PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

The Movement Ability Measure (MAM) is a survey that asks patients in physical therapy about how they move now and how they would like to move. The survey covers six areas of movement: flexibility, strength, accuracy, speed, adaptability, and endurance. Physical therapists can use the survey to help understand patient movement goals in physical therapy.

Project Purpose

The research team wanted to learn whether a computer-based version of the MAM survey could help physical therapists learn about and use patient preferences during physical therapy visits, so that they would be able to provide better treatment for their patients.

Methods

The research team recruited adult patients from physical therapy clinics. A total of 367 patients enrolled in the study, and 326 patients answered enough MAM questions for the research team to study.

The researchers put the patients into two groups. In the first group, the researchers did not give the physical therapist their patient’s MAM survey answers. This group had 62 people in it. In the second group, the researchers gave the physical therapist their patient’s MAM survey answers to help the therapist plan care. The second group had 264 people in it. Patients in both groups took the survey before physical therapy started, when physical therapy ended, and then again 30 days later.

The researchers looked at the notes that a physical therapist takes when working with a patient. Researchers looked at the level of agreement between the physical therapy notes and the patients’ answers to the MAM survey to see how well physical therapists understood and used patient movement goals during physical therapy.

The researchers then compared the two groups to learn whether sharing the MAM scores with therapists made a difference in the patients’ progress toward their movement goals.

Findings

The agreement between patients and physical therapists on the goals of care improved when physical therapists and patients reviewed the results of the MAM together.

Physical therapy helped patients in both groups improve their movement. However, patients in the group where physical therapists saw the MAM scores made more progress toward their goals than the group where their therapists did not see the MAM scores.

Limitations

For the people in this study, physical therapy mainly focused on improving flexibility and strength. Results might not be the same for physical therapy that focuses on other movement goals, like endurance.

Importance of Findings

Using the MAM survey can help physical therapists work with patients to meet their goals in physical therapy. Physical therapists who took part in the study felt that using the MAM would help all patients in physical therapy.

Sharing the Results

The research team received additional funding from PCORI to add the MAM to electronic health records and make it available at other clinics. The research team has published on the results of this project (see below).

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Prior to initiation of this study, the principal investigator developed the Movement Ability Measure (MAM) from rehabilitative theory and structured interviews of current and former patients. The MAM asks patients in physical therapy to indicate how they move “now” and how they “would like” to be able to move with respect to six dimensions of movement: flexibility, strength, accuracy, speed, adaptability, and endurance, providing a unique assessment of disability from the patient’s perspective. Previous testing showed fair to good correlation between physical performance and perception of current movement ability.

Project Purpose

For this study, researchers reconfigured the MAM as a computer-adaptive test version (MAM-CAT) to obtain and use patient preferences in the course of physical therapy episodes of care. The MAM-CAT calculated the current-preferred gap in movement ability for different movement dimensions according to each patient. Researchers asked whether the movement dimensions with the largest gaps matched the therapists’ foci of care according to the clinical notes for each patient. Researchers also asked whether the movement ability gaps narrowed, indicating decreased disability, over the episode of care, more when patient and therapist reviewed the MAM-CAT gaps together when planning treatment versus when they did not. It was expected that the information from participants would be helpful in promoting more effective rehabilitative intervention for patients.

Study Design

Prospective cohort study.

Participants, Interventions, Settings, and Outcomes

The research team used clinic-based convenience sampling, recruiting current patients from a physical therapy wellness center and consecutive patients starting care at an outpatient practice. Any adult patients who could complete the MAM-CAT were included; no specific diagnoses were excluded. Enrollees included 367 patients, and 326 had sufficient data for analysis. Eighty-four percent of patients had musculoskeletal diagnoses, and 16 percent had neuromuscular or other diagnoses. All patients gave informed consent to allow researchers to copy clinical notes to a de-identified database for comparison with coded MAM-CAT responses.

All patients were seen in outpatient physical therapy clinics. In the first group (n = 62), clinicians had no access to the MAM-CAT results during the episode of care; in the second group (n = 264), clinicians had access to the MAM-CAT results to review with the patient in planning the episode of care.

Results included a Movement Ability Plot of the movement dimensions having larger and smaller gaps between current and preferred movement ability. The effectiveness of the episode of care was measured by decreases in the size of the gaps when the MAM-CAT was completed at discharge and about a month later. The decreases in MAM-CAT gap sizes were compared across the two groups.

Data Analysis

Qualitative analysis of clinical notes started with categorization of initial and discharge assessments, goals, interventions, and outcomes into the same six dimensions of movement addressed in the MAM-CAT or into a category called “miscellaneous.” Kappa statistics were used to note the level of agreement between foci of care according to clinical notes and the largest MAM-CAT gaps based on patient responses. The researchers used t tests to assess the differences in MAM-CAT changes between groups.

Two blinded researchers categorized the clinical notes, and a third researcher adjudicated where the foci of care were labeled differently. Researchers recorded reasons for missing MAM-CAT data where known, such as single visit only, patients did not keep scheduled appointments, and no MAM-CAT data available. Researchers also noted the outcomes on clinical notes to confirm that goals were met.

Findings

Agreement between clinicians and patients on the foci of care was no more than random chance (kappa < .02) when clinicians did not see patients’ responses on the MAM-CAT but improved when clinicians and patients reviewed results together. The average decrease in total gap size at discharge was 0.99 when clinicians did not see MAM-CAT results (p = .04) and 3.90 when clinicians and patients viewed results together (p < .001), a significant between-group difference (p < .001) despite the fact that interventions were typically effective for both groups.

Limitations

It was expected that the foci of care would include various dimensions of movement, but, in this setting, mostly flexibility and strength were addressed. Statistical analyses were adjusted to accommodate this restriction. As was typical for outpatient physical therapy practices, mostly musculoskeletal diagnoses were represented, although about 11 percent were neurological diagnoses.

Conclusions

This study recorded improved outcomes when patients participated in determining the emphasis of care. The MAM-CAT standardized use of patient preferences to compare with clinicians’ recorded treatment foci, facilitated treatment planning between clinicians and patients, and documented outcomes following an episode of care. The theoretical constructs and methodology could be used to advance patient-centered outcomes research in other areas of health care.

Dissemination

The clinicians’ final recommendation was to have all patients complete the MAM-CAT and have the results available at the point of care. Researchers received a PCORI award to link the MAM-CAT with the electronic medical records and make the MAM-CAT available to other clinics.