
• etiology and risk factors;
• prediction and diagnosis;
• diagnostic accuracy and other phenomena including hypothesis generation. ³

The evidence base in rehabilitation is growing rapidly but translating these findings into practice remains a challenge.^4-8 The goal of this resource is to provide evidence-informed guidance on rehabilitation for adults and children living with HIV.

Rycroft-Malone et al.⁹ describe four types of evidence that can contribute to the delivery of care: 1) research, 2) clinical experience, 3) patient experience, and 4) information from the local context.

Research: The strongest type of research evidence is a blinded, randomized controlled trial (RCT) for testing an intervention.¹⁰ However, other types of quantitative and qualitative research are valuable when used appropriately.

Clinical experience: Knowledge from clinical experience is a crucial component of evidence-based practice to achieve client-centred care. This perspective allows clinicians to work according to their skills and experiences.

Patient experience: Knowledge from clients, family members and carers regarding what works for the client is crucial. Communication of desires and goals are necessary to apply the research-based evidence appropriately.

Information from the local context: Finally, practice can be improved by incorporating knowledge from the local context, including knowledge of an organization’s culture and the local health system.

Why use outcome measures?

As evidence-based practice and initiatives to improve healthcare have grown around the world, there has been increased recognition of the need to measure outcomes.

Using outcome measures in practice is important because it helps rehabilitation providers:

• Maintain objectivity and standardize assessment when working with clients.
• Compare a client’s function to other people living with HIV, or the general population.
• Determine whether changes in a client’s health status occur over time.
• Facilitate communication about a client’s health status among members of the health care team, clients, or policymakers to ensure all stakeholders speak the same language.
  • e.g., when a client is transferred from acute to rehabilitation care, the rehabilitation provider in acute care can indicate scores on a symptom index in the chart, and the rehabilitation provider in the rehabilitation department will be able to know what they mean
• Determine whether a change in health status occurs in response to a particular intervention.